Juxtapid (lomitapide) is used to treat a rare, genetic type of high cholesterol, known as homozygous familial hypercholesterolemia (HoFH). It's typically used along with other cholesterol-lowering medications and dietary changes, such as a low-fat diet. Because it has a risk of severe liver damage, only certified healthcare providers can prescribe this medication.
Homozygous familial hypercholesterolemia (HoFH, genetic condition that causes high cholesterol)
Juxtapid (lomitapide) is a microsomal triglyceride transfer protein (MTP) inhibitor. MTP is a protein in your body that helps make cholesterol. Juxtapid (lomitapide) works by blocking MTP, which stops your body from making cholesterol, including low-density lipoprotein cholesterol (LDL-C, a type of "bad cholesterol"). This helps lower the levels of "bad cholesterol" in your blood.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Arm, back, or jaw pain
chest pain or discomfort
chest tightness or heaviness
dark urine
fast, irregular, pounding, or racing heartbeat or pulse
light-colored stools
loss of appetite
sweating
trouble breathing
unusual tiredness or weakness
upper right abdominal or stomach pain
yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
back pain
belching
chills
decreased weight
dizziness
excess air or gas in the stomach or intestines
frequent urge to defecate
full or bloated feeling
general feeling of discomfort or illness
headache
indigestion
joint pain
muscle aches and pains
passing gas
pressure in the stomach
shivering
stomach discomfort, upset, or pain
straining while passing stool
stuffy or runny nose
sweating
swelling of the abdominal or stomach area
trouble sleeping
weakness
Incidence not known
Hair loss or thinning of the hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Only need to take once daily
Available in many dosage strengths
Works well as an add-on medication to treat a rare, genetic form of high cholesterol
Must remember to take on an empty stomach
Must follow a low-fat diet while taking this medication
Risk of serious liver damage
Only available as a brand medication, so it can be expensive
Your Juxtapid (lomitapide) dose will be adjusted (up or down) until you and your healthcare provider agree on a dose that works well for you. If you miss a dose, skip the missed dose and wait to take your normal dose at your usual time the next day. If you miss doses for more than 1 week or if you stop taking the medication for more than 1 week, don't restart your medication until discussing it with your provider. The levels in your body might be affected, so your provider might have to make adjustments to your dose.
Avoid eating grapefruit or drinking grapefruit juice with Juxtapid (lomitapide). Grapefruit can raise levels of this medication in your body, leading to greater side effects such as stomach pain, bloating, and indigestion.
Juxtapid (lomitapide) interacts with many medications. Let your provider and pharmacist know about all the medications you're taking or plan to take, including over-the-counter medications and supplements. They will decide if you need to switch medications or if your dose of Juxtapid (lomitapide) needs to be changed.
If you're taking warfarin (Coumadin), a blood thinner, you might need to check your INR (bleeding time) more often. Juxtapid (lomitapide) raises levels of warfarin (Coumadin) in your body, which puts you at higher risk for bleeding.
If you're taking cholesterol medications like simvastatin (Zocor) or lovastatin (Mevacor), let your pharmacist or healthcare provider know because you might need a lower dose of Juxtapid (lomitapide). Juxtapid (lomitapide) raises levels of these cholesterol medications in your body, which puts you at greater risk for muscle breakdown and pain.
Juxtapid (lomitapide) can cause serious liver damage in some people. If you take other medications that also affect your liver, such as acetaminophen (Tylenol) or methotrexate, let your pharmacist or healthcare provider know. Depending on the medication, you might need to get blood tests done more often to check your liver function.
You can only start Juxtapid (lomitapide) if you have a negative pregnancy test. If you're of childbearing age, it's important to use a reliable method of birth control while taking this medication. This is because taking Juxtapid (lomitapide) while pregnant can potentially cause harm to your unborn baby. Juxtapid (lomitapide) can lower how well some birth control pills work, especially if you have diarrhea or vomiting. If this happens, use an alternative form of birth control for 1 week, even if your symptoms go away. If you plan on stopping Juxtapid (lomitapide), remember to continue using birth control for 2 more weeks after your last dose because the medication might still be present in your body for some time. Tell your pharmacist or healthcare provider if you start any new birth control pills while you're taking Juxtapid (lomitapide) because your dose might need to be adjusted.
Juxtapid (lomitapide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: History of liver disease | Taking other medications that cause liver damage, such as acetaminophen (Tylenol) | Drinking alcohol
There's a risk of serious liver damage and buildup of fat in your liver (hepatic steatosis) while taking Juxtapid (lomitapide). This medication should not be used if you currently have liver disease or damage. If you have a history of liver disease, let your healthcare provider know before you start Juxtapid (lomitapide), since they'll need to check if the medication is safe for you.
