Lipid-lowering medications in children

Class	Drug	Initial daily dose	Upper daily dose studied in clinical trials (children aged ≥10 years)^[1]	Maximum daily dose (adult)	Available strengths (United States)
Statins
	Atorvastatin	5 to 10 mg	20 mg	80 mg	10, 20, 40, 80 mg
	Fluvastatin	20 mg	80 mg	80 mg	20, 40 mg, 80 mg (extended release)
	Lovastatin	10 mg	40 mg	80 mg	10, 20, 40 mg 20, 40, 60 mg (extended release)
	Pravastatin	10 mg	40 mg (age 14 to 18 years) 20 mg (age 8 to 13 years)	80 mg	10, 20, 40, 80 mg
	Rosuvastatin	5 mg	20 mg	40 mg	5, 10, 20, 40 mg
	Simvastatin	10 mg (age ≥10 years) 5 mg (age 10 years)	40 mg	40 mg	5, 10, 20, 40, 80^¶ mg
Cholesterol absorption inhibitors
	Ezetimibe	10 mg	10 mg	10 mg	10 mg
Fibric acid derivates
	Gemfibrozil	1200 mg^*	Data lacking	1200 mg	600 mg
	Fenofibrate	40 mg	Data lacking	130 to 200 mg (maximum dose depends on preparation; see Lexicomp drug reference)	40, 43, 48, 50, 54, 67, 100, 120, 134, 145, 160, 200 mg (available strengths vary by preparation; see Lexicomp drug reference)
Bile acid sequestrants
	Cholestyramine	2 to 4 g or 240 mg/kg per day	8 g 4 g (age <10 years)	16 g	4 g per packet or scoop
	Colestipol	2.5 to 5 g	12 g	20 g	5 g per packet or scoop 1 g tablet
	Colesevelam	1.25 g	3.75 g	3.75 g	3.75 g per packet 625 mg tablet
Omega-3 fish oils
	Omega-3 acid ethyl esters	1 g	Data lacking	4 g	1 g (many strengths available)

Always review drug interactions upon initiation and alteration of treatment. Specific interactions may be determined using the drug interactions tool (Lexi-Interact Online) included with UpToDate. This tool can be accessed from the UpToDate online search page or through the individual drug information topics in the section on Drug interactions.
Children and adolescents are generally not managed with more than one class of lipid-lowering agents due to increased risk of side effects. Combinations of statins and fibrates should be administered under the supervision of a pediatric lipid specialist.

LDL-C: low-density lipoprotein cholesterol.
* An initial 600 mg daily dose of gemfibrozil may be considered. Data in children are lacking.
^¶ The US Food and Drug Administration has placed a black box label on simvastatin at a dose of 80 mg per day because it is associated with muscle toxicity in adults. If a daily dose of 40 mg of simvastatin is insufficient to achieve LDL-C control, a change to a more potent statin (eg, atorvastatin or rosuvastatin) is suggested. Doses of simvastatin that exceed 40 mg per day should be given under the supervision of a pediatric lipid specialist, and are generally not required, as more potent statins are available.

Reference:

Data from: Daniels DR, Benuck I, Christakis DA, et al. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report-2011. National Heart Lung and Blood Institute. Available at: https://www.nhlbi.nih.gov/node/80139 (Accessed April 4, 2012).

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Lipid-lowering medications in children