The Truth About Beauty Product Dangers

Pretty Poison or Harmless Cosmetic?

When you cover your blemishes, give yourself a sunless tan, or straighten your hair, chances are you use a product with a long list of ingredients. But are those ingredients safe? Headlines proclaiming the dangers of beauty products are often based on hype, so WebMD takes a look at the science. And we offer some alternatives for those who want to reduce their use of chemicals.

Concern: Keratin Straighteners

Salon-based keratin hair treatments can deliver silky, smooth locks with no frizz. These treatments are often marketed as formaldehyde-free, but Oregon's OSHA found high concentrations of the chemical in more than half of samples. Long-term exposure to formaldehyde can cause cancer. Getting your hair straightened or "smoothed" once every few months will not put you over OSHA's exposure limits. But there could be a real risk to your stylist.

Option: Conditioner and Flat Iron

Conditioner can help you fight frizz by neutralizing the impact of static electricity. And while the results will only last until your next shampoo, a flat iron can get the kinks out of most naturally curly hair. Using a blow dryer is less effective than a flat iron for smoothing hair, but your stylist might show you a few good techniques, combined with safe hair products, to tame a frizzy look.

Concern: Permanent Hair Dye

Research connecting hair dye to cancer has had conflicting results. Some studies suggest that women are slightly more likely to get leukemia or lymphoma if they use permanent hair dyes, particularly darker colors. But other studies have found there is no increased risk. Most research looking at hair dye and breast cancer has found no link. There is also no evidence suggesting hair dye poses a threat during pregnancy, although some health care providers recommend waiting until the second trimester to be extra cautious.

Option: Plant-Based Hair Dyes

Plant-based hair dyes, including henna and vegetable dyes, can change hair color without harsh chemicals. But there are some drawbacks. Most won't result in a dramatic color change, and the results tend to fade sooner than with permanent dyes. A second option is to get highlights at a salon. A special cap or foil hair wrappers prevent the dye on your tresses from touching your scalp, so the chemicals aren't absorbed by your skin.

Concern: Crazy Contacts

Colored or patterned lenses that don't correct your vision can help you change your look. But avoid any lenses that are sold without a prescription, often available at salons, costume shops, or online. Contact lenses require proper fitting, cleaning, and care, even for a short wearing. If you don't care for them properly, you run the risk of eye injuries or infections that can lead to vision loss.

Option: Rx Colored Lenses

If you feel Mother Nature gave you the wrong eye color, ask a licensed eye care professional about colored contact lenses. Even if you have sharp vision, you'll still need an eye exam. The doctor can write a prescription for you and show you how to take care of the lenses properly. Buy lenses from a prescription-only source. Follow the doctor's directions to avoid injuring your eyes.

Concern: Prescription Eyelash Serum

Latisse is a prescription drug that can temporarily give you long, flirty eyelashes. You daub the serum onto your upper lash line every day and wait about four months for results. You may love the lashes, but it's important to note a small risk of side effects, some permanent. The drug may darken the skin around your eyes or turn the colored part of your eyes (the irises) brown.

Option: Eyelash Extensions

False eyelashes or eyelash extensions can give you that long-lashed look without a prescription drug. But that doesn't mean they're risk-free. The adhesives can irritate the eyelids or cause an allergic reaction. And beware of permanent eyelash tints that promise thicker-looking lashes. They have been linked to serious injury, including blindness. No permanent dyes are FDA-approved for use on the lashes.

Concern: Hydroquinone

Hydroquinone is a skin lightener that is available by prescription or in a less potent strength over the counter. Dermatologists often recommend it for reducing age spots or dark patches known as melasma. Overuse of hydroquinone can cause skin discoloration. Animal studies have also linked the chemical to cancer, though the risk to humans is unclear. Scientists are currently studying hydroquinone's safety.

Option: Laser Skin Resurfacing

Laser skin resurfacing uses a special type of laser to remove the top layer of skin. The procedure, which is done by a dermatologist, can minimize age spots and even out skin color without the long-term use of a chemical lightener. Drawbacks include the expense, pain, the downtime while your skin is healing, and a small risk of scarring or discoloration.

