Reasons For High Cholesterol

Beat Cholesterol in 30 Days

Scott Davis is an Australian writer, medical researcher, alternative health expert and former cholesterol sufferer, whose cholesterol was once over 300. He did everything that his doctor told him to, but his cholesterol didnt go down. When his doctor told him that he would need surgery if it didnt come down he went on a mission to write the Beat Cholesterol ebook. Some of Davis' suggestions are lesser-known herbal remedies for high cholesterol: the most ubiquitous, of course, is the author's suggestion to buy red yeast rice. Red yeast rice is in fact a natural source of monocolin K, known in medical circles as lovastatin. In fact, the prescription version of lovastatin is nothing more than a concentrate of monocolin K. Davis' ability to collect such an astounding array of oftentimes obscure information and arrange it in a way that is easy for people of all ages to follow and apply to their lives immediately is itself quite an achievement. More here...

Natural Cholesterol Guide Summary


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Bile Acid Sequestrants

Cholestyramine (Questran) and colestipol (Colestid) are examples of bile acid sequestrants. Bile, which is manufactured and secreted by the liver and stored in the gallbladder, emulsifies fat and lipids as these products pass through the intestine. Once emulsified, fats and lipids are readily absorbed in the intestine. These drugs bind to bile acids to form an insoluble substance that cannot be absorbed by the intestine, so it is secreted in the feces. With increased loss of bile acids, the liver uses cholesterol to manufacture more bile. This is followed by a decrease in cholesterol levels.

Cholestyramine and other lipid reducers

Cholestyramine is an anion-cxchange resin which is not absorbed systemically. It binds bile acids, producing an insoluble complex which is excreted in the stool. This leads to a reduction of cholesterol and the low-density (LD) lipoproteins in the serum. Cholestyramine is used in pregnancy for the treatment of obstetric cholestasis to relieve the itching. Ursodeoxycholic acid is, however, more effective than cholestyramine in intrahepatic cholestasis of pregnancy (see ursodeoxycholic acid Kondrackiene 2005). There is at least a theoretical risk for the fetus because, in addition to bile acids, cholestyramine also binds other lipophile substances - such as fat-soluble vitamins and medications. One case report concerning the gestational use of cholestyramine has described severe intracranial hemorrhage in a fetus vitamin K deficiency was suspected (Sadler 1995). Recommendation. Cholestyramine - and, as a second choice, colestipol -may be used for intrahepatic cholestasis of pregnancy or...

Long Term Effects Drug abuse

The claimed body-building effect of the so-called anabolic compounds reflects their ability to promote muscular development, even beyond physiological limits, and this can bring with it cardiovascular complications. Surreptitious misuse by athletes remains a recurrent problem in professional sport (50) apart from the cardiovascular risks, one observes numerous physiological changes, including effects on plasma levels of enzymes, minerals and vitamins and reduced concentrations of HDL cholesterol (51).

General Information

Weight for weight, cerivastatin is the most potent statin. Like other statins, the chance of rhabdomyolysis increases when cerivastatin is taken together with certain other drugs (1). Although cerivastatin is degraded by two different isoforms of P450 in the liver, and therefore should be less likely to take part in drug interactions than most of the other statins, clinically important interactions do occur, and reports of drug interactions in 2001 triggered its withdrawal, after 31 people in the USA taking ceriva-statin, 12 of whom had also taken gemfibrozil, died of severe rhabdomyolysis (2). In other respects, the adverse effects of cerivastatin are similar to those of other statins (3), and a pooled analysis of studies of cerivastatin 100-400 micrograms day taken for at least 8 weeks showed no differences in drug-related adverse events between cerivastatin and placebo (4). There was no association between plasma transaminase or creatine kinase activities and cerivastatin dosages....

Vitamin B15 And Dimethylglycine

Effects Prevents oxygen deprivation in the body's tissues, while reducing oxidation within cells. The active ingredient is dimethylglycine (DMG), a metabolic brain enhancer said to detoxify the body, lower cholesterol, and protect the liver. Its advocates contend that DMG increases energy, endurance, and strength (mainly by reducing the lactic acid in the muscles), improves the immune system (mainly be creating phosphocreatine, which also helps the muscles contract), and maximizes blood transport from the blood to the heart and brain.

Pharmacokinetic Effects

Absorption of TCAs can be inhibited by cholestyramine, which therefore must be given at different time intervals than the antidepressants. Specific substances reported to increase TCA levels include fluoxetine, antipsychotic medications, methylphenidate, and cimetidine. Methylphenidate has been combined with desipramine to treat attention deficits and depression in children. The combination therapy had a higher incidence of ECG changes (particularly higher ventricular rates), nausea, dry mouth, and tremor. Enzyme inducers that can lower tricyclic agent levels include phenobarbital and carbamazepine. The nicotine from cigarettes can also induce enzyme activity.

Organs and Systems Cardiovascular

Estrogens have both wanted and unwanted effects on the cardiovascular system, depending on the manner in which they are used. Hormone replacement therapy is used in the hope of reducing the risk of ischemic heart disease after the menopause. The reduction in risk may be as much as 50 and is attributed variously to vasodilatation mediated by the endothelial production of prostaglandin I2 (prostacyclin), effects on coagulation factors and endothelial function, and improvements in serum lipids (increased concentrations of HDL cholesterol and reduced concentrations of LDL and total cholesterol) (11), but variable effects on triglycerides. However, estrogens (especially as used in contraception but also post-menopausally) can have a marked effect on clotting factors and renin substrate, increasing the risk of thromboembolism.

HMGCoA Reductase Inhibitors

Another group of antihyperlipidemic drugs are called HMG-CoA reductase inhibitors. HMG-CoA (3-hydroxy-3-methyglutaryl coenzyme A) reductase is an enzyme that is a catalyst (a substance that accelerates a chemical reaction without itself undergoing a change) in the manufacture of cholesterol. These drugs appear to have one of two activities, namely, inhibiting the manufacture of cholesterol or promoting the breakdown of cholesterol. This drug activity lowers the blood levels of cholesterol and serum triglycerides and increases blood levels of HDLs. Examples of these drugs are fluvastatin (Lescol), lovastatin (Mevacor), and simvastatin (Zocor).

Preadministration Assessment

In many individuals, hyperlipidemia has no symptoms and the disorder is not discovered until laboratory tests reveal elevated cholesterol and triglyceride levels, elevated LDL levels, and decreased HDL levels. Often, these drugs are initially prescribed on an outpatient basis, but initial administration may occur in the hospitalized patient. Serum cholesterol levels (ie, a lipid profile) and liver functions tests are obtained before the drugs are administered.

