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Home > Formulary : Adult > Chapters > 2. Cardiovascular System >

BNSSG Adult Joint Formulary

2.6 Hyperlipidaemia

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Last edited: 03-06-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Lipid-regulating drugs

 

Bile acid sequestrants

Bile acid sequestrants are not routinely used for hyperlipidaemia, except in the context of bile acid malabsorption. Please see NHS Accelerated Access Collaborative: Statin intolerance pathway  for management of patients with statin intolerance. Please see 1.7 Liver disorders and related conditions for further information on bile acid sequestrants.

 

Cholesterol Absorption inhibitors

Ezetimibe (TLS Green)

  • NICE TA385 Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
  • As an alternative to a statin in adults in whom statins are contraindicated or not tolerated
  • In addition to a statin in adults who have started statin treatment but whose serum total or LDL cholesterol concentration is not appropriately controlled (either after appropriate dose titration or because dose titration is limited by intolerance to the initial statin therapy) consideration is being given to changing from initial statin therapy to an alternative statin
  • For use with Bempedoic acid (TLS Blue) in line with NICE TA694 for treating primary hypercholesterolaemia or mixed dyslipidaemia 

 

Fibrates

Fenofibrate (micronised or modified-release) (TLS Blue)

Bezafibrate (TLS Blue)

  • No longer recommended for routine use for cardiovascular disease prevention- for existing patients only. 
  • May be used for management of severe hypertriglyceridaemia by lipic clinic for patients intolerant to fenofibrate.
  • Use with care if patient has renal impairment, avoid if eGFR <15mL/min/1.73m2

 

Omega-3 fatty acid compounds

Not recommended

 

Statins

Atorvastatin (TLS Green)

Pravastatin (TLS Blue)

  • Low intensity statin and no longer recommended for routine use

Simvastatin (TLS Blue)

  • Low intensity statin and no longer recommended for routine use

Rosuvastatin (TLS Blue)

 

Monoclonal antibodies

Alirocumab (TLS Red)

  • NICE TA393 Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Evolocumab (TLS Red)

  • NHSE commissioned drug for treatment of homozygous familial hypercholesterolaemia only
  • NICE TA394 Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

 

Other

Lomitapide (TLS Red)

Volanesorsen (TLS Red)

Bempedoic Acid (TLS Blue)

  • For use with ezetemibe in line with NICE TA694 for treating primary hypercholesterolaemia or mixed dyslipidaemia 

Inclisiran (TLS Blue)

Icosapent ethyl (TLS Blue)

  • NICE TA805 Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides

 

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