Concern: Tanning Beds

No matter what you've heard about the safety of tanning salons, here's what the research says: frequent use of tanning beds raises your risk of melanoma, the most deadly form of skin cancer. In addition, tanning beds mainly emit UVA rays, which contribute to premature aging – wrinkles and brown spots. Even if tanned skin looks good to you, tanned skin is actually damaged skin.

Option: Sunless Tanning Products

It's easy to fake a tan. Sunless tanning lotions typically contain DHA, a color additive that reacts with amino acids in the skin's surface to create a temporary "tan." DHA is FDA-approved for external application, but not for use in commercial spray tanning booths. These booths may cause you to inhale some of the spray or get it in your eyes. Be sure to use sunscreen even when you have a sunless tan. It does not protect your skin.

Concern: Nail Salon Hazards

Manicure products contain a wide range of chemicals, including formaldehyde, phthalates, acetone, or toluene. Their fumes may irritate the skin, eyes, nose, and respiratory tract. These reactions are more common in salon workers than in clients. Manicures and pedicures can also result in fungal or bacterial infections – particularly if equipment has not been sterilized properly.

Option: Minimize Risks

Before having a manicure or pedicure, inspect the salon's cleanliness. Leave if you doubt the quality of the salon's sanitation or disinfection practices. Don't shave your legs before a pedicure, and avoid the nail salon if your skin is cut, nicked, or broken. If you're a salon worker, ensure that your salon obeys laws designed to protect workers' safety.

Concern: Phthalates

Phthalates are chemicals used to make products more pliable. They're found in toys, food packaging, and some beauty products, including nail polish, shampoo, and soap. Two studies suggest phthalate exposure during pregnancy may lead to abnormal development in male infants, including low hormone levels and small genital size. But the FDA says there is not enough evidence to conclude that phthalates pose a health risk.

Option: Phthalate-Free Products

If you're concerned about phthalates, look for phthalate-free beauty products. You can check the ingredients for the term phthalate (dibutylphthalate, dimethylphthalate, diethylphthalate, etc.), butyl ester, or plasticizer. It's important to note that phthalates are also found in flooring, shower curtains, food packaging, and many other staples of modern life. But using phthalate-free cosmetics and skin-care products can reduce your overall exposure.

Concern: Parabens

Parabens are the most common preservative found in cosmetics, including makeup, moisturizers, and hair care products. One study found parabens in breast tumors, but did not indicate that parabens actually caused the cancer. Other researchers have concluded it is "implausible" that the amount of parabens in cosmetics could lead to cancer.

Option: Paraben-Free Cosmetics

If you're concerned about parabens, you can find paraben-free beauty products. Cosmetics tend to spoil without preservatives, but parabens aren't the only option. Some products use vitamin C (ascorbic acid) or vitamin E (tocopheryl acetate) as preservatives.

Does Makeup Expire?

If you're hanging onto your glittery disco-era eye shadow, toss it now. Preservatives in the makeup may break down over time, allowing bacteria to grow. Experts offer the following "use by" guidelines:

• Foundation - one year
• Blush/powder/shadow - two years
• Lipstick - one year
• Mascara - 3-4 months

Throw out eye makeup immediately if you have an eye infection.

Is Mineral Makeup Better?

Mineral makeup contains fewer irritating fillers and preservatives than regular cosmetics. But it can still contain allergens, so people with sensitive skin should look for products with as few ingredients as possible. Although mineral makeup often has built-in sunscreen, like titanium dioxide or zinc oxide, don't rely on this as your sole protection from the sun. It's best to use mineral makeup over your regular sunscreen.

Sunscreen Safety

The ingredients in sunscreen have been used for many decades and are considered safe. The real danger is choosing a sunscreen that is too weak. To protect against both UVA and UVB rays, choose a product labeled "broad spectrum" and choose SPF 30 or higher to reduce the risk of skin cancer and early skin aging.

12 Ways to Wreck Your Skin

Skin Sins

Your skin is the largest organ in your body, and it takes a lot of abuse. Constantly exposed to the elements, your epidermis (and the layers beneath) really takes a beating, especially if you're guilty of skin sins.

Want to preserve your skin? The following slides show what not to do.

1. Get Overexposed

There was a time when people thought it was healthy to slather their bodies in baby oil and spend entire days baking in the sun in order to tan their skin. Over the years, dermatologists set us straight, telling us in no uncertain terms that sun worshipping will only put us on the path to premature aging -- and skin cancer.

"If there's one thing in the world that one can do to avoid the ravages of injury to the skin, it's avoid the sun," says Norman Levine, MD, a dermatologist in Tucson, Arizona Ariz., and the author of Skin Healthy: Everyone's Guide to Great Skin. "When the sun damages the cells and deeper skin tissues irreparably you get skin aging and you are more prone to skin cancer."

2. Skimp on Sunscreen

Your sunscreen probably isn't shielding you from sun damage because most of us don't apply the shot-glass-sized amount (1 ounce) of SPF 30 or higher sunscreen -- the minimum experts say we need to protect us.

"Most people under-apply by one-fourth. Whatever you're putting on is probably too little, so at least double it," says Jeffrey Dover, MD, FRCPC, associate clinical professor of dermatology at Yale University School of Medicine] and director of SkinCare Physicians in Chestnut Hill, Mass. Also, many people also don't apply sunscreen every two hours as dermatologists recommend.

3. Head to the Tanning Bed

Think a tanning bed is safer than being outside in the sun? Think again.

Tanning beds give you a concentrated burst of ultraviolet light that causes skin aging and will increase your risk for melanoma skin cancer. "Never go into a tanning parlor," Levine says. "There couldn't be a worse thing to do to your skin."

4. Smoke

If the risk of lung cancer, emphysema, heart disease, and stroke aren't enough to scare you off cigarettes, how about all those wrinkles you'll get?

Study after study shows just how extensively smoking ages the skin. "It does a lot of what the sun does. It just does it inside (the body) instead of outside," Dover says. "It makes the skin weak, tired, and listless looking."

If that weren't enough, smoking also yellows the skin, interferes with its blood supply, and slows wound healing. "So if you injure your skin it may not heal as well if you're a smoker," Levine says

5. Use the Wrong Cleanser

A big mistake people make when they wash their face is using a harsh soap that's meant for their body. Keep the bar soap in the shower. Use only a mild cleanser for your face, especially if you have sensitive skin, Stein advises.

If your skin is acne-prone, make sure the cleanser you use is oil-free and noncomedogenic, which means it does not promote acne. People whose skin is on the dry side should follow up each wash by applying a layer of lotion (preferably one that contains sunscreen) to seal in the skin's moisture.

6. Scrub Your Skin

Washing your face is a good idea. Scrubbing it isn't.

"Scrubbing can be very irritating to the skin," cautions Stein. "A lot of times people who have acne will feel like they have to scrub the skin to make it better, but that can actually worsen the acne."

Be gentle to your skin. Wash your face using a soft, circular motion using your fingertips.

7. Pop Your Pimples

Whenever you feel tempted to pop a pimple, control the urge. "Picking will make the acne worse and lead to permanent scarring," Stein says. "Better to leave it alone."

Instead of popping pimples, try an over-the-counter pimple remedy containing benzoyl peroxide or salicylic acid. If that doesn't clear up your breakouts, call your dermatologist. If you use a magnifying mirror, give it to your worst enemy.

8. Stress Out

It's not your imagination. When you're stressed out, it really does show in your skin.

"It's not well understood, but it's clear that stress makes many skin conditions worse," Dover says.

Stress can flare up psoriasis and rosacea, as well as acne. It may also lower the skin's ability to keep out harmful irritants and infections. Plus, people who are wrapped up in their stress have less time to care for their skin properly.