Promoting an Optimal Response to Therapy

Bile acid sequestrants may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. When the bile acid sequestrants are used for long-term therapy, vitamins A and D may be given in a water-soluble form or administered parenterally. If bleeding tendencies occur as the result of vitamin K deficiency, parenteral vitamin K is administered for immediate treatment, and oral vitamin K is given for prevention of a deficiency in the future.

Drug Administration Drug formulations

Once-daily administration of modified-release formulation of fluvastatin 80-320 mg day was generally safe and well tolerated in 40 patients with primary hypercholesterolemia over 13 days (7). However, fluvastatin 640 mg in this formulation was not well tolerated six of seven patients had adverse events, including diarrhea, headache, and rises in serum transaminases. In addition, the pharmacokinetics of fluvastatin were non-linear at this dose, possibly because of saturation of first-pass metabolism, causing higher than expected serum drug concentrations.

Pregnancy Category None

Intoxicated persons can be unaware of what they are doing and unaware of what is going on around them, additional hazards on top of the drug's sometimes dangerous physical effects. As with other substances accidental dosage can occur. Cases are documented of agricultural workers and gardeners being affected by apparently rubbing their eyes after contact with jimson weed or other datura plants a case report also exists of absorption through the skin. Contamination of food is known, and unsuspecting persons have used wine and honey made from the plants. Rats on a 90-day diet including jimson weed seed experienced lower cholesterol levels, less weight gain, and increased weight of livers. Investigators running the experiment described the consequences of chronic jimson weed seed diet as undesirable, but of course humans do not eat the seeds as a regular food. In this experiment female rats were more affected by jimson weed than males. Jimson seed meal has also been found to harm...

Long Term Effects Tumorigenicity

It has been suspected that low concentrations of serum cholesterol might be associated with an increased risk of cancer or overall mortality. All fibrates and statins cause cancer in rodents, but the relevance of this finding to man has been questioned (47). In an epidemiological study these risks were almost non-existent after adjusting for confounding factors. However, in the CARE study, breast cancer occurred in one patient in the control group and 12 in the pravastatin group (48). The incidence of cancers,

Observational studies

A Japanese study of the use of estriol 2 mg day for 12 months in 68 postmenopausal women with climacteric symptoms showed a significant effect in relieving hot flushes, night sweats, and insomnia (8,9). There were significant falls in serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations, but no effect on lipids, bone demineralization, or blood pressure. There was slight vaginal bleeding in 14 of women treated during a natural menopause, but histological and ultrasound evaluation showed no changes in the endometrium or breasts. It is evident, however, that higher doses might be needed when treating women of other races with a higher body weight. Other workers have found that when given with a progestogen over long periods, estriol 2.0 mg day seems much less likely to cause undesirable lipid changes than are equine conjugated estrogens, which can cause increased HDL cholesterol and triglyceride concentrations (10).

Other DrugSt Johns Wort Interactions

Sugimoto et al. reported interactions of St. John's wort with cholesterol-lowering drugs simvastatin and pravastatin. In a double blind crossover study using 16 healthy male volunteers, the authors demonstrated that use of St. John's wort (900mg day) for 14 days decreased peak serum concentration of simvastatin hydroxyl acid, the active metabolite of simvastatin, from an average of 2.3 ng mL in the placebo group to 1.1 ng mL in the group taking St. John's wort. The AUC was also reduced in the group of volunteers taking St. John's wort compared to the placebo group. Simvastatin is extensively metabolized by CYP3A4 in the intestinal wall and liver, and St. John's wort induces this enzyme. On the other hand, St. John's wort did not influence plasma pravastatin concentration (53). St. John's wort also induces both CYP3A4-catalyzed sulfoxidation and 2C19-dependent hydroxylation of omeprazole. In a study involving 12 healthy adult men, a group of volunteers received St. John's wort (900 mg...

Interaction Of Garlic Allium Sativum With Drugs

Garlic is widely used as a herbal supplement promoted to lower cholesterol and blood pressure. Garlic is rich in the sulfur-containing compounds allicin and alliin. Piscitelli et al. studied the effect of garlic on pharmacokinetics of saquinavir, a protease inhibitor, with 10 health volunteers. In the presence of garlic, the mean saquinavir AUC during 8-h dosing interval decreased by 51 , and trough serum concentration 8h after dosing reduced by 54 . After a 10-day washout period, the AUC and trough serum concentrations returned to 60-70 of the baseline values. The altered pharmacokinetics of saquinavir were considered to be related to decreased bioavailability of saquinavir (73). This may be due to inhibition of P-glycoprotein pump in the gut mucosa by garlic. Although interaction between warfarin and garlic has been reported, Macan et al. (74) recently reported that aged garlic extract may not have any interaction with warfarin.

Novel Uses for RXRActive Compounds

Another interesting application for RXR-selective agents may be in the treatment of hypercholesterolemia. Mangelsdorf and colleagues have recently discovered that the RXR agonist LG100268, acting through RXR LXR heterodimeric complexes, transcriptionally induces the expression of the gene encoding the ABCl protein, which mediates reverse cholesterol transport (240). In intestinal cells, this protein transports cholesterol into the lumen of the intestine, effectively reducing cholesterol uptake by the cell and ultimately lowering blood cholesterol levels. In the case of agonists, this effect is amplified because RXR agonists (rexinoids) also decrease bile acid secretion through the activation of RXRFXR heterodimeric complexes (243,244) (Table 7.4). Because bile acids are important vehicles for cholesterol dissolution and gener- ally promote cholesterol absorption in the gut, the effect of RXR-mediated induction of ABCl expression has an even more dramatic effect on serum cholesterol...

Grapefruit Juice and Drug Interactions

Grapefruit juice increases bioavailability of several benzodiazepines including diazepam, triazolam and midazolam but has no effect on alprazolam even after repeated intake (101). Ozdemir et al. (119) reported a threefold increases in AUC of diazepam due to intake of grapefruit juice. Grapefruit juice also interacts with cholesterol lowering drugs. Simvastatin, a substrate for CYP3A4, is extensively metabolized during first pass. Grapefruit juice (200 ml once a day for 3 days) increased the AUC (0-24 h) of simvastatin by 3.6-fold and simvastatin acid by 3.3-fold. The peak concentrations were also increased significantly, and only one glass of grapefruit juice taken daily is capable of producing such effects (120). On the other hand, when subjects ingested double strength grapefruit juice three times a day (200 ml) for 3 days, the peak serum concentrations and the AUC were increased by 12.0-fold and 13.5-fold respectively compared to the control. When simvastatin was taken 24 h after...

