Hypertriglyceridemia and mixed hyperlipidemia:
Firstly, nicotinic acid and its derivatives (amotis). Nicotinic acid and its derivatives lower blood triglyceride and cholesterol levels by blocking the release of fatty acids from adipose tissue. Another method to lower blood triglyceride and cholesterol levels is to accelerate the lipolysis or breakdown of VLDL.
There is a lipoprotein lipase in the capillaries of muscle and adipose tissue, which promotes the release of triglycerides from VLDL to tissues. The dosage of nicotinic acid is relatively large, 3-6 grams per day, so there are more adverse reactions. Initially, a daily dose of 100 milligrams is taken three times a day after meals, with the dose gradually increased every 3-7 days. The daily dose should not exceed 2.5 grams in the first month, 5 grams in the second month, and 7.5 grams in the third month.
Second, fibric acid derivatives – fibrates (gemfibrozil, fenofibrate, bezafibrate, ciprofibrate, etc.). Fibric acid derivatives can increase the activity of lipoprotein lipase, accelerate the lipolysis of VLDL, and lower VLDL and triglyceride levels. These drugs not only lower triglyceride levels but also have an effect on lowering cholesterol. After lipolysis, VLDL is converted to intermediate-density lipoprotein, which then transforms into LDL. If the VLDL level is high, such as in patients with hypertriglyceridemia, the above conversion can cause an increase in LDL levels and also an increase in HDL levels.
In patients with hypertriglyceridemia treated with fibric acid derivatives, even if LDL levels increase to some extent, the net effect is a decrease in total cholesterol and triglyceride levels due to a significant reduction in very low-density lipoprotein cholesterol. Therefore, fibric acid derivatives are effective drugs for the treatment of hypertriglyceridemia and mixed hyperlipidemia. The dosage of gemfibrozil is 1.2 grams per day, divided into two doses, and bezafibrate is 200 milligrams per day, divided into three doses.
