Your doctor may feel it is beneficial for you to take more than one cholesterol
drug, especially if you have:
- Metabolic syndrome -- this is when you have several risk factors
for heart disease, including elevated triglycerides, low HDL, poor handling
of blood glucose (sugar), and abdominal obesity (excessive weight concentrated
in the abdominal area)
- Inherited cholesterol imbalances -- also called familial hypercholesterolemias,
these are characterized by extremely high levels of one or more components
of the lipid profile, with high cholesterol often starting at a young age
Statins, for example, are widely used as first-choice drugs to lower LDL cholesterol.
They also can help raise HDL cholesterol somewhat.
Because fibrates focus more on lowering triglycerides and VLDL cholesterol,
while raising HDL, statins and fibrates are sometimes used together for maximum
effect. However, using medications in combination may increase the chances
for side effects and serious complications. For instance, when statins are
combined with fibrates, particularly with gemfibrozil, there is an increase
risk for rhabdomyolysis. This is a serious condition that causes muscle pain
and, in rare cases, can lead to kidney failure.
Fatalities associated with
rhabdomyolysis occurred with the statin cerivastatin (Baycol), especially at
high doses and in combination with fibrates. This statin was withdrawn from
the market in 2001. Combining a statin with fenofibrate (Antara, Lofibra, Tricor,
Triglide) may be less likely to cause side effects. Nevertheless, you should
consult a specialist in lipid management before using a statin-fibrate combination.
Nicotinic acid (niacin) is also used to raise HDL and to lower non-HDL cholesterol.
Many clinical studies have now been done using combinations of a statin and
niacin. The statin is responsible for most of the LDL lowering. Adding niacin
improves the rest of the lipid profile. Adding niacin, however, can increase
side effects. The most common side effects include flushing, itching, and elevated
The U.S. Food and Drug Administration has approved some single tablet statin
- Advicor -- a combination of niacin and lovastatin
- Vytorin -- a combination of ezetimibe and simvastatin
- Caudet -- a combination of atorvastatin and a calcium channel blocker
Vega GL. Management of atherogenic dyslipidemia of the metabolic syndrome:
evolving rationale for combined drug therapy. Endocrinol Metab Clin North
Am. 2004 Sep;33(3):525-544.
Review Date: 10/31/2006
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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