Pregnancy Category X

A case report mentions that a person using the hormone along with the anticholesterol medicine clofibrate developed extremely low levels of high-density lipoprotein (the so-called good cholesterol), a development attributed to methyltestosterone. A similar result occurred in an experiment tracking women using this anabolic steroid along with female hormones called esterified estrogens. Methyltestosterone interferes with blood clotting, which can be a serious problem for persons taking anticlotting medicine. A case report indicates that the substance interacts badly with cyclosporine, an immunosuppressive agent used to fight rejection of organ transplants. A small experiment using methyltestosterone to increase benefits from the tricyclic an-tidepressant imipramine went awry when almost all patients became paranoid, a condition that rapidly disappeared when methyltestosterone dosage stopped.

Educating the Patient and Family

The nurse stresses the importance of following the diet recommended by the primary health care provider because drug therapy alone will not significantly lower cholesterol and triglyceride levels. The nurse provides a copy of the recommended diet and reviews the contents of the diet with the patient and family. If necessary, the Using Diet and Drugs to Control High Blood Cholesterol Levels Emphasizes that drug therapy alone will not significantly lower blood cholesterol levels. nurse refers the patient or family member to a teaching dietitian, a dietary teaching session, or a lecture provided by a hospital or community agency (see Patient and Family Teaching Checklist Using Diet and Drugs to Control High Blood Cholesterol Levels). The nurse develops a teaching plan to include the following information BILE ACID SEQUESTRANTS Cholestyramine powder The prescribed dose must be mixed in 4 to 6 fluid ounces of water or noncar-bonated beverage and shaken vigorously. The powder can also be...

Critical Thinking Exercises

A patient in the medical clinic is taking cholestyramine (Questran) for hyperlipidemia. The primary health care provider has prescribed TLC for the patient. The patient is on a low-fat diet and walks daily for exercise. His major complaint at this visit is constipation, which is very bothersome to him. Discuss how you would approach this situation with the patient. What information would you give the patient concerning his constipation 2. Discuss the important points to include in a teaching plan for a patient who is prescribed atorvastatin (Lipitor).

Comparative studies

That the adverse events profile of sirolimus is different from that of ciclosporin has been further suggested in 83 patients taking primary immunosuppressant regimens containing sirolimus (41 patients) or ciclosporin (42 patients) (3). Arthralgia (20 ), hypercholesterolemia (44 ), hypertriglyceridemia (51 ), leukopenia (39 ), thrombocytopenia (37 ), and pneumonia (17 ) were significantly more frequent in patients taking sirolimus, particularly during the first 2 months of treatment, that is until sirolimus trough concentrations were carefully monitored. Serum creatinine concentrations were lower in the sirolimus group, confirming that sirolimus probably has no direct nephrotoxic effect.

Congestive Heart Failure

A number of adverse reactions can occur such as dehydration this is a common risk in the use of all diuretics especially in the elderly patients. Other effects include hypokalemia (usually mild), hyperuricemia gout, impaired glucose tolerance diabetes mellitus, insulin resistance (significance is uncertain), Hypercholesterolemia (usually in short-term therapy rather than in long-term therapy), impotence, and hypercalcemia. Contraindications are gout, diabetes mellitus, and renal disease. Interaction with diuretics may worsen digoxin toxicity and cause hypokalemia. Amiodarone, quinidine and verapamil all increase the levels of plasma digoxin levels by causing a reduction in its clearance. Additionally, interaction with cholestyramine may block absorption of digoxin.

Hmg Coenzymea Reductase Inhibitors

Nervous system Previous reports have not connected sleep disturbances with the use of statins (SED-14, 1530), but there has been one recent report (9A). In this case the statins may have interacted with metoprolol, and it may have been relevant that metoprolol is more lipid soluble than atenolol. Skin A series of skin reactions have been described in patients using statins (13r), among them an ichthyosiform eruption in a patient taking lovastatin (SED-14, 1530) and now also linear IgA bullous dermatosis in a patient using atorvastatin (14A) and dermographism in a patient taking atorvastatin (13c). Musculoskeletal Four cases of tendinopathy have been reported in three men and one woman taking statins (15A). The diagnoses were extensor tenosynovitis in the hands, tenosynovitis of the tibialis anterior tendon, and Achilles tendinopathy. Two patients were taking sim-vastatin and two atorvastatin. The tendinopa-thy developed 1-2 months after the start of treatment. The outcome was...

Pharmacological Tools to Tackle Obesity and Obesity Related Diseases

A large phase III trial named as RIO (rimonabant in obesity) was initiated in August 2001 including more than 6600 overweight or obese patients (323). All studies have already been concluded, and some of them are already reported in the literature (326, 327). Two of these studies, named RIO-North America and RIO-Europe, recruited obese and overweight patients with or without comorbidities who were treated for 2 yr with 5 or 20 mg rimonabant vs. placebo. The primary endpoints of the RIO-North America study were the absolute change in weight from baseline to 1 yr and the prevention of weight regain after rerandomization (second year), whereas the main endpoint of the RIO-Europe study was the assessment of weight reduction by using the same dosages. Secondary endpoints of both studies were the number of weight responders and the changes in waist circumference, metabolic and lipid parameters, and the number of patients affected by the metabolic syndrome as defined by National Cholesterol...

Will Pharrnacogenornics Improve Medical Care

Recently, the Statin Response Examined by Genetic HAP Markers Study (STRENGTH) completed enrollment of 600 patients with hy-perlipidemia. Patients were randomized to one of four statin treatment regimens (ceri-vastatin, pravastatin, atorvastatin, or simvastatin) for a 16-week duration. The goal is to identify genetic markers that predict which of the four statins is most beneficial in reducing cholesterol levels. However, whether this approach is superior to management of patients in a specialized lipid clinic remains to be determined.

Rio North America Findings

Metabolic parameters were also significantly improved in patients treated with rimonabant 20 mg throughout the 2-year period, with HDL cholesterol increased by 24.5 in the rimonabant 20 mg group vs 15.6 and 13.8 in the rimonabant 5 mg and placebo groups, respectively (p 0.001). Triglycerides were reduced by 9.9 in patients treated with rimonabant 20 mg throughout the 2-year period vs 5.9 and 1.6 in the rimonabant 5 mg and placebo groups, respectively (p 0.05). Although diabetic patients were not included in the study, patients on rimonabant 20 mg had significantly improved their insulin sensitivity compared to those on rimonabant 5 mg and on placebo. The effect of rimonabant on HDL cholesterol, triglycerides, fasting insulin, and insulin sensitivity (as measured by homeostasis model assessment) appeared to be twice that which would be expected from the degree of weight loss achieved (all p 0.05). Of particular note is that the number of patients diagnosed with metabolic syndrome at...

