Microsomal Triglyceride Transfer Protein Inhibitors
Approved in December 2012, lomitapide (Juxtapid™) is the first and only medication in this class. It is approved for a specific genetic high cholesterol disorder known as homozygous familial hypercholesterolemia (HoFH).
This medication may be prescribed and dispensed only by healthcare providers and pharmacies that have been specially certified to do so, due to the potentially serious risks associated with its use. In particular, lomitapide can cause serious liver problems. It also has several significant drug interactions, and dosing is not particularly straightforward (people must start with a low dosage and gradually increase to a higher one).
Oligonucleotide InhibitorsApproved in January 2013, mipomersen (Kynamro™) is the first and only medication in this class. It is approved for a specific genetic high cholesterol disorder known as homozygous familial hypercholesterolemia (HoFH). It is given as an injection just under the skin (a subcutaneous injection) once a week and is intended for use in combination with other cholesterol medications. Like many other cholesterol medications, mipomersen can cause serious liver problems, and careful monitoring of the liver (using routine blood tests) is recommended.
In the past, when there was a large focus on LDL goals, if you did not reach your LDL goal after three months of taking a single cholesterol medication, your healthcare provider would consider starting a second medicine along with it. However, now that there is very little emphasis on the old LDL goals, it is unclear what role these other medications may have. One important role may be in people who cannot tolerate their recommended dose of statin due to side effects, since the use of low doses of each medicine may help reduce side effects.
Examples of combination cholesterol drugs include: