Drug Therapy In People Research Articles

Non adherence to treatment and the associated factors in patients with epilepsy in Southern Ethiopia

Adherence to antiepileptic drug therapy in people with epilepsy is critical for seizure control. Poor adherence to epilepsy treatment, on the other hand, is recognized as a worldwide problem, particularly in developing countries such as Ethiopia. As a result, the current study seeks to ascertain patients’ adherence to antiepileptic medications and the factors that influence it at Hawassa University Comprehensive Specialized Hospital in Southern Ethiopia. From February 1 to October 15, 2017, 187 people with epilepsy who were on followup at Hawassa University Comprehensive Specialized Hospital underwent a hospitalbased retrospective medical review. Adherence was measured using Morisky Medication Scale-8. Data was entered and analyzed using the soft ware Statistical package for social sciences version 20. The results were summarized using cross-tabulations and frequency tables. While binary logistic regression was used to analyze factors associated with adherence to antiepileptic drug therapy, significance was declared at p<0.05. According to the findings of the current study, about nineteen percent of the study participants were nonadherent to their treatment. Compared to patients with monthly income of less than 1000.00 ETB, those who earn>3000.00 ETB [AOR=0.164, 95% CI (0.038: 0.702)] and those with monthly income between 2000 and 3000 ETB [AOR=0.110, 95%CI (0.026:0.461)] [AOR=0.110, 95% CI (0.026:0.461)] are less likely associated with non-adherent to antiepileptic drugs (P<0.05). Likewise, patients who perceived epilepsy as psychiatric disorder [AOR= 0.250, 95%CI (0.087: 0.716)] compared to those who perceive it as neurologic, and those patients with seizure free period of less than one year [AOR= 0.206, 95%CI(0.076:0.562)] compared to those with seizure free period of more than one year are found to be less non adherent (p<0.05).

The Relationship between Antipsychotic Drug Use and Liver Enzyme Levels in People with Mental Disorders

The long-term use of some drugs causes side effects in the form of elevated liver enzyme levels. Meanwhile, antipsychotic drug therapy in people with mental disorders induces liver injury which leads to an elevation in serum glutamic oxaloacetic and pyruvic transaminases. Therefore, this study aims to analyze the relationship between the uses of antipsychotic drugs with elevated liver enzymes in people with mental disorders. This observational study used a cross-sectional design that included 69 people with mental disorders. The respondents were selected based on consecutive non-random sampling, while the data were collected using a questionnaire to obtain the universal characteristics of the subjects, therapy duration, and antipsychotic type, as well as an examination of AST and ALT levels using the ultraviolet test method. Furthermore, data analysis was conducted using the chi-Square test with a significance level of p<0.05. The results showed that thirty-two among the respondents or 46.4% used atypical antipsychotics, while 37 or 73.0% received the drugs for 1-6 months. In the subjects receiving typical antipsychotics, 10 or 55.6% had a significant elevation in liver enzymes compared to others receiving atypical antipsychotics namely 6 (18.8%) or a combination of both drugs namely 6 (31.6%). Therefore, the type of antipsychotic used in therapy has a significant relationship with elevated liver enzymes in people with mental disorders (p=0.028).
 Keywords: antipsychotics, drugs, elevated

Type2 diabetes:changing patterns of use of antidiabetic drugs 8 years after starting treatment(snds)

Abstract Objective To describe the changing patterns in the use of the various classes of antidiabetic drugs in a cohort of patients newly treated for diabetes from 2008 to 2015 on the basis of comprehensive health insurance data. Methods General scheme beneficiaries 45 years and older were identified in the French National Health Data System (SNDS) as newly treated when antidiabetic drugs were dispensed on at least 3 different dates in 2008 and at least once during the last 4 months of 2008, but were dispensed less than 3 times in 2006-2007. Treatment regimens for the last 4 months of each year were defined for this cohort. Results 158,000 people (53% men, mean age 62 years) initiated antidiabetic drug therapy in 2008: monotherapy (without insulin): 74%, dual therapy: 17%, treatment with 3 or more drugs: 3%, and insulin therapy: 7%. The proportion of patients taking monotherapy decreased by 13 percentage points during the second year and only 32% of the cohort was treated by monotherapy 8 years after starting treatment. The proportions of patients taking dual therapy increased by 4 percentage points (21% in 2015), triple therapy increased by 8 percentage points (11%), a combination of insulin+other antidiabetics increased by 4 percentage points (7%) and insulin alone remained stable (4%). At the last quarter of 2015, 12% of patients did not receive any antidiabetic drugs and 13% had died. The creation of a cohort of diabetic patients newly treated in 2013 demonstrated changing prescribing practices: a lower proportion of monotherapy in the first year of treatment, but a growing use of metformin. Conclusions Treatment was intensified during the first 8 years for one half of the cohort. The maximal dosage of Metformin is not used before introducing a second antidiabetic in 1 case in 2. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving. Key messages Initiation of antidiabetic drug therapy in people 45 years and older consisted of monotherapy in 3/4 of cases in 2008. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.