Antihyperlipidemic Drugs

Bile acid sequestrants lipoproteins (LDL) rhabdomyolysis triglycerides Discuss therapeutic life changes and how they affect cholesterol levels. Hyperlipidemia is an increase (hyper) in the lipids (lipi), which are a group of fats or fatlike substances in the blood (demia). Cholesterol and the triglycerides are the two lipids in the blood. Elevation of one or both of these lipids is seen in hyperlipidemia. Serum cholesterol levels above 240 mg dL and triglyceride levels above 150 mg dL are associated with atherosclerosis. Atherosclerosis is a disorder in which lipid deposits accumulate on the lining of the blood vessels, eventually producing degenerative changes and obstruction of blood flow. Atherosclerosis is considered to be a major contributor in the development of heart disease. Triglycerides and cholesterides are insoluble in water and must be bound to a lipid-containing protein (lipopro-tein) for transportation throughout the body. Although several lipoproteins are found in the... Effects

Atherosclerosis the importance of HDL cholesterol and prostacyclin a role for niacin therapy. Med Hypotheses 1990 32(1) 21-8. 41. Guyton JR, Goldberg AC, Kreisberg RA, Sprecher DL, Superko HR, O'Connor CM. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998 82(6) 737-43.

Diethylstilbestrol stilbestrol

Alone do not relieve all menopausal symptoms. Adding androgens has sometimes been found to improve relief of vasomotor symptoms, as well as alleviating some psychosexual problems. However, evidence has also been advanced that part of the value of estrogens lies in their ability to exert a positive inotropic effect on cardiac muscle and to increase cardiac output, left ventricular mass, and end-diastolic volume. In theory, one might expect the addition of androgens to interfere with these effects. This possibility has now been examined by an Italian group using Doppler flowmetry in an open randomized study in 40 patients over 8 months. All were using transdermal E2 (50 g day) and cyclic medroxyprogesterone acetate (10 mg day). Half of the trial subjects now received in addition testosterone undecanoate (40 mg day). The investigators concluded that while the androgen improved sexual desire and satisfaction and had no effect on endometrial thickness it did in part counteract the...

Nutritional Content Not known

A complex group of polysaccharides have been isolated from this mushroom which reportedly stimulate the immune system. One theory is that these polysaccharides stimulate helper T cell production which attack infected cells. Ganoderic acids have also been isolated from Ling Chi and purportedly have anti-coagulating effects on the blood and lower cholesterol levels (See Morigawa et al., 1986). Most recently, studies have been published showing its modulating effects on blood

Hypolipidemic Hypocholesterolemic Drugs

The fact that even young men can develop atherosclerosis was reported following autopsies of German soldiers during World War I. However, it was a U.S. Armed Forces Institute of Pathology report toward the end of the Korean War (Enos et al., 1953) showing that young men (average age 22) had evidence of coronary heart disease (CHD) that made the medical profession take note of the epidemic that was CHD. The problem is still extensive in spite of considerable, but slow, progress since the 1950s. By the early 1980s there were 5.4 million Americans with symptomatic diagnosed CHD. The number of undiagnosed cases is, of course, unknown. In any case, the results were 1.5 million heart attacks and over 550,000 deaths. A review of the medical literature since the late 1950s shows the name cholesterol, and particularly hypercholesterolemia (HPC), to be associated with CHD with increasing frequency. By the early 1970s HPC was implicated as the primary CHD risk factor. Hypertension and smoking...

Cholesterol synthesisenzyme inhibitors

The lipophylic statins atorvastatin.fluvastatin, lovastatin (mevinolinic acid), pitavastatin, simvastatin, and hydrophilic statins pravastatin and rosuvastatin, are used to treat hyperlipidemia and hypercholesterolemia. These agents reduce the biosynthesis of cholesterol through a competitive inhibition of the rate-limiting enzyme, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase. A collection of human malformations - including the aforementioned cases, holoprocencephaly, other CNS malformations, and limb anomalies - involving first-trimester exposure to the lipophylic HMG-CoA reductase inhibitors atorvastatin, cerivastatin, lovastatin, and simvastatin has been published. The authors suggest a possible link to abnormal Sonic Hedgehog signaling. Cholesterol binding to Sonic Hedgehog protein is required for this protein to play a signaling role in embryonic development. The same authors hypothesized that statins may affect fetal development by lowering in utero cholesterol...

Drug Drug Interactions General

Many statins are metabolized by CYP3A4, and this and other mechanisms of drug interactions involving statins have been reviewed (50). Other drugs metabolized by CYP3A4 can greatly increase statin concentrations in the body and precipitate rhabdomyolysis. Although the statins are similar in their ability to lower cholesterol concentrations, there are dissimilarities in their interactions with other drugs. With the exception of fluvastatin and pravastatin, the statins are metabolized by CYP3A4. Selective inhibition of CYP3A4 or of P-glycoprotein (50) in the small intestine probably increases the systemic availability of CYP3A4 substrates. Some drugs that are metabolized by this enzyme, such as the macrolide antibiotics and the antidepressant nefazodone, can greatly enhance the concentrations of statins in the body and thereby precipitate rhabdomyolysis. However, other drugs that are metabolized by CYP3A4, such as cimetidine, have not been reported to have this effect. The antifungal...

Safety factors that govern the choice of antianginal drug

Insights into the epidemiology, physiology, cellular biology, molecular biology, and treatment of ischemic heart disease have shown that there are three major modifiable risk factors (hypertension, hypercholesterolemia, smoking) that are the main targets of our preventive strategies. However, evidence that intervention is beneficial has been considerably strengthened. Hypercholesterolemia The landmark 4S study of cholesterol-lowering therapy has convincingly shown the effectiveness of treating patients with high serum cholesterol concentrations and ischemic heart disease (14). This has largely been confirmed by subsequent studies (15-17), and the beneficial effects of lowering serum cholesterol have been extended to primary prevention (18,19). Currently, statins are recommended in all those over the age of 55 years and or in those with pre-existing cardiovascular disease (20). Statins reduce cardiac events if begun early after acute coronary syndromes (21) and may also be indicated in...

Drug Drug Interactions

Statins Since HMG CoA reductase inhibitors (statins) are partially or completely metabolized by CYP3A4, drug interactions with protease inhibitors can be expected. When nelfinavir was combined with atorvastatin and simvastatin, their AUCs increased by 74 and 505 respectively (17). As myopathy and rhabdomyolysis are concentration-related, simvastatin is contraindicated with any protease inhibitor, not just nelfinavir. Based on the data, the starting dose of atorvastatin should be reduced by about 50 .