9. Overdo It

Looking young and vibrant is highly prized, but the quest for it can have a price, especially if you trust your chemical peel to someone without an MD after his or her name. "I think they should be done under the guidance of a doctor because they can certainly be very irritating, particularly to sensitive skin or people who have skin conditions," Stein says. In the wrong hands, a chemical peel could leave you with an infection or permanent scars.

You also don't want to overdo home microdermabrasion and peels. Instead of making you look younger, they'll leave your skin red and irritated. Let your dermatologist guide you if you are going to try at-home skin procedures.

10. Overeat

Before you take another bite of that bacon double cheeseburger, consider this: When you gain a lot of weight, your skin has to stretch to accommodate your new girth. Lose the weight and you'll be left with flabby, saggy skin. If your skin isn't elastic enough to bounce back, you may have to resort to surgery to tighten it up.

11. Fall Short on Sleep

More than a quarter of us aren't getting the seven to nine hours of sleep we need nightly, and our exhaustion is as obvious as the pallor of our skin and the bags under our eyes.

"Your skin rejuvenates while you're sleeping," Dover says. He warns that a lack of sleep makes your face look "dull and listless" and can exaggerate the appearance of dark circles.

12. Ignore Warning Signs

A changing mole is one of the clearest signs of skin cancer. Spotting it early gives your doctor a chance to treat it before it has time to spread. But how will you ever know a mole is changing if you never look at your skin?

Once a month, you should be checking your skin from top to bottom, front to back in a full-length mirror. "You're looking for changes in the size, shape, and color of moles, or new moles," Dover says. If you spot anything, or if you've got a personal or family history of skin cancer, let your dermatologist do a full exam as well, Stein says.

Pilihan Makanan Sehat untuk Menambah Berat Badan

Jika Anda ingin menambah berat badan, faktor terpenting yang harus Anda pertimbangkan adalah pola diet dengan nutrisi yang mencukupi. Latihan beban tetap merupakan rutinitas yang harus Anda lakukan, tetapi pastikan tubuh Anda mendapatkan makanan dengan nutrisi terbaik untuk membantu pemeliharaan dan pertumbuhan tubuh.
Panduan Pilihan Makanan dengan Nutrisi Seimbang
Untuk menambah berat badan, maka Anda harus mengkonsumsi makanan dengan kandungan nutrisi seimbang, yaitu yang mengandung protein tinggi, karbohidrat tinggi, dan lemak sehat. Berikut ini adalah tabel pilihan makanan sebagai panduan Anda dalam memilih makanan terbaik untuk menambah berat badan secara optimal.
Sumber Protein
- Sumber protein yang superior:

• Ikan: tuna, salmon, herring, cod. sarden, makarel, ikan forel. Hindari ikan kalengan
• Produk susu: Whey

- Sumber protein yang baik:

• Produk Susu: yogurt rendah lemak, keju cottage, kefir, keju mozarela, susu rendah lemak
• Daging dan Unggas: daging sapi tanpa lemak, ayam (tanpa kulit), kalkun

Sumber Karbohidrat
- Sumber karbohidrat yang superior:

• Buah: alpukat, mangga, apel, jeruk, chery, pir, strawberry, kiwi, lemon, angur, nanas, papaya, semangka, melon, aprikot
• Padi-padian: roti gandum, pasta gandum, cracker gandum, beras merah, quinoa, popcorn, granola
• Sayuran: brokoli, wortel, barley, kol, asparagus, bayam, tomat, labu, bawang, mentimun, dll

- Sumber karbohidrat yang baik:

• Buah: buah kering (untuk snack), anggur, pisang
• Pemanis: fruktosa, molasses, madu

Sumber Lemak
- Sumber lemak sehat yang superior:

• Ikan: salmon, herring, sarden, makarel
• Minyak: minyak dari saripati kacang,, minyak zaitun, safflower, minyak bunga matahari
• Biji-bijian dan kacang-kacangan: kacang mete, hazelnut, almon, kwaci dari biji melon dan bunga matahari

- Sumber lemak sehat yang baik:

• Produk susu: susu rendah lemak

Hardgainer terkadang kesulitan untuk mengkonsumsi lebih banyak makanan. Kurangi porsi makan Anda, dan pisahkan ke dalam 6 porsi kecil agar tubuh Anda terjaga tetap kenyang sepanjang hari. Yang terpenting adalah semua nutrisi yang Anda butuhkan terpenuhi.
Carilah resep yang tepat agar Anda dapat mengkombinasikan semua jenis makanan ini untuk membantu menambah berat badan dengan lebih mudah dan sehat. Selamat mencoba!