Contemporary Drug-Drug Interactions in HIV Treatment.

Despite development of modern antiretrovirals with lower drug interaction potential than their predecessors, drug interaction challenges remain. Standard treatment regimens still require multiple antiretrovirals that may cause, or may be the target of, drug interactions. Additionally, people living with HIV are living longer and often present with comorbid conditions that require concomitant long-term drug therapy. Also, treatment of infectious diseases in resource-limited settings can result in significant interactions. In this review, we describe absorption, distribution, metabolism, and excretion pathways as they relate to relevant drug interactions with antiretrovirals along with the potential clinical consequences of these interactions. We highlight clinical data that illustrate pertinent interactions and provide tools to assist in predicting drug interactions in the absence of clinical data. Given these tools and thoughtful consideration of drug combinations, drug therapy in people living with HIV can be safely and effectively managed throughout their lifetime.

PDB28 - TYPE 2 DIABETES: CHANGING PATTERNS OF USE OF THE VARIOUS CLASSES OF ANTIDIABETIC DRUGS 8 YEARS AFTER STARTING TREATMENT: A NATIONWIDE COHORT STUDY USING THE FRENCH NATIONAL HEALTH DATA SYSTEM (SNDS)

To describe the changing patterns in the use of the various classes of antidiabetic drugs in a cohort of patients newly treated for diabetes from 2008 to 2015. General scheme beneficiaries 45 years and older were identified in the French National Health Data System (SNDS) as newly treated when antidiabetic drugs were dispensed on at least 3 different dates in 2008 and at least once during the last 4 months of 2008, but were dispensed less than 3 times in 2006-2007. 158,000 people initiated antidiabetic drug therapy in 2008: monotherapy (without insulin): 74%, dual therapy: 17%, treatment with 3 or more drugs: 3%, and insulin therapy: 7%. The proportion of patients taking monotherapy decreased by 13 percentage points during the second year and only 32% of the cohort was treated by monotherapy 8 years after starting treatment. The proportions of patients taking dual therapy increased by 4 percentage points (21% in 2015), triple therapy increased by 8 percentage points (11%), a combination of insulin + other antidiabetics increased by 4 percentage points (7%) and insulin alone remained stable (4%). The proportion of patients taking metformin monotherapy increased slightly (67% in 2008, +2 percentage points). At the last quarter of 2015, 12% of patients did not receive any antidiabetic drugs and 13% had died. The creation of a cohort of diabetic patients newly treated in 2013 demonstrated changing prescribing practices: a lower proportion of monotherapy in the first year of treatment, but a growing use of metformin. Initiation of antidiabetic drug therapy in people 45 years and older consisted of monotherapy in 3/4 of cases in 2008. Treatment was intensified during the first 8 years for one half of the cohort. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.

Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study.

Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. To examine the prevalence of polypharmacy and PIM in older people with and without dementia in a nationwide population. Cross-sectional study of the Danish population aged ≥65 in 2014 (n = 1,032,120) based on register data, including information on diagnoses and dispensed prescriptions. Polypharmacy and PIM use among people with (n = 35,476) and without dementia (n = 994,231) were compared, stratified by living situation and adjusted for age, sex, and comorbidity. The red-yellow-green list from the Danish Institute for Rational Pharmacotherapy and the German PRISCUS list were used to define PIM. People with dementia were more frequently exposed to polypharmacy (dementia: 62.6% versus no-dementia: 35.1%, p < 0.001) and likewise PIM (red-yellow-green: 45.0% versus 29.7%, p < 0.001; PRISCUS: 24.4% versus 13.2%, p < 0.001). After adjustments for age, sex, and comorbidity, the likelihood of polypharmacy and PIM was higher for community-dwelling people with dementia than without dementia (odds ratio (OR); [95% confidence interval (CI)] polypharmacy: 1.50 [1.45-1.55]; red-yellow-green: 1.27 [1.23-1.31]; PRISCUS: 1.25 [1.20-1.30]). In contrast, dementia slightly decreased the odds of polypharmacy and PIM in nursing home residents. Use of polypharmacy and PIM were widespread in the older population and more so in people with dementia. This could have negative implications for patient-safety and demonstrates the need for interventions to improve drug therapy in people with dementia.

Drug therapy for people with mental disorders in the view of nursing professionals

Abstract Objective: To identify the perception of nursing professionals about drug therapy for people with mental disorders. Methods: An exploratory qualitative research was carried out in four Psychosocial Care Centers of Curitiba, Paraná, Brazil. Data, collected from January to March 2015 using an individual semi-structured interview applied to 56 nursing professionals, were submitted to qualitative data analysis and interpretation as proposed by Creswell. Results: The data were organized into three thematic categories: drug therapy improves the life of the person with a mental disorder; negative and positive consequences related to drug therapy; and drug therapy as one of the resources needed to treat mental health. Conclusion: Nursing staff perceive the importance of medications as a resource to treat people with mental disorders as psychotropic drugs minimize he acute symptoms of disorders and improve living conditions when associated with other therapeutic resources.

Drug therapy for chronic idiopathic axonal polyneuropathy.

Chronic idiopathic axonal polyneuropathy (CIAP) is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, CIAP reduces quality of life. CIAP is diagnosed in 10% to 25% of people referred for evaluation of polyneuropathy. There is a need to gather and review emerging evidence on treatments, as the number of people affected is likely to increase in ageing populations. This is an update of a review first published in 2004 and previously updated in 2006, 2008, 2011 and 2013. To assess the effects of drug therapy for chronic idiopathic axonal polyneuropathy for reducing disability and ameliorating neurological symptoms and associated impairments, and to assess any adverse effects of treatment. In July 2016, we searched Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews in the Cochrane Library, MEDLINE, Embase, and the Web of Science. We searched two trials registries for ongoing trials. We also handsearched the reference lists of relevant articles, reviews and textbooks identified electronically, and we would have contacted authors and other experts in the field to identify additional studies if this seemed useful. We sought all randomised or quasi-randomised (alternate or other systematic treatment allocation) trials that examined the effects of any drug therapy in people with CIAP at least one year after the onset of treatment. People with CIAP had to fulfil the following criteria: age 40 years or older, distal sensory or sensorimotor polyneuropathy, absence of systemic or other neurological disease, chronic clinical course not reaching a nadir in less than two months, exclusion of any recognised cause of the polyneuropathy by medical history taking, clinical or laboratory investigations, and electrophysiological studies in agreement with axonal polyneuropathy, without evidence of demyelinating features. The primary outcome was the proportion of participants with a significant improvement in disability. Secondary outcomes were change in the mean disability score, change in the proportion of participants who make use of walking aids, change in the mean Medical Research Council sum score, degree of pain relief and/or reduction of other positive sensory symptoms, change in the proportion of participants with pain or other positive sensory symptoms, and frequency of adverse effects. Two review authors independently reviewed the results of the literature search and extracted details of trial methodology and outcome data of all potentially relevant trials. We identified 39 studies and assessed them for possible inclusion in the review, but we excluded all of them because of insufficient quality or lack of relevance. We summarised evidence from non-randomised studies in the Discussion. Even though CIAP has been clearly described and delineated, no adequate randomised or quasi-randomised controlled clinical treatment trials have been performed. In their absence there is no proven efficacious drug therapy.

Effect of Temperature on Tolbutamide Binding to Glycated Serum Albumin.

Glycation process occurs in protein and becomes more pronounced in diabetes when an increased amount of reducing sugar is present in bloodstream. Glycation of protein may cause conformational changes resulting in the alterations of its binding properties even though they occur at a distance from the binding sites. The changes in protein properties could be related to several pathological consequences such as diabetic and nondiabetic cardiovascular diseases, cataract, renal dysfunction and Alzheimer’s disease. The experiment was designed to test the impact of glycation process on sulfonylurea drug tolbutamide-albumin binding under physiological (T = 309 K) and inflammatory (T = 311 K and T = 313 K) states using fluorescence and UV-VIS spectroscopies. It was found in fluorescence analysis experiments that the modification of serum albumin in tryptophanyl and tyrosyl residues environment may affect the tolbutamide (TB) binding to albumin in subdomain IIA and/or IIIA (Sudlow’s site I and/or II), and also in subdomains IB and IIB. We estimated the binding of tolbutamide to albumin described by a mixed nature of interaction (specific and nonspecific). The association constants (L∙mol−1) for tolbutamide at its high affinity sites on non-glycated albumin were in the range of 1.98–7.88 × 104 L∙mol−1 (λex = 275 nm), 1.20–1.64 × 104 L∙mol−1 (λex = 295 nm) and decreased to 1.24–0.42 × 104 L∙mol−1 at λex = 275 nm (T = 309 K and T = 311 K) and increased to 2.79 × 104 L∙mol−1 at λex = 275 nm (T = 313 K) and to 4.43–6.61 × 104 L∙mol−1 at λex = 295 nm due to the glycation process. Temperature dependence suggests the important role of van der Waals forces and hydrogen bonding in hydrophobic interactions between tolbutamide and both glycated and non-glycated albumin. We concluded that the changes in the environment of TB binding of albumin in subdomain IIA and/or IIIA as well as in subdomains IB and IIB influence on therapeutic effect and therefore the studies of the binding of tolbutamide (in diabetes) to transporting protein under glycation that refers to the modification of a protein are of great importance in pharmacology and biochemistry. This information may lead to the development of more effective drug therapy in people with diabetes.

The Role of Antiepileptic Treatment in the Recurrence Rate of Seizures After First Attack: A Randomized Clinical Trial.

Epilepsy is a serious, potentially life-shortening brain disorder that occurs in patients of all ages and races. A total of 2-4% of people have experienced seizures at least once in their lifetime. Although treatment usually begins after a seizure, it is an important question whether the first cases of seizure do need to be treated by antiepileptic drugs. In this manner, we compare the recurrence rates of epilepsy in first seizure patients treated with sodium valproic acid as an antiepileptic drug versus a placebo. In a randomized clinical trial study, 101 first seizure patients were randomly divided into two groups: one group was treated with antiepileptic drugs (sodium valproate 200mg, three times a day) and the other group was given a placebo. The recurrence rate of seizures was evaluated and compared between the groups after 6 months of follow up. Eight recurrence cases were detected. All recurrence cases came from the placebo group, with four patients suffering an additional seizure after four months and between 4-6 month follow up. A comparison of recurrence rate detected a statistically significant difference between the drug group and placebo group. Our data shows that the recurrences occurred only in the placebo group with the difference between the recurrence rates in the placebo versus drug-treated was significant. Our results suggest that drug therapy for people after their first seizure attack might reduce the probability of seizure recurrence.

Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension

OBJECTIVE—Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown. RESEARCH DESIGN AND METHODS—We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like diuretic (chlorthalidone), a calcium channel blocker (CCB; amlodipine), or an ACE inhibitor (lisinopril) in nondiabetic individuals with or without metabolic syndrome. RESULTS—In participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose ≥126 mg/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P = 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P &amp;lt; 0.05, lisinopril vs. chlorthalidone). For those without metabolic syndrome, the rate of newly diagnosed diabetes was 7.7% for chlorthalidone, 4.2% for amlodipine, and 4.7% for lisinopril (P &amp;lt; 0.05 for both comparisons). There were no differences in relative risks (RRs) for outcomes with amlodipine compared with chlorthalidone in those with metabolic syndrome; in those without metabolic syndrome, there was a higher risk for heart failure (RR 1.55 [95% CI 1.25–1.35]). In comparison with lisinopril, chlorthalidone was superior in those with metabolic syndrome with respect to heart failure (1.31 [1.04–1.64]) and combined cardiovascular disease (CVD) (1.19 [1.07–1.32]). No significant treatment group–metabolic syndrome interaction was noted. CONCLUSIONS—Despite a less favorable metabolic profile, thiazide-like diuretic initial therapy for hypertension offers similar, and in some instances possibly superior, CVD outcomes in older hypertensive adults with metabolic syndrome, as compared with treatment with CCBs and ACE inhibitors.

Clinical effectiveness and cost-effectiveness of implantable cardioverter defibrillators for arrhythmias: A systematic review and economic evaluation

The clinical effectiveness and cost-effectiveness of implantable cardioverter defibrillators (ICD) for arrhythmias was assessed. A systematic review of the literature of systematic reviews and randomized controlled trials that reported mortality outcomes associated with implantable cardioverter defibrillators compared with antiarrhythmic drug therapy in people at risk of sudden cardiac death due to arrhythmias was undertaken. Economic evaluations were also sought. Inclusion criteria, data extraction, and quality assessment were undertaken by standard methodology. A decision analytic model was constructed using best available evidence to determine cost-effectiveness in a UK setting. Eight randomized controlled trials, two systematic reviews, and a meta-analysis met the inclusion criteria and were of variable quality. Evidence suggests that ICDs reduce mortality in both secondary and primary prevention, although the magnitude of benefit depends on baseline risk for sudden cardiac death. Incremental cost per quality-adjusted life year ranged from 52,000 UK pounds ($98,000) to over 200,000 UK pounds ($379,000), depending on mortality risk and assumptions made. Evidence suggests that ICDs reduce total mortality but may be cost-effective only in some subgroups of patients at high risk of ventricular arrhythmias. Further research is needed on risk stratification of patients in whom ICDs are most likely to be clinically and cost-effective.

Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data

Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. We did a secondary analysis of public-access data sets in 18 African countries (132,800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified.

A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes

To assess efficacy and tolerability of insulin detemir or NPH insulin added to oral therapy for type 2 diabetes in a treat-to-target titration protocol. Individuals (n = 476) with HbA(1c) (A1C) 7.5-10.0% were randomized to addition of twice-daily insulin detemir or NPH insulin in a parallel-group, multicenter trial. Over 24 weeks, insulin doses were titrated toward prebreakfast and predinner plasma glucose targets of < or =6.0 mmol/l (< or =108 mg/dl). Outcomes assessed included A1C, percentage achieving A1C < or =7.0%, risk of hypoglycemia, and body weight. At 24 weeks, A1C had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C </= 7.0%; [corrected] there was a trend towards [corrected] the proportion achieving this without hypoglycemia being [corrected] higher with insulin detemir than with NPH insulin (34% [corrected] vs. 25[corrected]%, P = 0.052[corrected]). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was -1.58 (P < 0.001). Addition of basal insulin to oral drug therapy in people with suboptimal control of type 2 diabetes achieves guideline-recommended A1C values in most people with aggressive titration. Insulin detemir compared with NPH insulin achieves this with reduced hypoglycemia and less weight gain.

Drug Treatment for Hypercholesterolaemia

In Britain hypercholesterolaemia is common, and roughly a quarter of the adult population have plasma cholesterol levels greater than 6.5 mmol/1. Such levels are widely accepted as being associated with an appreciable risk of coronary heart disease. The risk appears to be directly related to the concentration of low density lipoprotein (LDL) cholesterol which is usually reflected in the total plasma cholesterol measurement [1]. High density lipoprotein (HDL) cholesterol is inversely related to coronary heart disease [1-3] but controversy remains as to whether it is an independent risk factor [4], The majority of people with a raised plasma cholesterol level have polygenic hypercholesterolaemia which is likely to respond to dietary modification (optimised calorie intake, reduction in saturated fat intake, an increase in the ratio of polyunsaturated to saturated fatty acids, and an increase in food containing soluble fibre). However, patients with a number of monogenic inherited disorders such as familial hypercholesterolaemia and familial combined hyperlipidaemia, have a particularly high risk of coronary heart disease and often show an inadequate response to diet changes alone. At least one in 500 people have familial hypercholesterolaemia, which in many adults is characterised by tendon xanthomas, xanthalasma and early corneal arcus, and is inherited in an autosomal dominant manner. The higher plasma concentration of LDL and total cholesterol is due to the fact that the cells of affected individuals have reduced numbers of the receptors responsible for LDL uptake. Untreated, these people have an estimated 50 per cent risk of dying from coronary heart disease before they reach 60 [5], and a significant number die or are disabled in their thirties and forties. Homozygotes, who are fortunately rare, seldom survive beyond the age of 25. Recent studies showing a reduction in the incidence and mortality from coronary heart disease associated with lowering of plasma cholesterol levels in people with primary hypercholesterolaemia [6, 7] have resulted in renewed interest in drug therapy for people who do not respond adequately to dietary modification. Coronary heart disease appears to be reduced irrespective of the type of hypercholeste rolaemia, but the potential benefit is likely to be particularly great in people with familial hypercholesterolaemia because their risk is so high if they are untreated. A number of different forms of lipid-lowerin g medication are available. For most patients with hypercholesterolaemia and normal, or near normal, plasma triglyceride concentration, an anion exchange resin such as cholestyramine or colestipol is the first line of treatment. These resins are not absorbed but act in the intestine by binding bile salts and reducing their enterohepatic circulation. This results in increased hepatic synthesis of bile salts from cholesterol. The dose of cholestyramin e required may vary from 4 to 28 g per day and the plasma cholesterol level can usually be reduced by at least 15 to 25 per cent. LDL cholesterol