Organs and Systems Nervous system

Ratings on a depression scale rose in four out of six men given cholesterol-lowering drugs, in two of them to a degree that met the criteria for mild clinical depression (2). Statins interfere with the production of isoprene which is somehow connected with sleep, but there have been neither changes in sleep EEG measures relevant to insomnia nor changes in the quality of sleep (SEDA-13, 1327) (3). However, there has been a report of sleep disturbances (4). In this case, the statins may have interacted with meto-prolol, and it may have been relevant that metoprolol is more lipid-soluble than atenolol. Peripheral neuropathy occurs with statins, and perhaps with all cholesterol-lowering drugs, and may be related to reduced production of ubiquinone, as suggested in a review (5). Moreover, it appears that once a statin produces a neuropathy, rechallenge with any other statin is likely to cause a recurrence. This is reported to occur 1-3 weeks after rechallenge, whereas the resolution takes...

Ipecacuanha emetine and dehydroemetine

Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med 2003 61(1) 19-21. 5. Maciejko JJ, Brazg R, Shah A, Patil S, Rubenfire M. Psyllium for the reduction of cholestyramine-associated gastrointestinal symptoms in the treatment of primary hypercholesterolemia. Arch Fam Med 1994 3(11) 955-60. 7. Zurier RB, Hashim SA, Van Itallie TB. Effect of medium chain triglyceride on cholestyramine-induced steatorrhea in man. Gastroenterology 1965 49(5) 490-5. 8. Cohen MI, Winslow PR, Boley SJ. Intestinal obstruction associated with cholestyramine therapy. N Engl J Med 1969 280(23) 1285-6. 12. Heaton KW, Lever JV, Barnard D. Osteomalacia associated with cholestyramine therapy for postileectomy diarrhea. Gastroenterology 1972 62(4) 642-6. 13. Brown DD, Schmid J, Long RA, Hull JH. A steady-state evaluation of the effects of propantheline bromide and cholestyramine on the bioavailability of digoxin when administered as tablets or...

Smoking Cessation Agents

Treating tobacco dependence is one of the most cost-effective preventive measures. It is estimated that smoking cessation is more cost-effective than several common clinical preventive services such as screening for cervical, breast, and colon cancer, treatment of mild-to-moderate high blood pressure, and treatment cf high cholesterol (163).

Chenodeoxycholic acid and ursodeoxycholic acid

Patients with intrahepatic cholestasis of pregnancy (Roncaglia 2004, Reyes 2000, McDonald 1999). It is too early to say whether the use of UDCA improves fetal outcome in pregnancies affected by intrahepatic cholestasis of pregnancy, but several studies suggest better perinatal outcome (Zapata 2005, Palma 1997, Diaferia 1996). In a randomized study on 84 pregnant women with intrahepatic cholestasis of pregnancy who received either ursodeoxycholic acid or cholestyramine, pruritus was more effectively reduced by ursodeoxycholic acid than by cholestyramine, as were the biochemical abnormalities babies were delivered significantly closer to term by patients treated with ursodeoxycholic acid than those treated with cholestyramine (Kondrackiene 2005).

Physiology of an Erection


Impotence, or erectile dysfunction, can be defined as the persistent inability to develop and or maintain an erection adequate for sexual intercourse. Vascular diseases, including atherosclerosis, hypertension, diabetes, and high cholesterol, can cause restricted blood flow to the penis and may account for approximately 70 of physically related causes of erectile dysfunction 11 . The arterial blood supply to the penis is mainly provided by the internal pudendal artery, which branches into several smaller arteries that contribute to vascularization of the erectile tissues. The erectile tissue of the human penis consists of two dorsal corpora cavernosa and a ventral corpus spongiosum. Reduced sympathetic input combined with stimulation

Toxicity of Herbal Drugs

The definition of toxic is ultimately a matter of viewpoint. Traditionally, herbs and herbal products have been considered to be nontoxic and have been used by the general public and traditional medicinal doctors worldwide to treat a range of ailments. The fact that something is natural does not necessarily make it safe or effective. The active ingredients of plant extracts are chemicals that are similar to those in purified medications, and they have the same potential to cause serious adverse effects. Whilst the literature documents severe toxicity resulting from the use of herbs, on many occasions the potential toxicity of herbs and herbal products has not been recognized 108 . In certain countries, such as Taiwan, herbs can be obtained from temples, night markets, street vendors, herbal stores, neighborhoods, or relatives, and from traditional medicine practitioners. Ordinary people recommend the medicines to others without safety considerations. The general public and many...

The Three Components of a Diagnosis

Sometimes we know part of the etiology and pathogenesis but do not have a complete picture. For example, we know that some of the reasons people have heart attacks include smoking, high blood pressure, obesity, high cholesterol, high-fat diet, and intense exertion. Physicians understand some cellular mechanisms of the pathogenesis, such as the tendency of the cells lining the walls to take cholesterol into themselves if there is a lot of cholesterol in the bloodstream. This causes the cell to swell so there is less room for blood to get through. If sudden exertion causes the heart to need more oxygen, not enough blood can get through the narrowed space. As the heart continues to beat quickly, the muscle cells cramp up and develop pain. If the lack of oxygen is prolonged and severe enough, the cells may even die (i.e., from a heart attack).

Uses of Dietary Reference Intakes

Ion exchange resins (colestipol, Colestyramine), which complex with the bile salts and can interfere with the absorption of the oil-soluble vitamins Aluminum antacids can complex with some of the vitamins and, when used chronically, most definitely can cause hypophosphatemia Cystic fibrosis, which can cause fat malabsorption (steatorrhea) attributed to inadequate production of pancreatic lipases

Role of Estrogen in Tumor Growth

Estrogen has effects on the growth and function of reproductive tissues and also preserves bone mineral density, thus reducing the risk of osteoporosis and protecting the cardiovascular system by reducing cholesterol levels. Estrogens act as promoters, rather than initiators, of breast tumor development and can also facilitate tumor invasiveness by stimulating the production of proteases, which can degrade the extracellular matrix.

Pharmaceutical interest

Dietetic properties There is an expanding body of evidences to suggest that the consumption of fruits of Coix lacryma-jobi L. could be of dietetic value, since it lowers fibrinogen levels and fibrinolytic activity in Wister rats (Check JB et a ., 1995). The fruits protect Sprague-Dawley male rats against plasma and liver hypercholesterolemia experimentally by lard-enriched diet (Park Y et a ., 1988). Note that a number of glycans with hypoglycaemic activity are known to occur in the seeds (Takahashi M et a ., 1986).