Cholesterol and Drugs

How can high cholesterol be controlled?

High cholesterol affects many people throughout the world. High cholesterol levels can greatly increase the risk of heart disease, including potentially fatal heart attacks. Exercise, weight loss, and a diet low in cholesterol and saturated fats can help lower cholesterol levels. However, when these measures fail, cholesterol-lowering medications are usually needed. In this slideshow we'll discuss cholesterol basics, and review the classes of drugs prescribed to lower cholesterol.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that your body needs to function normally. The cholesterol in a person's blood originates from two major sources; the diet and the liver. Dietary cholesterol comes primarily from meat, poultry, fish, and dairy products. Cholesterol is naturally present in cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart. Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess may be deposited in arteries, including the coronary (heart) arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.

 

What are LDL cholesterol, HDL cholesterol, and triglycerides?

Cholesterol is carried in the blood as particles of differing sizes and densities along with lipoproteins, proteins that associate with cholesterol. Cholesterol carried in particles of low density (LDL cholesterol) is referred to as the "bad" cholesterol because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick, substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the arterial walls and narrowing of the arteries, a process called atherosclerosis.

Cholesterol carried in particles of high density (HDL cholesterol) is referred to as the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the arterial walls and disposing of it through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high levels of HDL cholesterol (low LDL/HDL ratios) are desirable.

Triglyceride is a fatty substance composed of three fatty acids. Like cholesterol, triglyceride in the blood comes from the diet or liver.

What types of cholesterol drugs are available?

Medications can be used to lower blood levels of undesirable lipids such as LDL cholesterol and triglycerides, and increase blood levels of desirable lipids such as HDL cholesterol. Several classes of medications are available in the United States, including statins (HMG CoA reductase inhibitors), nicotinic acid (niacin), fibric acid derivatives (fibrates), bile acid sequestrants, and cholesterol absorption inhibitors. Some of these medications can also be combined to more aggressively lower LDL, as well as lower LDL and increase HDL cholesterol levels at the same time.

What are statins?

Statins are a class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that controls the production of cholesterol. Most patients are placed on statins because of high levels of cholesterol; however, statins are also used for preventing and treating atherosclerosis that causes chest pain, heart attacks, strokes, and intermittent claudication in individuals who have or are at risk for atherosclerosis.

Risk factors for atherosclerosis include:

• abnormally elevated cholesterol levels,
• a family history of heart attacks (particularly at a young age),
• increasing age,
• diabetes, and
• high blood pressure.

The next several slides are examples of statins currently prescribed to lower cholesterol.

atorvastatin (Lipitor)

Drug Class: Statins
Prescription: Yes
Generic: No
Preparations: Tablets of 10, 20, 40, and 80 mg.

Prescribed for: Atorvastatin (Lipitor) is used for the treatment of elevated total cholesterol, LDL, triglycerides, and to elevate HDL cholesterol. The effectiveness of atorvastatin (Lipitor) in lowering cholesterol is dose-related, meaning that higher doses reduce cholesterol more.

Side effects: Atorvastatin (Lipitor) is generally well-tolerated. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin (Lipitor) may cause liver and muscle damage.

rosuvastatin (Crestor)

Drug Class: Statins
Prescription: Yes
Generic: No
Preparations: Tablets of 5, 10, 20, and 40 mg.

Prescribed for: Rosuvastatin (Crestor) is used for the reduction of blood total cholesterol, LDL cholesterol and triglyceride levels, and to increase HDL cholesterol levels.

