Pediatric Lipid Disorders in Clinical Practice Medication
- Author: Henry J Rohrs, III, MD; Chief Editor: Stuart Berger, MD more...
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- Table 1. Biology of Lipoproteins
- Table 2. Frederickson Classification of Dyslipidemias
- Table 3. NCEP Lipid Assessments for Children and Adults
- Table 4. Summary of Evidence Based Recommendations for the CHILD-1
- Table 5. Dosing of HMG-CoA–Reductase Inhibitors
- Table 6. FDA-Approved Uses and Doses of Fibric Acid Derivatives
|Lipoprotein||Major Lipid Composition||Role in Normal Fasting Plasma||Measured Substance|
|High-density lipoprotein cholesterol (HDL-C)||Cholesterol||Antiatherogenic (involved in reverse cholesterol transport from the tissues to the liver)||HDL-C|
|LDL-C||Cholesterol||Major cholesterol carrier||Can be measured directly (direct LDL-C) or can be calculated*|
|Intermediate-density lipoprotein cholesterol (IDL-C)||TG and cholesterol||Intermediate between very–low density lipoprotein (VLDL) and low-density lipoprotein (LDL)||Not routinely measured; can be assessed by LPE† or measured by ultracentrifugation|
|VLDL||TG||Major TG carrier||TG‡|
|Chylomicron||TG||Absent||Not routinely measured; can be assessed by LPE or measured by ultracentrifugation|
|* Calculated using the Friedewald equation: LDL-C = Total cholesterol (TC) - HDL-C - TG/5|
† LPE = Lipoprotein electrophoresis
‡ TG/5 is the estimate of the VLDL-C.
|Phenotype||Elevated Particles||Major Lipid Increased||Frequency|
|IIB||LDL and VLDL||LDL-C, TG||Common|
|III||IDL and remnants||TC, TG||Rare|
|V||Chylomicron and VLDL||TG||Uncommon|
|Children (< 20 y)||Desirable level (mg/dL)||Borderline level (mg/dL)||Undesirable level (mg/dL)|
|Adults (≥20 y)‡||Desirable level (mg/dL)||Borderline level (mg/dL)||Undesirable level (mg/dL)|
|* This was not established by NCEP; these values were the adult cutpoints used at the time that the pediatric NCEP guidelines were established.|
† This was not established by NCEP; a TG level of 125 mg/dL approximates the mean 95th percentile for TGs in boys and girls during childhood and adolescence.
‡ In March of 2001, cutoff points for desirable and undesirable cholesterol, HDL-C, and other levels were revised in the Adult Treatment Panel III (ATPIII).
§ The optimal LDL-C concentration is less than 100 mg/dL; in patients with cardiovascular disease or diabetes, the optimal LDL-C level is less than 70 mg/dL.
|| If the HDL-C level is 60 mg/dL or higher, one risk factor for coronary heart disease can be subtracted in adults.
|Birth to 6 months|
|Generic Name||Adult Dose||Pediatric Dose||Dose Adjustment for Renal Insufficiency or Coadministration with Food or Drugs That Decrease Clearance*|
|Lovastatin (Mevacor)||Initial: 20 mg/d orally every bedtime|
Followed by: 10-80 mg/d orally every bedtime or divided twice daily
|10-17 years: 10-20 mg/d orally every bedtime initially; maintenance dosage ranges from 10-40 mg/d||Not to exceed 20 mg/d|
|Simvastatin (Zocor)||Initial: 5-10 mg/d orally every bedtime|
Followed by 5-80 mg/d orally every bedtime or divided twice daily
|10-17 years: 10 mg/d orally every bedtime initially; maintenance dosage ranges from 10-40 mg/d||5 mg/d initially; not to exceed 20 mg/d|
|Pravastatin (Pravachol)||Initial: 10-20 mg/d orally every bedtime|
Followed by 5-40 mg/d orally every bedtime
|8-13 years: 20 mg orally every day|
14-18 years: 40 mg orally every day
|Initiate at 5-10 mg/d; not to exceed 20 mg/d (also decrease with hepatic impairment)|
|Fluvastatin (Lescol)||Initial: 20-30 mg/d orally every bedtime|
Followed by 20-80 mg/d orally every bedtime; for 80 mg/d, divide twice daily
|10-16 years: 20 mg orally every day initially; maintenance dosage ranges from 20-80 mg/d||No adjustment|
|Atorvastatin (Lipitor)||Initial: 10 mg/d PO orally every bedtime|
Followed by 10-80 mg/d orally every bedtime
|10-17 years: 10 mg orally every day initially; maintenance dosages do not exceed 20 mg/d||No adjustment for renal insufficiency; decrease dose or avoid with drugs that decrease clearance|
|Rosuvastatin (Crestor)||10-20 mg orally every day initially; maintenance dosage range is 5-40 mg/d||Not established||5 mg orally every day initially; not to exceed 10 mg/d|
|* Renal insufficiency is indicated by a creatinine clearance of less than 30 mL/min; agents known to decrease HMG-CoA–reductase inhibitor clearance include grapefruit juice, gemfibrozil, ritonavir, cyclosporine, danazol, amiodarone, azole antifungals, macrolide antibiotics, and verapamil.|
|Drug Name||Approved Indications||Adult Dose|
|Gemfibrozil (Lopid)||HLP types IIB, IV, and V||600 mg orally twice daily (ie, 1200 mg total daily dose) 30 min before meals (ie, before breakfast and dinner)|
|Fenofibrate (Tricor)||HLP types IIA, IIB, IV and V||Initial: 67 mg/d orally; not to exceed 67 mg orally twice daily|