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Ezetimibe 10mg once a day. This can be used alone or in combination with a statin and will lead to an additional 15-20 per cent reduction in LDL-C. With proven tolerability (main side effects are gastro-intestinal) plus CVD outcome data from the IMPRIOVE-IT trial, it is often the next option for both primary and secondary prevention
Bempedoic acid 180mg once a day is a relatively new option – approved for both primary and secondary prevention. It works on the same pathway as statins but does not go into the muscles and as a result, it does not have the muscle side effects of statins, but does increase uric acid levels and therefore may increase the risk of gout. NICE recommends use in combination with ezetimibe in statin intolerant patients
Icosapent ethyl, a highly purified form of fish oil, may be added to statin therapy (two capsules twice a day) in selected people where triglycerides are also raised.
Pharmacy technician CPD: First prescriptions for lipid management
Oral treatment options