Drugs Active Against Human Immunodeficiency Virus Protease Inhibitors

In attempts to lower the amprenavir capsule burden, low-dose ritonavir has been used as a pharmacokinetic booster. When ritonavir was added to amprenavir, the amprenavir AUC increased 3-4 times (46c), which should allow the total daily capsule burden to be reduced. Adverse effects included diarrhea, nausea, paresthesia, rash, increased cholesterol, and increased triglycerides. The frequency of adverse events correlated with the dose of riton-avir. Drug interactions Since HMG CoA reduc-tase inhibitors (statins) are partially or completely metabolized by CYP3A4, protease drug interactions can be expected. When nelfinavir was combined with atorvastatin and simvasta-tin, their AUCs increased by 74 and 505 respectively (58c). As myopathy and rhabdomy-olysis are concentration-related, simvastatin is contraindicated with any protease inhibitor, not just nelfinavir. Based on the data, the starting dose of atorvastatin should be reduced by about 50 .

Treatment Options for Psychotic Disorders

All atypical antipsychotics can cause substantial weight gain (an increase of 10 to 20 of your current body weight in the first couple of months), diabetes, and elevations of cholesterol or triglycerides (another form of fat in the blood). People with a family history of diabetes are at a higher risk for developing these complications. These serious complications are associated with high blood pressure, heart attacks, strokes, and gallbladder problems. It's not clear if high doses are more likely to cause these problems than low doses. It's not clear if atypical antipsychotics cause these changes in metabolism directly or whether the changes result from weight gain. In either case, it is important to monitor your weight and be tested regularly for the presence of high cholesterol and diabetes. Careful dieting and exercise can minimize weight gain and even permit weight loss in people who have gained weight. There are significant differences among the six atypical antipsychotics....


Effects An adaptogen that may provide energy and stamina, boost the immune system, detoxify various drugs and metals, have antiviral properties, improve peripheral circulation, balance the bodily systems, counteract stress, and improve mental functioning. It is said to be a potent anticancer agent and may be useful in fighting off the flu and other respiratory infections. Evidence suggests it might be useful in the treatment of colds, flu, high cholesterol, chronic lung weakness, HIV, cancer, and tumors.


While I fully support marijuana's use for medicinal purposes, why don't we regulate it like we do Lipitor or Viagra You can't buy those two without getting it through a legitimate pharmacy. If this drug is so important and so helpful, why is it not regulated like every other drug They pass a law, then they have no regulations as to how to enforce the darn thing and, as a result, we have hundreds of these locations selling drugs to every Tom, Dick and Harry.16


Drug formulations The California State Health Director has warned consumers to stop using the herbal product Anso Comfort capsules immediately, because the product contains the undeclared prescription drug chlordiazepoxide (7A). Anso Comfort capsules, available by mail or telephone order from the distributor in 60-capsule bottles, are clear with dark green powder inside. The label is yellow with green English printing and a picture of a plant. An investigation by the California Department of Health Services Food and Drug Branch and Food and Drug Laboratory showed that the product contains chlordiazepoxide. The ingredients for the product were imported from China and the capsules were manufactured in California. Advertising for the product claims that the capsules are useful for the treatment of a wide variety of illnesses, including high blood pressure and high cholesterol, in addition to claims that it is a natural herbal dietary supplement. The advertising also claims that the...

Blood lipids

The importance of these effects for the long-term management of patients with hypertension or ischemic heart disease is unknown, but it is recognized that a high serum total cholesterol and a low HDL cholesterol are associated with an increased risk of ischemic heart disease. However, a significant reduction in HDL cholesterol after treatment for 1 year with timolol was of no prognostic significance and did not attenuate the protective effect of the drug (195). In a 4-year randomized, placebo-controlled study of six antihypertensive monotherapies, acebutolol produced only a small and probably clinically irrelevant (0.17mmol l) reduction in total cholesterol (196), which was not statistically different from four of the other antihypertensive drugs.

Milk Thistle

Effects Contains the bioflavonoid mixture silymarin, which protects the liver against hepatitis, cirrhosis, and toxins such as carbon tetrachloride, alcohol, and the poisonous Amanita mushroom. It may also help protect the liver from otherwise beneficial pharmaceuticals such as antianxiety drugs, antidepressants, cholesterol-lowering drugs such as Zocor (simvastatin) and Mevacor (lovastatin), and high doses of Tylenol (acetaminophen) and iron. Milk thistle may even reverse damage that has already occurred. Studies published in the Journal of the American Medical Association have revealed that at least three-quarters of all adult Americans show at least some sign of chronic liver damage which could manifest itself as irritability, fatigue, malaise, anxiety, depression, and mild intellectual impairment possibly indicating that this may be an important herb to add to the diet. This bioflavonoid mixture may also be useful in preventing or treating gallstones and in relieving the symptoms...


All atypical antipsychotics can cause substantial weight gain (an increase of 10 to 20 of your current body weight in the first couple of months), diabetes, and elevations of cholesterol or triglycerides (another form of fat in the blood). People with a family history of diabetes are at a higher risk for developing these complications. These serious complications are associated with high blood pressure, heart attacks, strokes, and gallbladder problems. It's not clear if high doses are more likely to cause these problems than low doses. It's not clear if atypical antipsychotics cause these changes in metabolism directly or whether the changes result from weight gain. In either case, it is important to monitor your weight and be tested regularly for the presence of high cholesterol and diabetes. Careful dieting and exercise can minimize weight gain and even permit weight loss in people who have gained weight. There are significant differences among atypical antipsychotics. Aripiprazole...

Lipid metabolism

High-dose glucocorticoid therapy can cause marked hypertriglyceridemia, with milky plasma (SEDA-15, 421) (SEDA-16, 450). It has been suggested that this is caused by abnormal accumulation of dietary fat, reduced postheparin lipolytic activity, and glucose intolerance (105). An association between glucocorticoid exposure and hypercholesterolemia has been found in several studies (106) and can contribute to an increased risk of atherosclerotic vascular disease.

Coenzym Q1o

Drug use, exposure to cold, illnesses, physical activity, and stress can all drain the body's supply of this nutrient. Exercise, however, can increase levels. Some cholesterol-lowering drugs such as Lescol, Lipitor, Mevacor, Prava-chol, and Zocor can also deplete levels of CoEnzyme QlO in the body, and it is advisable to take supplements to counteract this Joe and Theresa Graedon, Ph.D., say experts recommend between 50 to 150 mg a day.


Effects Saponins are believed to have anti-oxidant, anti-cancer, anti-inflammatory, and anti-viral properties. They may also bolster the immune system. They have been used to treat diabetes liver ailments such as hepatitis, cardiovascular problems such as high blood pressure, high cholesterol, and blood clots and mental and physical stress.


