Bile acid sequestrants: their use in combination with other lipid-lowering agents

Several potent drugs are currently available for the treatment of hyperlipidemia. These pharmacotherapies include bile acid sequestrants, HMG-CoA reductase inhibitors (commonly referred to as 'statins'), fibrates and nicotinic acid. Combination therapy to reduce plasma cholesterol levels in hyperlipidemic patients is becoming more popular, as concerns about toxicity resulting from the long-term used of systemically acting drugs are raised. One of the more widespread combinations used to reduce plasma cholesterol levels is that of a bile acid sequestrant and a statin. Combinations of bile acid sequestrants with either niacin or fibrates have been found to be very effective in patients with mixed hyperlipidemia, since the triglyceride-lowering effect of niacin or a fibrate complements the cholesterol-lowering effect of the sequestrant. One major advantage of combination therapy is the ability to reduce the dose of each component to more tolerable levels for the patient. An additional advantage is the reduced cost to achieve the cholesterol reduction goal, as the dose response is relatively good at greatly reduced doses for each component.