From the FDA Drug Label
As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia.
The patient is already taking atorvastatin 20 mg daily. The dosage range for atorvastatin is 10 mg to 80 mg once daily. Since the patient's triglycerides level is 258 and they are already taking atorvastatin, the best course of action would be to consider increasing the dosage of atorvastatin or adding another medication to treat hypertriglyceridemia. However, the FDA drug label does not provide a specific recommendation for the best medication to use in this scenario.
- Key considerations:
- The patient's current medication, atorvastatin, is indicated for the treatment of hypertriglyceridemia.
- The patient's dosage of atorvastatin is 20 mg daily, which is within the recommended dosage range.
- Increasing the dosage of atorvastatin or adding another medication may be necessary to achieve the desired triglyceride level. 1 1
From the Research
For a patient with hypertriglyceridemia and normal cholesterol, LDL, and HDL levels who is already taking atorvastatin 20 mg daily, the best additional medication would be icosapent ethyl (Vascepa) 2 grams twice daily, as it has been shown to reduce cardiovascular mortality in patients with high triglyceride levels despite statin use 2. The patient's fasting triglyceride level of 258 mg/dL indicates hypertriglyceridemia, which is associated with an increased risk of cardiovascular disease. Given that the patient is already taking atorvastatin 20 mg daily, the focus should be on adding a medication that specifically targets triglyceride levels.
- Icosapent ethyl (Vascepa) is a purified eicosapentaenoic acid (EPA) that has been shown to reduce triglyceride levels and cardiovascular events in patients with hypertriglyceridemia despite statin therapy 2.
- The typical starting dose of icosapent ethyl is 2 grams twice daily, and it can be taken with or without food.
- When adding icosapent ethyl to a statin, liver function and muscle symptoms should be monitored, although the risk of myopathy is lower compared to fibrates.
- Lifestyle modifications remain essential alongside medication, including reducing alcohol and simple carbohydrate intake, increasing physical activity, and achieving weight loss if needed.
- Icosapent ethyl works by enhancing triglyceride clearance and reducing hepatic triglyceride production through different mechanisms than statins, making it a complementary therapy for patients with persistent hypertriglyceridemia despite statin therapy 3.