Question

60 yo M is evaluated for abdominal cramping and diarrhea that began after starting ezetimibe. The pt has had persistently elevated LDL cholesterol levels while taking maximally tolerated statin therapy.Most appropriate management?

Answer 1

The most appropriate management for a 60-year-old male experiencing abdominal cramping and diarrhea after starting ezetimibe, and with persistently elevated LDL cholesterol levels despite maximal statin therapy, would be to consider combination treatment with ezetimibe and a bile acid sequestrant.

Step-by-step explanation:

The most appropriate management for a 60-year-old male who is experiencing abdominal cramping and diarrhea after starting ezetimibe, and who has persistently elevated LDL cholesterol levels despite maximal statin therapy, would be to consider combination treatment with ezetimibe and a bile acid sequestrant.

Bile acid sequestrants, such as colesevelam, work by binding to bile acids in the intestines, preventing their reabsorption. This leads to increased excretion of cholesterol and reduction in LDL cholesterol levels. Ezetimibe, on the other hand, works by inhibiting the absorption of cholesterol from the small intestine, further reducing LDL cholesterol levels.

By combining these two medications, there can be a synergistic effect in reducing LDL cholesterol levels. However, it is important to note that combination treatment with statins and fibrates should be avoided due to the increased risk of myopathy and rhabdomyolysis.