Hypolipidemic agent

Kelompok 4Fakultas Kedokteran

Universitas Nusa Cendana2015

Hypolipidemic AgentPengertian

Obat yang digunakan untuk menurunkan kadar lipid plasma. Tindakan menurunkan kadar lipid plasma merupakan salah satu tindakan yang ditujukan untuk menurunkan resiko penyulit aterosklerosis

Overview

Inhibitor Penyerap Sterol

Sekuestran asam empedu

Atorvastatin, Simvastatin, Rosuvastatin, Pitavastatin

Statin (HMG-CoA reductase inhibitor)

Atorvastatin, Simvastatin, Rosuvastatin, PitavastatinMenghambat biosintesis kolestrol (Kompetitif inhibitor HMG-CoA reduktase) Pembentukan Kolesterol Reseptor lipoprotein LDL dan VLDL di hepatosit trigliserida (sedikit)

KontraindikasiHipersensitifitas pada atorvastin,Penyakit liver aktif, Kehamilan dan laktasiToksisitas : miopati dan disfungsi hati

LDL Reduction : 25-60%

Atorvastin (Regular tablet)*Initial : 10-20 mg PO /hari*Maintenance: 10-80 mg PO /hari IndikasiHiperlipidemia Pencegahan penyakit kardiovaskular(10-80 mg /hari)

FibratGemfibrozil, fenofibrate

Lipoprotein lipase katabolisme VLDL Fatty acid oxidation Triglycerides elimination hepatic axtration of fatty acid HDL

KontraindikasiPenyakit hepatik, Penyakit ginjal, penyakit gallblader, primary biliary cirrhosisToksisitas : Miopati dan disfungsi hati

Gemfibrozil*600mg PO q12hr*administration : 30 min before morning and evening mealIndikasi : Hipertrigliseridemia dan HDL rendah

LDL Reduction : 15% Agonis peroxisome proliferator – activated receptor-Alpha

Sekuestran Asam EmpeduCholestyramine, colesevelam, colestipol

Ikat asam empedu Katabolime kolesterol Reseptor LDL LDL

KontraindikasiHipersensitifitas, Complete biliary obstruction, serum trigleserida >500mg/dL, history of hypertrigliseridemia induced pancreatitisToksisitas : konstipasi, perut kembung, mengganggu penyerapan sebagian obat dan vitamin

LDL Reduction : 15%

Cholestyramine* 4g PO q12-24hr*not to exceed 24g/day (4g q4hr)*indikasi : LDL Meningkat, Toksisitas digitalis, Pruritus

Inhibitor Penyerap SterolEzetimibe

Inhibit sterol transpoter Absorbsi kolestrol intestinal oleh asam empedu LDL dan Fitosterol

KontraindikasiBersama statin pada penderita penyakit hepatik, hipersensitifitasToksisitas : Insiden rendah hepatotoksisitas & miositis

Ezetimibe*10 mg PO qDay*administration : 30 min before morning and evening meal*Indikasi : LDL meningkat dan Fitosterolemia

LDL Reduction : 15%

Vitamin B3Niacin

Menghambat sintesis VLDL (dan sekresinya di hati) HDL LDL dan trigliserida

KontraindikasiHipersensitifitas,Penyakit hepatik,active pentic ulcer, severe hypotension, arterial bleeding

Niacin *Immediate release : 250mg PO q6-8h/DayDose adjusted every 4-7 days Do not exceed 6g/day*Extended release : 500mg/day PO at bed timeDose adjusted every 4 weeksDo not exceed 1-2g/day*indikasi : HDL rendah, VLDL dan LDL meningkat

LDL Reduction : 10%

Combination Drug

Lovastatin and niacin Atorvastatin and amlodipine Simvastatin and niacin Atorvastatin and ezetimibe Simvastatin and ezetimibe

Refference based on :1. American Heart Association. Drug Therapy for

Cholesterol. December 10, 2012. Accessed May 14, 2014

2. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al. Tryglicerides and cardiovaskular diseaseL a scientific statement from the American Heart Association. Circulation. May 24 2011:123(20): 2292-333[Medline]

3. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, et al. Treatment of Blood Cholestrol to reduce Atherosclerotic Cardiovaskular risk in adults : A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. Nov 7 2013 [Medline]

4. Farmakologi dasar dan klinik (Bertram G. Katzung) edisi 12, 2014

5. Farmakologi dan terapi (FKUI) edisi 5, 2007