Side effects: The most common side effects of rosuvastatin (Crestor) are headache, nausea, vomiting, diarrhea, and muscle pain. The most serious side effects are liver failure, muscle breakdown (rhabdomyolysis) and kidney failure

simvastatin (Zocor)

Drug Class: Statins
Prescription: Yes
Generic: Yes
Preparations: Tablets of 5, 10, 20, 40, and 80 mg.

Prescribed for: Simvastatin (Zocor) is used for reducing total cholesterol, LDL cholesterol, and triglycerides, and for increasing HDL cholesterol. In patients with coronary heart disease, diabetes, peripheral vessel disease, or history of stroke or other cerebrovascular disease.

Side effects: The most common side effects of simvastatin (Zocor) are headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain, and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown.

pravastatin (Pravachol)

Drug Class: Statins
Prescription: Yes
Generic: Yes
Preparations: Tablets of 10, 20, 40, and 80 mg.

Prescribed for: Pravastatin (Pravachol) is used for the reduction of total and LDL cholesterol as well as triglycerides, and to increase HDL cholesterol. It has been suggested that pravastatin may reduce the occurrence of heart attacks, strokes, and death caused by coronary artery disease.

Side Effects: The most common side effects of pravastatin (Pravachol) are headache, nausea, vomiting, diarrhea, muscle pain, and abnormal liver tests. The most serious potential side effects are liver damage and muscle inflammation or breakdown.

lovastatin (Mevacor)

Drug Class: Statins
Prescription: Yes
Generic: Yes
Preparations: Tablets of 10, 20, and 40 mg.

Prescribed for: Lovastatin (Mevacor) is used to treat high LDL cholesterol. Effectiveness of the medication in lowering cholesterol is dose-related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made. A reduction in LDL cholesterol level can be seen two weeks after starting therapy.

Side Effects: Side effects of lovastatin (Mevacor) are rare. Minor side effects include constipation, diarrhea, gas, heartburn, headache, and insomnia. Major side effects include abdominal pain or cramps, blurred vision, dizziness, itching, muscle pain or cramps, rash, or yellowing of the skin or eyes

fluvastatin (Lescol)

Drug Class: Statins
Prescription: Yes
Generic: No
Preparations: Tablets of 20 and 40 mg.

Prescribed for: Fluvastatin (Lescol) is used to treat high LDL cholesterol. Effectiveness of the medication in lowering cholesterol is dose-related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made.

Side effects: Side effects of fluvastatin (Lescol) are rare. Minor side effects include constipation, diarrhea, gas, heartburn, headache, and insomnia. Major side effects include abdominal pain or cramps, blurred vision, dizziness, itching, muscle pain or cramps, rash, or yellowing of the skin or eyes.

What are fibric acid derivatives (fibrates)?

Fibrates are effective medications that lower blood triglyceride levels. Fibrates lower blood triglyceride levels by inhibiting production in the liver of VLDL (particles in the blood that carry triglycerides and lipoproteins), and by speeding up the removal of triglycerides from the blood.

Fibrates also are modestly effective in increasing blood HDL cholesterol levels; however, fibrates are not effective in lowering LDL cholesterol. Doctors may consider combining a fibrate with a statin. Such a combination will not only lower the LDL cholesterol, but will also lower blood triglycerides and increase HDL cholesterol levels.

Fibrates also have been used alone to prevent heart attacks in patients with elevated blood triglycerides and low HDL cholesterol levels.

fenofibrate (Tricor)

Drug Class: Fibrates
Prescription: Yes
Generic: No
Preparations: Tablets of 48 and 145 mg.

Prescribed for: Fenofibrate (Tricor) is used along with a non-drug program (including diet changes) to treat elevated cholesterol and triglyceride levels.

Side effects: Common side effects of fenofibrate (Tricor) include upset stomach, constipation, headache, dizziness or trouble sleeping. Muscle damage may occur, and muscle pain, tenderness, weakness and fever should be reported promptly to the responsible physician. Decreased sexual drive, yellowing of the eyes or skin (jaundice), and stomach pain may occur and also should be reported.

gemfibrozil (Lopid)

Drug Class: Fibrates
Prescription: Yes
Generic: No
Preparations: Tablet of 600 mg.

