Its link with coronary heart disease has certainly earned high blood cholesterol its laurels as one of the most unwanted conditions. Sometimes, high cholesterol levels do not respond to lifestyle changes alone, such as a diet that is low in cholesterol and saturated fats. In these cases, medications such as Advicor can provide the extra "push" you need to lower excessive blood cholesterol and help prevent such cardiovascular events as heart attacks.
Description
Due to its water-hating structure, cholesterol requires special transport molecules known as lipoproteins in order to circulate in your bloodstream. The main lipoproteins include LDL, or low-density lipoprotein, HDL or high-density lipoprotein, and VLDL, or very low-density lipoprotein. You may recognize HDL and LDL as "good" and "bad" cholesterol, respectively. HDL scavenges excess cholesterol in the blood and takes it back to the liver for elimination. In contrast, LDL carries cholesterol from the liver to your organs and tends to form heart disease-promoting plaque in your blood vessels. VLDL is an intermediate form of LDL and, therefore, contributes to high cholesterol levels.
Blood Levels
The American Heart Association considers a total blood cholesterol level below 200 mg/dL to be optimal. Levels that range from 200 to 239 mg/dL are considered borderline high, while a level of 240 mg/dL or more is high. High cholesterol more than doubles your heart disease risk, compared to an individual with a normal level, indicates the AHA. However, your risk also depends on your HDL and LDL levels. Ideally, your LDL count should be lower than 100 mg/dL to minimize heart disease risk. Normal HDL levels are 40 mg/dL or more for men and 50 mg/dL or more for women.
Contents
Known as an anti-lipemic agent, Advicor is actually a combination of two cholesterol-lowering drugs: lovastatin and niacin. Also known as nicotinic acid, niacin is one of the B vitamins. All Advicor formulations contain extended-release niacin and immediate-release lovastatin. Immediate release niacin is another term for long-acting niacin, which has special coatings or ingredients that control its rate of release from the tablet into your body. This reduces the number of times you have to take it for a given effect. In contrast, lovastatin is released immediately to exert its effects on blood cholesterol.
Mechanisms of Action
In "Goodman & Gilman's Pharmacological Basis of Therapeutics" Laurence Brunton, University of California's professor of pharmacology and medicine notes that lovastatin works by inhibiting HMG-CoA reductase, an enzyme that controls a key step in cholesterol production. It also increases the activity of your liver's LDL receptors, so that they remove circulating LDL cholesterol from the blood. Lovastatin and niacin both inhibit the synthesis of VLDL thereby interfering with LDL or "bad" cholesterol production. As a component of two coenzymes, niacin is also necessary for tissue respiration, fat metabolism and the breakdown of glycogen, the storage form of glucose.
Therapeutic Effects
Lovastatin mostly affects LDL levels. In "Goodman & Gilman's Pharmacological Basis of Therapeutics" Brunton also notes that studies have reported incremental reductions in LDL cholesterol: 20 to 25 percent LDL reduction with 10 mg lovastatin doses; 26 to 30 percent LDL reduction with 20 mg doses; 31 to 35 percent LDL reduction with 40 mg doses; and 36 to 40 percent LDL reduction with 80 mg doses. Niacin, on the other hand, raises HDL by increments of 30 to 40 percent. It also lowers LDL levels by 20 to 30 percent. Even though niacin has been shown to enhance the effects of statins, their combination also increases the chance of certain adverse effects.
Side Effects
Like any other medication, Advicor may cause adverse reactions in your body. The most common side effect, according to RxList, is flushing. Flushing manifests as a combination of warmth, redness, itching and/or tingling. Additional symptoms may accompany flushing episodes including dizziness, fainting, rapid heart rate, palpitations, shortness of breath, sweating, burning sensation, chills and swelling. Also, lovastatin may cause myopathy, or muscular disorders. Myopathy can manifest as muscle pain, tenderness or weakness. A rare but more serious possible side effect is rhabdomyolysis, a condition in which muscle tissue breaks down.
Precautions
You may reduce flushing episodes by gradually increasing the dosage of niacin or by taking aspirin 30 to 60 minutes before dosing, according to Access Medicine. Refrain from drinking alcohol or hot liquids with Advicor, to minimize flushing. Because certain populations are particularly at risk for serious side effects, disclose all conditions to your health care provider prior to taking Advicor, particularly diabetes, cardiovascular disease, gallbladder disease, gout, liver conditions and kidney disorders. Because tablet strengths are not interchangeable, adhere to your specific dosage form.
References
- American Heart Association: Cholesterol Levels
- Rx List: Advicor
- "Drug Monoraphs"; Access Medicine; The Mc Graw-Hill Company; 2010
- "Goodman & Gilman's Pharmacological Basis of Therapeutics" (11th edition); Laurence Brunton, Ph.D., et al.; 2006
- "Medical Biochemistry at a Glance"; Jack G.Salway, Ph.D.; 2006
