Colestyramine Acipimox

A statin could be considered in this patient with appropriate monitoring. Fibrates, niacin or ezetimibe could be used with appropriate monitoring of LFTs. Colestyramine/colestipol and acipimox should be safe to use. 

Pravastatin is the statin of choice in this patient as it is least likely to accumulate, is hydrophilic, and is not highly protein bound. The starting dose should be low and should be increased cautiously. Monitoring of LFTs is required. Colestyramine and colestipol may be considered and may help the patient s pruritus. Niacin and acipimox could be used if the pruritus does not worsen. The fibrates should be avoided because of the risk of gallstone formation. Ezetimibe could be considered alone. 

Statins should be avoided. If absolutely necessary, pravastatin could be used, starting at a low dose and with cautious adjustment according to clinical response. The patient s synthetic liver function should be monitored closely. In the event of the slightest deterioration of function, pravastatin should be stopped immediately. Colestyramine/colestipol should be safe to use but may cause a reduction in vitamin K absorption and increase the risk of a bleed. Constipation might induce encephalopathy. The fibrates should be avoided due to their potential effect on coagulopathy. Ezetimibe should be safe to use alone. Acipimox and niacin are gastric irritants and would be best avoided. 

A randomised crossover study in 7 healthy subjects given acipimox 150 mg with three 4-g doses of colestyramine (taken concurrently, and then 8 and 16 hours later) found that the pharmacokinetics of acipimox were slightly but not significantly altered by the colestyramine. There would seem to be no good reason for avoiding concurrent use. 

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