Triglycerides are a blood fat and up to a certain amount can be used as energy, but excess triglycerides can lead to hypertriglyceridemia. Many prescription medications can treat high triglycerides. People with hypertriglyceridemia should make changes to their diet and lifestyle and in some cases should consider alternative medications.
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According to the Mayo Clinic, normal triglycerides are below 150 mg/dL, borderline high triglycerides are between 150 and 199 mg/dL and high triglycerides are over 200 mg/dL. High triglycerides are a risk factor for heart disease and stroke and are associated with high blood pressure, high blood sugar and high cholesterol. According to a June 2001 article in American Family Physician (AFP), research physicians recommended that the primary treatment for triglycerides up to 400 mg/dL should be lifestyle modifications such as weight control, dietary changes, exercise and smoking cessation. Medication is recommended for triglycerides above 400 mg/dL.
Fibrates are derivatives of fibric acid, an organic molecule that influences the synthesis and breakdown of fat. The American Heart Association (AHA) says fibrates are the best medication to lower triglyerides. According to the AFP article, fibrates can lower triglycerides by 25 to 45 percent. Examples of fibrates include Gemfibrozil (Lopid), Fenofibrate (Tricor, Triglide) and Clofibrate (Atromid-S). The dosage and cost of fibrates depend on the medicine. For example, Gemfibrozil is administered at 600mg twice a day and costs approximately $82 per month while Fenofibrate starts at 67mg a day and costs $21 per month. Side effects of fibrates include upset stomach, sensitivity to sun, gallstones, irregular heartbeat and liver damage, according to the University of Maryland Medical Center (UMMC).
Statins are the largest class of medications used to treat lipid (fat) disorders, but only have a moderate effect on lowering triglycerides, according to the AHA. The AFP article says statins can lower triglycerides by 10 to 37 percent. Examples include Atorvastatin (Lipitor), Fluvastatin (Lescol), Locastatin (Mevacor), Pravastatin (Pravachol), Rosuvastatin Calcium (Crestor) and Simvastatin (Zocor). Statins have a dosage of 10 to 20 mg once a day and cost $40 to $114 per month. Side effects include muscle problems and liver abnormalities and should not be taken by pregnant women or individuals with pre-existing liver disease.
Niacin can lower triglycerides more than statins, but less than fibrates and according to the AHA affects the liver’s ability to produce triglycerides. According to the AFP article, niacin can lower triglycerides by 21 to 28 percent. Niacin is available as a prescription medication or over the counter (OTC) dietary supplement, but OTC niacin should never replace prescription niacin because it is not regulated by the FDA. Prescription dosages of niacin start at 500 mg a day and cost about $15 per month. An example of prescription niacin is Niaspan. Side effects of niacin include flushing, itching and upset stomach. In large doses, niacin can cause liver poisoning and is used cautiously with diabetics because it can raise blood sugar.
Supplements and herbs are considered alternative medications and may help treat hypertriglyceridemia. Patients should consult a physician prior to taking any alternative medications because many have not been scientifically proven to be safe or effective and can have side effects and interact with prescription medications. According to the UMMC, supplements that may help lower triglycerides include fiber and omega-3 fatty acids from fish oil, the latter of which is available as an OTC supplement or prescription medication. Herbs that have been used to treat and prevent heart disease and blood fat disorders include hawthorn, garlic, olive leaf extract, red yeast, psyllium and guggul.
REFERENCES & RESOURCES
- “American Family Physician”; Choosing drug therapy for patients with hyperlipidemia; R. Safeer, C. Lacitiva; June 2000.
- American Heart Association: Cholesterol-Lowering Drugs
- Mayo Clinic: Triglycerides
- Thagard Student Health Center: Medication for High Triglycerides
- University of Maryland Medical Center: Hypercholesterolemia
- Center for Cholesterol Management: Fibric Acid Biochemistry