This review considers the hypolipidaemic drugs that act on the gastrointestinal (GI) tract. We searched PubMed up to April 2008 and included randomized controlled trials, original papers, review articles and case reports.
Bile acid sequestrants (BAS) have a well-established
low density lipoprotein cholesterol (
LDL-C) lowering effect, but may increase
triglyceride (TG) levels. BAS have no systematic adverse effects, but are associated with increased GI adverse effects and interactions with the absorption of other drugs.
Ezetimibe improves
LDL-C,
high density lipoprotein cholesterol and TG levels, as monotherapy or especially when given with a
statin.
Ezetimibe has not been associated with serious adverse effects.
Ezetimibe has not been evaluated in large clinical trials with
cardiovascular disease (CVD) endpoints.
Phytosterols are not licensed drugs; they have a well-established
LDL-C lowering effect, but there are no large long-term randomized clinical trials investigating their effects on CVD events.
Orlistat is an
antiobesity drug with a small additional
LDL-C lowering effect independent of
weight loss.
Orlistat-assisted
weight loss improves the overall
lipid profile, carbohydrate metabolism and
transaminase activities. However, its use should be limited to
weight reduction. This
drug is associated with increased GI adverse effects.