Ito - Figure 5 - Drug treatment of FH Text
Because the older, low-potency statins will generally not be sufficient to get patients down to the recommended LDL cholesterol target levels, the new NLA recommendations include initial treatment with moderate-to-high doses of high potency statins to achieve at least a 50% reduction from baseline in LDL cholesterol. If the initial statin dose or initial statin is not tolerated, physicians should consider switching to an alternative statin or to use of alternate-day dosing.
If statins are poorly tolerated or contraindicated for any reason, then non-statin drugs can be utilized. These include the intestinal cholesterol absorption inhibitor, ezetimibe; niacin (or nicotinic acid); and bowel acid sequestrants. The NLA committee did recommend that the bile acid sequestrant colesevelam should be preferred over the older bile acid sequestrants because there are fewer GI adverse events with colesevelam and because many of these patients may be taking multiple medications, especially the high- risk patients. Colesevelam has less exposure to drug-drug interactions and therefore it was felt that it should be the preferred bile acid sequestrant.
J Clin Lipidol. 2011; 5(6).