Many drugs may affect the action of the sulfonyl-ureas the nurse must monitor blood glucose carefully when beginning therapy, discontinuing therapy, and any time any change is made in the drug regimen with these drugs. The sulfonylureas may have an increased hypoglycemic effect when administered with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. The hypo-glycemic effect of the sulfonylureas may be decreased when the agents are administered with beta blockers, calcium channel blockers, cholestyramine, corticos-teroids, estrogens, hydantoins, isoniazid, oral contraceptives, phenothiazines, thiazide diuretics, and thyroid agents.


Drug interactions When erythromycin was co-administered with atorvastatin, the mean maximum blood concentration of atorvasta-tin and the AUC increased by more than 30 (157R). It has recently been proposed that the risk of myotoxicity increases when statins are prescribed concurrently with ery-thromycin (183R). Studies in dogs have shown that some statins are associated with cataract when given in excessive doses (184E). A case-control analysis of 7405 cases and 28 327 controls suggested that concomitant use of sim-vastatin and erythromycin is associated with an increased risk of cataract (185C).

Thyroid Hormones

Its effect can be inhibited by cholestyramine, colestipol, oral contraceptives, estrogens, and phenytoin, and enhanced by large continuous doses of aspirin. In combination, it can enhance the effects of amphetamines, oral anticoagulants, tricyclic antidepressants, oral antidiabetics or insulin, ephedrine, epinephrine, and methylphenidate, and diminish the effects of barbiturates, beta-adrenergic blocking agents, cortisone drugs, and digitalis medications. It can also interact with sympathomimetics, possibly causing a rapid or irregular heartbeat. Combining it with cocaine can result in excessive stimulation.

Acidbase balance

Colestyramine has been reported to have caused a hyper-chloremic metabolic acidosis. A 70-year-old woman with a 2-year history of primary biliary cirrhosis confirmed by histological and immuno-logical criteria took colestyramine sachets twice daily for 2 months and developed lethargy, confusion, and drowsiness (3). She had signs of chronic liver disease, portal hypertension, and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis, and a urinary pH of 4.85 together with tests of renal acidification excluded renal tubular acidosis. No other cause was found and she responded


Patients taking colestyramine often have constipation, abdominal discomfort, and heartburn, but dietary fiber, such as psyllium, can reduce the symptoms (5,6). Other effects are flatulence, nausea, and fecal impaction a mild laxative may be needed, particularly in the elderly. Many other patients complain of anorexia and occasionally there is diarrhea. Doses of colestyramine higher than the 10-16 g normally used can cause steatorrhea (7).

Cardiac glycosides

Colestyramine and colestipol bind digoxin and digitoxin and can affect their absorption. When the ion exchange resins and digoxin are co-administered the absorption of digoxin is reduced (13). However, even when they are not administered together, the resins can bind cardiac glyco-sides that have re-entered the gut after absorption by virtue of enterohepatic recycling and enteral secretion, increasing their rate of elimination. This action has been used to treat digoxin toxicity (14-16), digitoxin toxicity (17), and toxicity from derivatives of digoxin (18).


The design of a combinatorial library against cathepsin D, an aspartyl protease, represented pioneering work in the field of structure-based library design by Ell-man's and Kuntz's groups 82 . The library was designed upon the (hydroxyethyl)-amine isostere, since statins and analogs were well-known mechanism-based inhibitors for aspartyl proteases. The central (hydroxyethyl)amine core was modeled in the active site with a binding mode similar to that of pepstatin. Substituents of the central core were introduced as acids and amines selected from ACD with a molecular weight limit of 270. The three sites of variation were independently investigated within the protein-binding site using CombiBuild 83 , which employed an exhaustive conformational search in the corresponding binding pockets. Next, for each site of variation, ten compounds were selected from the 50 top-scoring reactants by cost and diversity criteria. A 10*10*10 library was obtained containing 23 compounds with 50...


Nausea and diarrhea are among the less serious reports of unwanted effects. The substance can masculinize female users and interfere with menstrual periods. In immature rats oxandrolone has drastically interfered with the male reproductive system, a finding that may be relevant to young athletes using the compound without medical supervision. In humans the substance can promote prostate disease and should be avoided by men with breast cancer and generally by anyone with kidney disease (although doctors sometimes give oxandrolone to dialysis patients). The drug has been used to treat hepatitis in alcoholics despite its ability to interfere with bile flow and to cause jaundice or liver malfunction. Fluid retention can occur and be a serious problem for heart patients. Other unwanted effects may include overall higher cholesterol levels (accompanied by reduction of the HDL good cholesterol ), although unlike some other drugs of this type, oxandrolone has been seen to reduce...

Inositol And Ip6

Effects Inositol acts as a cell membrane stabilizer. It also helps redistribute body fat, keep cholesterol low, prevent eczema, and keep hair healthy. Claims that myoinositol lowers triglycerides and cholesterol in the blood, protects against cardiovascular disease, promotes sleep, or relieves anxiety are, as yet, unproven, though these last two effects may result from its effects on phosphatidylinositol levels in brain cells. It has been shown to provide some benefit in improving sensory nerve function in those with diabetic peripheral neuropathy, though more research is needed to determine its exact role in this disease. Phytic acid (IP6) is an antioxidant. It also fights cancer, protects cells (particularly blood cells) from excess iron by chelating the iron atoms. It may be a more potent cancer-fighter when taken by itself than when taken as part of a high-fiber diet, mainly because it is not bound up in protein, allowing phytase, a food enzyme, to break it down before it can be...


Phentermine may interfere with sleep, cause dry mouth, make bowel movements looser or harder, produce impotence, make people edgy and ill-tempered, or (in contrast) create euphoria. The compound is suspected of involvement with stroke, but reported cases have confounding factors. In one instance the patient had a history of headaches before taking phentermine and a family history of migraine and stroke. In another case the person was also taking phendimetrazine, had used birth control pills for 14 years, had smoked cigarettes for two decades, and had a personal history of migraines and a family history of high cholesterol and high blood pressure. Phentermine has also been linked to narrowing of abdominal arteries with a possibility of ruptured aneurysms there. Uncommon accounts exist of phentermine users


Hydroxylation of miocamycin metabolites is mainly performed by CYP3A4. Some macrolide antibiotics cause drug interactions that result in altered metabolism of concomitantly administered drugs by the formation of a metabolic intermediate complex with CYP450 or competitive inhibition of CYP450 (28). The resulting interactions can cause rhabdomyolysis (associated with the coadministration of some statins, for example lovastatin or simvastatin), hypoprothrombinemia (associated with warfarin), excessive sedation (associated with certain benzodiazepines, for example alprazolam, diazepam, mid-azolam, or triazolam), ataxia (associated with carbamaze-pine), and ergotism (associated with ergotamine).


