Serum lipid reducing agents

Recent literature does not point to side effects of nicotinic acid and its derivatives other than those which were reviewed in SED VIII (p. 936). The field has been reviewed by Parsons (26 ), who has stressed the need for a major study to determine the long-term effects of nicotinic acid as compared with other lipid-reducing agents. One of the few long-term studies recently reported, that of Zbllner et al. (27 ) is a follow-up on 37 patients who had been treated for hypercholesterolaemia with nicotinyl alcohol for between 6 and 8 years. Those who had taken more than 0.9 g daily still had a lower serum cholesterol than at the beginning of treatment, and there was no evidence of long-term adverse effects. 

Metformin also has been shown to produce beneficial effects on serum lipid levels and thus has become a first-line agent for type 2 DM patients with metabolic syndrome. Triglyceride and low-density lipoprotein (LDL) cholesterol levels often are reduced by 8% to 15%, whereas high-density lipoprotein (HDL) cholesterol improves by approximately 2%. A modest weight loss of 2 to 3 kg (4.4—6.6 lb) also has been reported with metformin therapy. Metformin often is used in combination with a sulfonylurea or a thiazolidinedione for synergistic effects. 

Clastogenic. Giving rise to or inducing disruption or breakages, as of chromosomes. Clofibrate. An antihyperlipidemic agent used to reduce elevated serum lipids when administered orally. 

Systemic effects are the most important adverse effects of / -blockers. Drug absorbed systematically may produce decreased heart rate, reduced blood pressure, negative inotropic effects, conduction defects, bronchospasm, central nervous system effects, and alteration of serum lipids, and may block the symptoms of hypoglycemia. The -specific agents betaxolol and possibly carteolol (due to ISA) are less likely to produce the systemic adverse effects caused by / -adrenergic blockade, such as the cardiac effects and bronchospasm, but a real risk still exists. The use of timolol as a gel-forming liquid or betaxolol as a suspension allows for administration of less drug per day, and therefore reduces the chance for systemic adverse effects compared with the aqueous solutions. 

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