Although the commonly used lipid-lowering drugs in the clinic are listed after strict clinical observation studies, they are generally safer to use and the side effects are relatively mild, but there are still a small number of patients who may have serious side effects during the medication, and the following briefly introduces the side effects of several commonly used lipid-lowering drugs in the clinic.
What are the side effects of lipid-lowering drugs?
(1) Statins: that is, commonly used drugs such as atorvastatin, rosuvastatin and other drugs that end with the word statin. Most people tolerate tantine well, with mild and short-lived side effects, and symptoms such as headache, insomnia, dyspepsia, abdominal pain, bloating, and nausea may occur. A small number of people may have elevated liver enzymes that are associated with the dose used with statins, i.e., the greater the dose, the greater the hepatotoxicity. Cholestasis and active liver disease are contraindications to statins, but there have been few reports of severe liver function impairment caused by long-term use of statins.
The most serious adverse reaction of statin is muscle toxicity, which is mainly manifested as muscle discomfort, myalgia, muscle weakness, etc., and in severe cases, it can lead to acute renal failure and even endanger the patient's life. Although the incidence of severe myotoxicity is extremely low, when the above muscle-related symptoms occur during the medication, it is necessary to go to the hospital in time to avoid serious consequences. In addition, long-term use of statin therapy may increase the risk of new-onset diabetes.
(2) Fibrates: such as the commonly used fenofibrate, benzalabrate and so on. The main side effects of such drugs are gastrointestinal reactions, liver and kidney function impairment, and cholelithiasis, which may also cause myopathy. When fibrates are used in combination with statins, they may increase the incidence of liver damage and myopathy, and caution should be exercised when combined.
(3) Niacin: such as commonly used niacin tablets, inositol nicotinate tablets, etc. Common side effects include flushing, erythema, itching, hyperglycemia, high uric acid (or gout), and upper gastrointestinal discomfort. These drugs are contraindicated in patients with chronic liver disease and severe gout and ulcer disease.
(4) Choleic acid chelating agent (resin): such as cholestyramine. The main side effects of these drugs are the effect on the absorption of certain drugs (such as folic acid, fat-soluble vitamins, digoxin, antibiotics, statins, etc.) and digestive symptoms such as nausea, vomiting, constipation, diarrhea, etc. It is recommended to supplement appropriate vitamins during the period of taking this drug, and the interval between taking other drugs should be 1 to 4 hours.
(5) Cholesterol absorption inhibitors: such as Yizhi Maibu and Haibo Maibu. Such drugs are well tolerated and safe. Common adverse effects are headache and nausea, and rarely liver damage and myopathy may occur.
(6) PCSK9 inhibitors: such as iluflizumab, alioximab, are subcutaneous injection preparations, less adverse reactions, can appear upper respiratory tract infections, influenza, gastroenteritis, nasopharyngitis, rash, urticaria and so on.
(7) Other hypolipidemia drugs: the main side effects of Probuco include gastrointestinal reactions, eosinophilia, hyperglycemia uric acid, etc., and its most serious adverse reaction is the prolongation of the QT interval, which may cause ventricular arrhythmias, but it is very rare, so it is disabled for patients with ventricular arrhythmias or QT interval prolongation. Side effects of fish oil preparations are uncommon, and a small number of patients may experience gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation, and occasionally liver damage, myopathy, or bleeding tendencies. A common adverse reaction of Chinese medicine lipids is gastrointestinal discomfort, because its composition contains lovastatin, which may occasionally cause an increase in the reversibility of liver enzymes and muscle enzymes.
In short, the current commonly used hypolipidemia drugs on the market are generally relatively safe to use, and the side effects are rare and light, so patients with dyslipidemia do not have to refuse to take drugs because of excessive fear or fear of side effects. During the medication period, attention should be paid to regular follow-up, and if discomfort symptoms occur, they should seek medical treatment in time, and the doctor will adjust the treatment plan as appropriate to reduce and avoid the side effects of the drug.
What should I pay attention to when taking lipid-lowering drugs for a long time?
Although long-term administration of hypolipidemic drugs is safe in most cases, the following points should be noted during the medication:
(1) Improve lifestyle: A good lifestyle includes adhering to a healthy diet, exercising regularly, staying away from tobacco and maintaining an ideal weight. Lifestyle improvement is the basic measure of hypolipidemic therapy, which can reduce cholesterol by 4% to 13%, improve vascular endothelial function, and improve heart and body function. Dietary control and active exercise should continue even after initiation of pharmacotherapy, and it is important to remember not to relax lifestyle interventions because of medication.
(2) Adhere to long-term regular medication: Long-term regular medication to maintain blood lipids, especially LDL-C, below the target level for a long time, in order to benefit patients for a long time. It should be noted that the target level of LDL-C is not the reference value on the lipid test, but is determined according to the risk level of cardiovascular disease in the patient, and the LDL-C level in very high-risk patients should be maintained at least 1.8 mmol/L or even below 1.4 mmol/L.
(3) Pay attention to monitoring blood lipids and adverse drug reactions: those who take lipid-lowering drugs for the first time should recheck blood lipids, transaminases and creatine kinases after 6 to 8 weeks of medication to find out whether blood lipids have reached the target value and whether there are adverse liver and muscle reactions. If the blood lipids have reached the target value and there are no adverse drug reactions, it should be gradually changed to a repeat examination every 6 to 12 months. If after 3 to 6 months of treatment, the blood lipids still do not reach the target value, the dose or type of lipid-lowering drugs should be adjusted under the guidance of a doctor, or a combination of different types of lipid-lowering drugs should be used for treatment. If muscle soreness, fatigue, urine is soy sauce color, decreased appetite, nausea, vomiting and other symptoms occur during treatment, you should seek medical attention in time.
(4) Pay attention to the time of medication and the interaction between drugs: since cholesterol is synthesized more at night, it is generally better to take statins before going to bed. If it is necessary to take both statins and fibrate lipid-lowering drugs, it is recommended that the shellfish be taken in the morning and statins taken in the evening to reduce the interaction between the two drugs and reduce the occurrence of adverse reactions. Heavy alcohol consumption and drinking a lot of grapefruit juice during the period of taking lipid-lowering drugs will increase the concentration of drugs in the blood, and there is a risk of increasing adverse drug reactions, so it should be avoided. Simultaneous administration of amiodarone, verapamil, diltiazem, some antifungals, clarithromycin and other macrolide antibiotics, as well as drugs such as cyclosporine and tacrolimus, can affect the metabolism of statins, increase the blood concentration of statins, and thus increase the adverse reactions of statins, and it is necessary to be cautious when combined with these drugs.
(5) Do not use Chinese herbal medicines instead of hypolipidemic drugs without authorization: There are some Chinese herbal medicines on the market that are marked with hypolipidemic effects, but their mechanism of action and efficacy are not clear, so it is not recommended to use Chinese herbal medicines instead of lipid-lowering drugs without authorization, so as not to delay the disease.