Drug interactions Pharmacokinetic interactions with clarithromycin, erythromycin, and troleandomycin have been reviewed (157R). They often result from inhibition of drug metabolism by CYP3A4. Resulting interactions include rhabdomyolysis (associated with the co-administration of some statins, e.g. lovasta-tin or simvastatin), hypoprothrombinemia (associated with warfarin), excessive sedation (associated with certain benzodiazepines, e.g. alprazolam, diazepam, midazolam, or triazolam), ataxia (associated with carbamazepine), and ergotism (associated with ergotamine). Beneficial drug interactions can also occur for example, co-administration of macrolides with ci-closporin may allow reduction of the dosage of the latter.

Index of drugs

169 chloroquine cardiovascular system, 315 formulations, 317 nervous system, 315-316 overdose, 316-317 pregnancy, 316 +proguanil, adherence, 317 sensory systems, 316 skin, 316 chloroxylenol, 169 chlorprocaine, 145 chlorquinaldol, 169 cholestyramine, 457 chromium, 245 cibenzoline, 207 cicloproxolamine, 169 ciclosporin 405-406 endocrine system, 532 hair, 532 interactions, 532 nervous system, 532 nevirapine concentration, 332 statin concentration, 487 tricyclic antidepressant concentration, 11 statins. see HMG coenzyme-A

Caapi Pinima

Larger doses of caffeine, especially when given to non-users, can produce headache, jit-teriness, abnormally rapid heartbeat (tachycardia), convulsions, and even delirium. Near-fatal doses cause a crisis resembling the state of a diabetic without insulin, including high levels of blood sugar and the appearance of acetone-like substances in urine. The lowest known dose fatal to an adult has been 3,200 mg - administered intravenously by accident. The fatal oral dose is in excess of 5,000 mg - the equivalent of 40 strong cups of coffee taken in a very short space of time. Tolerance refers to the body's getting used to a drug with its repeated taking. It is difficult to study the tolerance of human subjects to the various effects of caffeine because nearly everyone in our society uses caffeine regularly in one form or another. Careful research has suggested that tolerance develops to most of caffeine's effects - meaning that, with experience of the drug, the same dose produces a reduced...


Simple Mechanism Action Aspirin

A mode of action need not involve enzyme inhibition. It could be a simple physical action. Cholestyramine resins are used to form nonpolar aggregates with lipophilic substances. With this action they constitute a good antidote for pesticide poisoning and can serve as a prophylactic in tying up dietary lipids in the s CH CH2 CH CH2s intestine so that they will not contribute to atherosclerosis. The pesticides are stored in fat tissue. As the molecules of pesticide are sequestered into the cholestyramine resin more molecules will move from the fat depots in cholestyramine (Questran ) The effects of a drug or poison refer to the observable biological responses such as bacteria dying when the host is treated with penicillin, fever and inflammation subsiding after aspirin therapy or the reversal of toxicity due to pesticide poisoning after a cholestyramine antidote is given. A primary effect is what is sought by the drug discoverer (or poisoner). Secondary effects are side effects, not...


Brunner-La Rocca et al. examined the effect of Padma 28 on lipids in 60 otherwise healthy participants with mild hypercholesterolaemia in a mixed clinical and in vitro trial 91 . Whereas after a 4-week intervention (two tablets three times daily) vs. placebo the blood lipids (total, HDL or LDL-cholesterol, triglycerides, apo-lipprotein A1 and B) did not change, the in vitro evaluation showed a dose-dependent reduction in blood lipid oxidisability in the verum group which persisted 1 week after cessation of the trial. triglycerides, beta-lipoproteins (rats) 86, 87

O2c nh3

Namide, but not tryptophan and niacin equivalents (see next section). Large doses of niacin and niacinamide do have adverse reactions. These are sometimes seen with patients who are prescribed niacin in doses up to 2 g daily for hyperlipidemia, including both hypercholesterolemia and hypertriglyceridemia. For the former, there is the desired decreased LDL and increased HDL. Adverse reactions include vasodilation from niacin, particularly in the


Effects A potent anti-oxidant which can regenerate other anti-oxidants, such as vitamins C and E, and form another anti-oxidant, dihydrolipoate, in cells. It is said to improve long-term memory by protecting brain cell membranes from damage by free radicals, insure that the two main enzymes that convert food into energy function properly, enhance the synthesis of glutathione, and, unlike other anti-oxidants, can attack free radicals in both the watery and fatty parts of the body. It produces a mild feeling of relaxation and well-being, plus a mild visual enhancement. It may also enhance the immune system and prevent atherosclerosis, and may prove helpful in treating diabetes, cataracts, brain and nerve degeneration, cardiovascular and cere-brovascular diseases, high cholesterol, infections (e.g., HIV), and cancer.

Ionexchange Resins

Rhabdomyolysis due to simvastatin in a transplant patient are some statins safer than others Nephrol Dial Transplant 2001 16 873-4. 20. Sabia H, Prasad P, Smith HT, Stoltz RR, Rothenberg P. Safety, tolerability, and pharmacoki-netics of an extended-release formulation of flu-vastatin administered once daily to patients with primary hypercholesterolemia. J Cardiovasc Pharmacol 2001 37 502-11.

Vitamin B12

Dilantin can deplete the body's stores of B-12, and an underactive thyroid gland can interfere with the absorption of this vitamin. It can also be destroyed or have absorption interfered with by acids and alkalies, alcohol, anticonvulsants, chloramphenicol, cholestyramine, cimetidine, coffee, colchicine, estrogen, famotidine, laxatives, neomycin, nizatidine, oral contraceptives, potassium (extended-release forms), ranitidine, sleeping pills, stomach medications (such as Prevacid, Prilosec, Pepcid, Tagamet, and Zantac), sunlight, tobacco, vitamin C (if taken within two hours of each other), and water. As it is only found in meat and dairy products, strict vegetarians may not get enough, though lack of deficiency in nonmeat eaters leads some to speculate that some vegetables may contain bacteria that produce B-12. The vitamin needs to be taken with calcium to be properly absorbed and utilized by the body.

Carp bile

In Asia, the raw bile of the grass carp (Ctenopharyngodom idellus) is believed by some to be health promoting. However, eating it can result in hepatic dysfunction and nephrotoxicity (15). The former usually resolves within a few days, but the latter is more serious, culminating in acute renal insufficiency within 2-3 days after ingestion (16). Experiments in rats have shown that the bile of the grass carp loses its lethality when treated with colestyramine, which forms insoluble complexes with bile acids (17).

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