Drug-induced lipid changes - A review of the unintended effects of some commonly used drugs on serum lipid levels

Many drugs besides lipid-lowering drugs affect serum lipid levels in either a potentially harmful or beneficial way, and may therefore increase or dec rease the risk of cardiovascular disease. Diuretics, beta -blocking agents, progestogens, combined oral contraceptive s containing 'second generation' propestogens, danazol, immunosuppressive a gents, protease inhibitors and enzyme-inducing anticonvulsants adversely af fect the lipid profile. They increase total cholesterol, low density lipopr otein cholesterol and triglycerides by up to 40, 50 and 300%, respectively, and decrease high density lipoprotein cholesterol by a maximum of 50%. Con versely, alpha -blocking agents, estrogens, hormone replacement therapy, co mbined oral contraceptives containing 'third generation' progestogens, sele ctive estrogen receptor modulators, growth hormone and valproic acid show m ostly beneficial effects on the lipd profile. Some drugs, for example, isot retinoin, acitretin and antipsychotics, mainly elevate triglyceride levels. Adverse or beneficial effects on serum cholesterol levels do not always tra nslate into a higher or lower, respectively, incidence of cardiovascular di sease, because these drugs may influence cardiovascular risk through multip le pathways. In some cases, excessive cholesterol levels occur for example, with protease inhibitor therapy, and several eases of pancreatitis attribu table to drug-induced hypertriglyceridaemia have been reported. Some general guidelines on the management of drug-induced dyslipidaemia can be given, Replacement of the dyslipidaemia-inducing drug by an equivalent alternative therapy is preferred. However, such alternatives are often diff icult to find, If there is no equivalent alternative and treatment with the dyslipidaemia-inducing drug must be initiated monitoring of serum lipid le vels is important. If drug use is expected to be long term, the existing gu idelines for the management of dyslipidaemia in the general population can be applied to drug-induced dyslipidaemia. In cases of extreme hyperlipidaem ia, medication use should be reassessed.