Class | Drug | Initial daily dose | Upper daily dose studied in clinical trials (children aged ≥10 years)[1] | Maximum daily dose (adult) | Available strengths (United States) |
Statins | |||||
Atorvastatin | 5 to 10 mg | 20 mg | 80 mg | 10, 20, 40, 80 mg | |
Fluvastatin | 20 mg | 80 mg | 80 mg | 20, 40 mg, 80 mg (extended release) | |
Lovastatin | 10 mg | 40 mg | 80 mg | 10, 20, 40 mg 20, 40, 60 mg (extended release) | |
Pravastatin | 10 mg | 40 mg (age 14 to 18 years) 20 mg (age 8 to 13 years) | 80 mg | 10, 20, 40, 80 mg | |
Rosuvastatin | 5 mg | 20 mg | 40 mg | 5, 10, 20, 40 mg | |
Simvastatin | 10 mg (age ≥10 years) 5 mg (age 10 years) | 40 mg | 40 mg | 5, 10, 20, 40, 80* mg | |
Cholesterol absorption inhibitors | |||||
Ezetimibe | 10 mg | 10 mg | 10 mg | 10 mg | |
Fibric acid derivates | |||||
Gemfibrozil | 1200 mg¶ | Data lacking | 1200 mg | 600 mg | |
Fenofibrate | 40 mg | Data lacking | 130 to 200 mg (maximum dose depends on preparation; refer to drug reference included within UpToDate) | 40, 43, 48, 50, 54, 67, 100, 120, 134, 145, 160, 200 mg (available strengths vary by preparation; refer to drug reference included within UpToDate) | |
Bile acid sequestrants | |||||
Cholestyramine | 2 to 4 g or 240 mg/kg per day | 8 g 4 g (age <10 years) | 16 g | 4 g per packet or scoop | |
Colestipol | 2.5 to 5 g | 12 g | 20 g | 5 g per packet or scoop 1 g tablet | |
Colesevelam | 1.25 g | 3.75 g | 3.75 g | 3.75 g per packet 625 mg tablet | |
Omega-3 fish oils | |||||
Omega-3 acid ethyl esters | 1 g | Data lacking | 4 g | 1 g (many strengths available) |
Always review drug interactions upon initiation and alteration of treatment. Specific interactions may be determined using the drug interactions program included within UpToDate. This tool can be accessed from the UpToDate online search page or through the individual drug information topics in the section on Drug interactions.
Children and adolescents are generally not managed with more than one class of lipid-lowering agents due to increased risk of side effects. Combinations of statins and fibrates should be administered under the supervision of a pediatric lipid specialist.LDL-C: low-density lipoprotein cholesterol.
* The US Food and Drug Administration has placed a black box label on simvastatin at a dose of 80 mg per day because it is associated with muscle toxicity in adults. If a daily dose of 40 mg of simvastatin is insufficient to achieve LDL-C control, a change to a more potent statin (eg, atorvastatin or rosuvastatin) is suggested. Doses of simvastatin that exceed 40 mg per day should be given under the supervision of a pediatric lipid specialist, and are generally not required, as more potent statins are available.
¶ An initial 600 mg daily dose of gemfibrozil may be considered. Data in children are lacking.Do you want to add Medilib to your home screen?