Prescribed for: Gemfibrozil (Lopid) is used for persons with either low HDL cholesterol and/or high triglyceride concentrations to reduce the risk of heart attacks. It also is used in persons with very high triglyceride levels that may cause pancreatitis (inflammation of the pancreas).

Side effects: Side effects of gemfibrozil (Lopid) include upset stomach (1 in 5 patients), diarrhea (1 in 14 patients), tiredness (1 in 30 patients) and nausea or vomiting (1 in 40 patients). Additional patients may experience dizziness, tiredness, tingling in the extremities, headache, decreased sexual drive, impotence, depression, or blurred vision. Less common side effects are muscle aches, pains, weakness or tenderness.

What are bile acid sequestrants?

Bile acid sequestrants bind bile acids in the intestine and cause more of the bile acids to be excreted in the stool. This reduces the amount of bile acids returning to the liver and forces the liver to produce more bile acids to replace the bile acids lost in the stool. In order to produce more bile acids, the liver converts more cholesterol into bile acids, which lowers the level of cholesterol in the blood.

Bile acid sequestrants have modest LDL cholesterol-lowering effects. However, bile acid sequestrants are most useful in combination with a statin or niacin to aggressively lower LDL cholesterol levels. The statin-bile acid sequestrant combination can lower LDL cholesterol levels by approximately 50%, lower than a statin alone. A statin-niacin combination also can substantially elevate HDL cholesterol.

colesevelam (Welchol)

Drug Class: Bile acid sequestrants
Prescription: Yes
Generic: No
Preparations: Tablet of 625 mg.

Prescribed for: Colesevelam (Welchol) is used to treat high blood cholesterol levels, especially high levels of LDL cholesterol. It does not lower cholesterol as much as the statin class of drugs, but when used in combination with a statin, it lowers cholesterol levels further than the statin alone.

Colesevelam (Welchol) also is used in combination with other drugs for treating type 2 diabetes such as metformin (Glucophage), sulfonylureas, or insulin to further lower blood sugar levels.

Side effects: Colesevelam (Welchol) usually is well-tolerated. Patients may experience constipation, upset stomach, indigestion, headache, stomach pain, or diarrhea.

colestipol (Colestid)

Drug Class: Bile acid sequestrants
Prescription: Yes
Generic: No
Preparations: Tablet of 1 gm. Granules in 5gm packets or bulk.

Prescribed for: Colestipol (Colestid) is used for the treatment of high cholesterol in conjunction with dietary control; for the treatment of diarrhea due to increased intestinal bile acids after some types of surgery; for the treatment of itching associated with partial obstruction to the flow of bile due to liver disease.

Side effects: Side effects of colestipol (Colestid) include constipation, stomach upset, heartburn, belching, gas, nausea, loss of appetite, aggravated hemorrhoids, change of taste, headache, or itching. If patients experience unusual bruising or bleeding, severe stomach aches, or vomiting they should notify their physicians.

cholestyramine (Questran)

Drug Class: Bile acid sequestrants
Prescription: Yes
Generic: Yes
Preparations: Powder

Prescribed for: Cholestyramine (Questran) is used for reducing cholesterol levels in the blood, to relieve the itching of liver and biliary disease, and to treat overdoses of digoxin or thyroid hormone.

Side effects: The most common side effects are constipation, abdominal pain, bloating, vomiting, diarrhea, weight loss, and excessive passage of gas (flatulence). Long-term use of cholestyramine may cause a deficiency of vitamins A, D, E, and K.

What is nicotinic acid (vitamin B3 or niacin)?

Nicotinic acid (vitamin B3 or niacin) is a B vitamin. An average American diet contains 15-30 mg of niacin per day. However, in treating blood cholesterol and triglyceride disorders, high doses (1-3 grams a day) of nicotinic acid are necessary. Nicotinic acid is available in several preparations. Prescription nicotinic acid includes immediate release niacin or sustained release niacin. Over-the-counter (OTC) nicotinic acid is available as sustained release niacin. OTC preparations are not federally regulated, and some OTC preparations may have no active ingredient and are ineffective in lowering LDL or raising HDL cholesterol.

