When should lipid-lowering drugs be taken?⌚⌚⌚

Dyslipidemia generally refers to elevated levels of cholesterol and/or
triglycerides (TG) in the blood. It is also called hyperlipidemia. At the same time, it also includes various dyslipidemias including low high-density lipoprotein cholesterol (HDL-C). The main clinical lipid-lowering drugs currently include cholesterol absorption inhibitors, HMG-CoA inhibitors (statins), fibrates, anti-lipid peroxidation drugs (probucol), niacin drugs, and PCSK9 inhibitors. , bile acid chelators, high-purity fish oil preparations and other lipid-lowering drugs, etc.

Lipid-lowering drugs can generally be divided into three categories.

1. Drugs that mainly lower cholesterol: Such drugs include statins, cholesterol absorption inhibitors, probucol, bile acid chelators. They reduce cholesterol levels by inhibiting cholesterol synthesis in liver cells, accelerating low-density lipoprotein cholesterol (LDL-C) catabolism, or reducing intestinal cholesterol absorption.
2. Drugs mainly aimed at lowering triglycerides: These drugs include fibrates, niacin and high-purity fish oil preparations. They can lower blood levels of triglycerides in patients.
3. PCSK9-inhibitors: such as evolocumab. It prevents the degradation of LDL-receptors by inhibiting PCSK9, thereby promoting the body's clearance of LDL-C. It reduces blood levels of LDL-C and has a powerful cholesterol-lowering effect.
4. Microsomal triglyceride transfer protein inhibitors: such as lomitapide. It lowers blood levels of LDL-C.
5. Apolipoprotein B-100 synthesis inhibitors: such as mipomexan. It reduces the production and secretion of VLDL. At the same time, it will also reduce the blood level of LDL-C.

The timing of taking lipid-lowering medications.

Drugs that mainly lower cholesterol:

1. Statins: Lovastatin, simvastatin, pravastatin, fluvastatin (tablets) and other statins with short half-lives are recommended to be taken before going to bed. While cholesterol will reach its synthesis peak at night, these drugs will also reach their concentration peak. Statins with long half-lives such as fluvastatin (sustained-release preparation), atorvastatin, rosuvastatin, and pitavastatin can be taken at any time, but it is recommended that patients take them at the same time every day to avoid missing doses. 
2. Cholesterol absorption inhibitors: such as ezetimibe. It inhibits the intestinal absorption of cholesterol. Statins will have a good synergistic effect when combined with it. At the same time, it will not affect the absorption of other drugs and fat-soluble vitamins. Food will not affect its absorption. Therefore, it is generally taken once daily, with or without food.
3. Probucol: It is mainly suitable for hypercholesterolemia. It will enter the core of LDL and affect lipoprotein metabolism. LDL becomes easily eliminated through non-receptor pathways. It can also reduce xanthomas on the skin. Food increases its absorption, so patients are advised to take it with a meal. Generally, it needs to be taken twice a day, with breakfast and dinner.

Drugs mainly aimed at lowering triglycerides: 

1. Fibrates: such as bezafibrate, fenofibrate, gemfibrozil. Bezafibrate generally needs to be taken with or after meals. To reduce stomach upset caused by fenofibrate, it is recommended to take it with food. Gemfibrozil is generally taken twice daily, and it is recommended to take it 30 minutes before breakfast and dinner. Additionally, when they are combined with statins, it is recommended to take fibrates in the morning and statins at bedtime. This reduces the occurrence of drug interactions.
2. Niacin drugs: This type of drugs includes acipimox and niacin extended-release tablets. The usual dose of acipimox is two or three times a day, taken with or after meals. Acipimox dispersible tablets need to be taken after meals. The usual dose of niacin extended-release tablets is once daily, taken before bed.