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Treatment Strategies
  

hyperlipidemia

Posted: Dec 8, 2005

QUESTION:

I am an internist at a tertiary care psychiatric hospital caring for a man with schizophrenia and longstanding AIDS. He is currently on Kaletra, Videx and Retrovir and his viral load is not detectable and his CD4 count has risen from 150 to over 400 on his current therapy.

The difficulty is that his psychosis is also refractory has he has receiving acute inpatient psychiatric care for the past 5 years.

His psychosis finally stabilized on a combination of 2 new generation atypical antipsychotics-Zyprexa and Risperdal- both of which along with his PI's can exacerbate his hyperlipidemia.

Have had no luck with Lopid-his triglycerides are still over 800.

Considering stopping the Lopid and starting lipitor but he would likely need high dose 80mg to see a significant change in his TG's.

Any suggestions?


  

RESPONSE FROM:   

    I would advise not to use Lipitor just yet. For one thing, as you know it is not as good at lowering TGs as it is LDL cholesterol. Also, protease inhibitors increase the plasma level of Lipitor so a does of 20 mg may provide a much greater level than usual.

    If you have other protease inhibitor agents I would consider a switch from Kaletra to one of these as it is likely his Kaletra is driving the TGs. A change to Reyataz 300 mg + Norvir 100 mg all once a day should work well. If you do not have Reyataz available much would depend on what you do have and his treatment history.

    Omega 3 fatty acid (fish oil) may help some. A dose of 3 grams a day with food has been shown to reduce TG levels by about 25%.

    IF you have no other option, Lipitor starting at 20 mg could be used but watch carefully for side effects such as muscle problems.

    DW




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