Combined medication in patients with hyperlipidemia:
Combination therapy is an unavoidable clinical approach for treating hyperlipidemia. It undoubtedly improves efficacy, but also brings some risks, so close monitoring of safety indicators is necessary to prevent life-threatening adverse reactions such as rhabdomyolysis.
Combination therapy is indicated for patients with severe lipid abnormalities, especially those with severe mixed lipid abnormalities. The use of combination therapy should be extremely cautious, considering both efficacy and risk. In lipid-lowering treatment, not all drugs can be used together; some drug combinations increase toxicity and cause serious consequences. When combination therapy is necessary, it should not be delayed, but started at a low dose, closely observing clinical reactions, and inquiring about muscle symptoms such as muscle weakness and myalgia.
Monitoring safety indicators such as creatine kinase (CK), alanine aminotransferase (ALT), creatinine (Cr), and urea nitrogen (BUN) is also important. When ALT is greater than 3 times the normal limit, CK is greater than 5 times the normal limit, and Cr and BUN show significant abnormalities, dosage reduction or discontinuation should be considered.
For example, when statin drugs are combined with erythromycin, cyclosporin, nicotinic acid, and fibrates drugs (especially gemfibrozil), rhabdomyolysis is more likely to occur, which can lead to acute renal failure and pose a threat to life. Additionally, rhabdomyolysis can also occur with individual use of fibrates drugs, with gemfibrozil being the most common. Therefore, when treating difficult-to-control lipid abnormalities that do not respond to single lipid-lowering drugs, special attention should be paid to the potential toxicities and individual characteristics of the patient when considering combination therapy.
Long-term persistence is required for the treatment of lipid abnormalities to achieve significant clinical benefits. Regular follow-up visits should be scheduled during medication, and dosage adjustments should be made based on changes in blood lipids. If lipids do not decrease to the desired level, increased dosage or alternative lipid-lowering drugs should be considered, or combination therapy may be warranted.
If lipids have already decreased to normal or reached target levels after treatment, continue with the same dosage unless the lipid levels are very low; in which case, dosage reduction is recommended. When taking lipid-lowering drugs continuously for a long time, lipid levels should be rechecked every 3 to 6 months, along with examinations of liver and kidney function, and measurement of creatine kinase (CK).
