Patient has triglyceride level of 2000mg/dl, which medication should be initiated?

1.

Elsevier ClinicalKey Clinical Overview

Treatment Subsubsection Title: Statins: Statins are the preferred initial drug in all patients with atherosclerotic cardiovascular disease for LDL-C goal achievement, before consideration for additional drugs if LDL-C level remains suboptimal. Statins are also indicated as the initial drug therapy for primary prevention in all people with increased risk of atherosclerotic cardiovascular disease and moderate increase in triglyceride level (150-499 mg/dL) More potent statins (eg, rosuvastatin, atorvastatin) may reduce triglyceride level by 15% to 40%, if baseline triglyceride level is more than 250 mg/dL Subsubsection Title: Fibrates: Fibrates are the initial drug of choice for severe hypertriglyceridemia with level approaching 1000 mg/dL, to reduce the risk of acute pancreatitis Fibrates can reduce triglyceride level by 20% to 50%, depending on baseline triglyceride level. To date, there is no clear evidence that fibrates reduce atherosclerotic cardiovascular disease events in statin-treated subjects, based on the results of ACCORD-Lipid trial In statin-treated patients, fenofibrate is preferred over gemfibrozil to minimize adverse effects due to drug interactions In patients with moderate to advanced chronic kidney disease (ie, GFR less than 45 mL/minute), fenofibrate dose should be adjusted, regardless of age Subsubsection Title: Omega-3 Fatty Acids: Omega-3 fatty acids, such as eicosapentaenoic acid and docosahexaenoic acid, are also effective in reducing triglyceride level, similar to fibrates, and may be combined with fibrates to achieve effective control in those with triglyceride level 500 mg/dL or more

2.

Food and Drug Administration (DailyMed).

Publish date: October 4, 2017.

Dosage And Administration 2 DOSAGE AND ADMINISTRATION Primary hypercholesterolemia or mixed dyslipidemia: Initial dose of 145 mg once daily (2.2). Severe hypertriglyceridemia: Initial dose of 48 to 145 mg once daily. Maximum dose is 145 mg (2.3). Renally impaired patients: Initial dose of 48 mg once daily (2.4). Geriatric patients: Select the dose on the basis of renal function (2.5). Maybe taken without regard to meals (2.1). 2.1 General Considerations Patients should be placed on an appropriate lipid-lowering diet before receiving Tricor (fenofibrate), and should continue this diet during treatment with Tricor (fenofibrate). Tricor (fenofibrate) tablets can be given without regard to meals. The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy. Physical exercise can be an important ancillary measure. Diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus should be looked for and adequately treated. Estrogen therapy, thiazide diuretics and beta-blockers, are sometimes associated with massive rises in plasma triglycerides, especially in subjects with familial hypertriglyceridemia. In such cases, discontinuation of the specific etiologic agent may obviate the need for specific drug therapy of hypertriglyceridemia. Lipid levels should be monitored periodically and consideration should be given to reducing the dosage of Tricor (fenofibrate) if lipid levels fall significantly below the targeted range. Therapy should be withdrawn in patients who do not have an adequate response after two months of treatment with the maximum recommended dose of 145 mg once daily. 2.2 Primary Hypercholesterolemia or Mixed Dyslipidemia The initial dose of Tricor (fenofibrate) is 145 mg once daily. 2.3 Severe Hypertriglyceridemia The initial dose is 48 to 145 mg per day.

Dosage And Administration 2.3 Severe Hypertriglyceridemia The initial dose is 48 to 145 mg per day. Dosage should be individualized according to patient response, and should be adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals. The maximum dose is 145 mg once daily. 2.4 Impaired Renal Function Treatment with Tricor (fenofibrate) should be initiated at a dose of 48 mg per day in patients having mild to moderately impaired renal function, and increased only after evaluation of the effects on renal function and lipid levels at this dose. The use of Tricor (fenofibrate) should be avoided in patients with severe renal impairment [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3) ]. 2.5 Geriatric Patients Dose selection for the elderly should be made on the basis of renal function [see Use in Specific Populations (8.5) ].

3.

Fish Oil, Omega-3 Fatty Acids (FDA-approved), Elsevier ClinicalKey Drug Monograph

Content last updated: September 5, 2023.

Indications And Dosage **For the treatment of hypertriglyceridemia (i.e., triglyceride blood concentrations 500 mg/dL or more) as an adjunct to diet** Oral dosage (Epanova) Adults: 2 or 4 g PO once daily. Individualize dosage according to response and tolerability. Oral dosage (Lovaza) Adults: 4 g PO once daily or 2 g PO twice daily. Oral dosage (Omtryg) Adults: 4.8 g PO once daily or 2.4 g PO twice daily.