Nicotinic acid is most effective in increasing HDL cholesterol, and modestly effective in lowering LDL cholesterol and triglyceride levels. Used alone, it can raise HDL cholesterol levels by 30% or more. However, it is not as effective as a statin in lowering LDL cholesterol

niacin, nicotinic acid, vitamin B3
(Niacor, Niaspan, Slo-Niacin)

Prescription: Yes and over-the-counter (OTC)
Generic: Yes
Preparations: Tablets of 50, 100, 250, 500 and 750 mg. Capsules of 125, 250, 400, 500, 750 and 1000 mg.

Prescribed for: Nicotinic acid (vitamin B3 or niacin) is used for treating niacin deficiency and elevated blood cholesterol and/or triglyceride levels and for increasing HDL cholesterol.

Side effects: The most common side effects of nicotinic acid (vitamin B3 or niacin) are stomach upset, flushing, headache, itching and tingling sensations of the extremities. Rare cases of liver failure or muscle injury have occurred from the use of nicotinic acid.

What are cholesterol absorption inhibitors?

This relatively new class of cholesterol-lowering medication works by preventing the absorption of cholesterol from the intestine. Selective cholesterol absorption inhibitors are most effective at lowering the LDL (bad) cholesterol but may also have modest effects on lowering triglycerides (blood fats), and raising HDL (good) cholesterol.

ezetimibe (Zetia)

Drug Class: Cholesterol absorption inhibitors
Prescription: Yes
Generic: No
Preparations: Tablets of 10 mg.

Prescribed for: Ezetimibe (Zetia) lowers blood cholesterol by reducing the absorption of cholesterol from the intestine. Used in combination with statins, it reduces levels of total cholesterol, LDL cholesterol, and triglycerides. It also may raise HDL cholesterol. Combining ezetimibe with a statin is more effective than either drug alone.

Side effects: Ezetimibe (Zetia) usually is well-tolerated. Diarrhea, abdominal pain, back pain, joint pain, and sinusitis were the most commonly reported side effects, occurring in one in every 25 to 30 patients. Hypersensitivity reactions, including angioedema (swelling of the skin and underlying tissues of the head and neck that can be life-threatening) and skin rash occur rarely. Nausea, pancreatitis, muscle damage (myopathy or rhabdomyolysis), and hepatitis have been reported.

Combining drugs to fight high cholesterol.

As noted on the previous slides, some medications are primarily useful in lowering LDL cholesterol, others in lowering triglycerides, and some in elevating HDL cholesterol. Doctors may also prescribe two medications from two different drug classes to more aggressively lower LDL, as well as increase HDL cholesterol levels at the same time.

ezetimibe/simvastatin (Vytorin)

Prescription: Yes
Generic: No
Preparations: Tablets of 10/10, 10/20, 10/40, 10/80 mg. (ezetimibe/simvastatin)

Prescribed for: Ezetimibe/simvastatin (Vytorin) is a combination of ezetimibe (Zetia) and simvastatin (Zocor) that is used for treating high levels of cholesterol in the blood. Vytorin reduces total cholesterol and LDL cholesterol while it increases HDL cholesterol.

Side effects: The most common side effects of ezetimibe/simvastatin (Vytorin) are headache, nausea, vomiting, diarrhea, muscle pain, and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown.

niacin and lovastatin (Advicor)

Prescription: Yes
Generic: No
Preparations: Tablet of 500/20 and 1000/20 mg (niacin/lovastatin).

Prescribed for: Niacin and lovastatin (Advicor) is used for treating elevated blood levels of total cholesterol, LDL cholesterol, and triglycerides, and for raising low levels of HDL cholesterol.

Side effects: Please refer to the individual slides for niacin and lovastatin.

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holesterol-altering drugs overview

This chart provides a textual overview of the various cholesterol drugs discussed in this slideshow. It lists each of the medication classes, examples within each class, and their areas of beneficial effectiveness.