Treatment for adult patients with FH should be initiated with use of moderate-to-high doses of high-potency statins, titrated to achieve reductions of serum LDL-C of up to 50% from baseline.  Low potency statins are generally inadequate for FH patients.  If the initial statin is not tolerated, consider changing to an alternative statin or even every other day statin therapy.  If initial statin therapy is contraindicated or poorly-tolerated, then ezetimibe, a bile acid sequestrant such as colesevelam, or niacin may be considered.  For patients who cannot use a statin, most will require combination drug therapy.  If the patient is not at LDL-C treatment goals with the maximum available and tolerable dose of statin, then this should be combined with ezetimibe, niacin, or a bile acid sequestrant such as colesevelam.  Decisions regarding selection of additional drug combinations should be based on concomitant risk factors.