21.4 Cholesterol Absorption Inhibitors
Learning Outcomes
By the end of this section, you should be able to:
- 21.4.1 Identify the characteristics of cholesterol absorption inhibitor drugs used to lower lipid levels.
- 21.4.2 Explain the indications, action, adverse reactions, and interactions of cholesterol absorption inhibitor drugs used to lower lipid levels.
- 21.4.3 Describe nursing implications of cholesterol absorption inhibitor drugs used to lower lipid levels.
- 21.4.4 Explain the client education related to cholesterol absorption inhibitor drugs used to lower lipid levels.
Ezetimibe is a cholesterol absorption inhibitor. It works by inhibiting the cholesterol transporter called Niemann-Pick C1-Like 1 (NPC1L1). It lowers LDL-cholesterol levels by 13%–20% (Grundy et al., 2019).
Cholesterol Absorption Inhibitor: Ezetimibe
One cholesterol absorption inhibitor will be discussed: ezetimibe. Table 21.9 is a drug prototype table for cholesterol absorption inhibitors featuring ezetimibe. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
|
Drug Class Cholesterol absorption inhibitor Mechanism of Action Inhibits the Niemann-Pick C1-Like 1 cholesterol transporter, which is responsible for absorption of cholesterol in the small intestine |
Drug Dosage 10 mg orally once daily. |
| Indications Primary hypercholesterolemia Homozygous familial hypercholesterolemia Homozygous sitosterolemia Therapeutic Effects Lowers LDL-cholesterol levels |
Drug Interactions Cyclosporine Fenofibrate/fibrates Cholestyramine Food Interactions No significant interactions |
| Adverse Effects Upper respiratory tract infection Diarrhea Arthralgia Sinusitis Pain in extremities Angioedema |
Contraindications Active liver disease, including unexplained persistent elevations in hepatic transaminase levels Pregnancy or possible pregnancy Lactation Known hypersensitivity to product components Caution: Not recommended in clients with moderate or severe hepatic impairment Monitor liver enzyme levels when taken with a statin Skeletal muscle effects (e.g., myopathy and rhabdomyolysis) have been reported |
Safety Alert
Ezetimibe
Ezetimibe is available as a single-drug tablet with the brand name Zetia. It is also one of the drugs included in the combination product sold under the brand name Vytorin, which contains both ezetimibe and simvastatin. Nurses should be careful to avoid confusing the single drug and the combination products.
Adverse Effects and Contraindications
The most significant adverse events associated with ezetimibe are liver enzyme abnormalities, myopathy, and rhabdomyolysis, especially when the drug is combined with statin medications. Another adverse effect is diarrhea.
Ezetimibe should not be used in clients with active liver disease or unexplained elevations in transaminase levels, those who are pregnant or breastfeeding, or those with hypersensitivity to the drug or any of its product components.
Nursing Implications
The nurse should do the following for clients taking ezetimibe:
- Monitor hepatic transaminase levels (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]).
- Monitor for adverse events such as liver toxicity and diarrhea.
- Monitor for muscle-related adverse events, especially when the drug is used in combination with statins.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking ezetimibe should:
- Take the medication daily, taking no more than one dose per day.
- Refrain from taking the medication when pregnant.
- Notify their health care provider about any muscle pain or weakness.
- Report any adverse events to their health care provider.