To make sure your liver is healthy, you'll need to get blood tests done before you start Juxtapid (lomitapide) and routinely while you're taking the medication. Depending on your labs, your provider might adjust your dose. If you have symptoms of liver damage, such as yellowing of your skin or eyes (jaundice), stomach pain or swelling, loss of appetite, dark urine, nausea, vomiting, tiredness, weakness, or confusion, stop taking Juxtapid (lomitapide) and let your provider know right away.
Because of this risk of serious liver damage, the FDA has required a Risk Evaluation and Mitigation Strategy (REMS) Program for Juxtapid (lomitapide). Under this program, Juxtapid (lomitapide) is only available at select pharmacies with a prescription from a certified provider. The REMS program educates you and your healthcare provider about this risk and the need for routine liver monitoring to make sure the medication is safe for you. For questions about the Juxtapid (lomitapide) REMS program, visit the website or call 1-855-JUXTAPID (1-855-898-2743).
Risk factors: Taking Juxtapid (lomitapide) while pregnant | Breastfeeding
Juxtapid (lomitapide) should never be used during pregnancy because of the risk of serious harm to your unborn baby. Studies show serious harm and death to unborn babies in pregnant animals. Because of this risk, you'll need to get a pregnancy test done before starting Juxtapid (lomitapide) to make sure you're not pregnant. Use birth control while taking Juxtapid (lomitapide) and for 2 weeks after your last dose of the medication to avoid becoming pregnant. If you plan on becoming pregnant or you think you might be pregnant, stop using Juxtapid (lomitapide) and call your healthcare provider right away.
Risk factors: Taking vitamin E or fatty acids (e.g., omega-3 acids) | History of conditions that affect absorption (e.g., long-term bowel conditions, pancreatic conditions)
Juxtapid (lomitapide) can lower the absorption of vitamins that dissolve in fat (fat-soluble vitamins), such as vitamin E. The same is true for dietary supplements containing fatty acids, such as alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). These fatty acids are important for your body's growth and development. Omega-3 fatty acids is a common supplement that contains some of these fatty acids. To prevent these levels from getting too low, your provider will suggest you take daily vitamin E and fatty acid supplements along with Juxtapid (lomitapide). Ask your pharmacist or provider about which supplements and dosages to take.
Risk factors: Eating high-fat foods
Stomach-related side effects can occur quite commonly while taking Juxtapid (lomitapide), especially if you're eating foods high in fat. It's important to follow a low-fat diet while taking this medication to prevent stomach-related symptoms, such as diarrhea, nausea, vomiting, indigestion, pain, and gas. Some severe cases of diarrhea might require treatment at a hospital. If you have severe diarrhea along with dizziness, lightheadedness, tiredness, or you're urinating less often, stop taking Juxtapid (lomitapide) and let your healthcare provider know right away.
Juxtapid (lomitapide) can interact with many medications. Certain medications can raise Juxtapid (lomitapide) levels in your body and raise your risk of side effects, such as liver damage and stomach symptoms. These medications include verapamil, amlodipine (Norvasc), fluconazole (Diflucan), and fluoxetine (Prozac), among many others. Avoid grapefruit while taking Juxtapid (lomitapide) because this can also raise medication levels in your body and raise the risk of side effects. Let your healthcare provider know about all the medications and supplements you're taking or plan to take so they can make sure Juxtapid (lomitapide) is safe for you to take. You might need to stop or change certain medications, or your provider might lower your Juxtapid (lomitapide) dose.
Risk factors: History of genetic conditions that cause absorption problems (e.g., galactose intolerance, glucose-galactose absorption problems, Lapp lactase deficiency
Juxtapid (lomitapide) can lead to absorption problems and diarrhea if you have certain rare, genetic health conditions that cause absorption problems. These include galactose intolerance, the Lapp lactase deficiency, and glucose-galactose absorption problems. Avoid using Juxtapid (lomitapide) if you have any of these conditions. Discuss other options with your healthcare provider.
Your dose will be adjusted based on how well you tolerate the medication and how well it's working to control your cholesterol.
The typical starting dose is 5 mg by mouth once daily. The maximum dose is 60 mg by mouth once daily.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Currently pregnant
History of liver damage or disease
Take medications that strongly interact with Juxtapid (lomitapide), such as verapamil, ritonavir (Norvir), or fluconazole (Diflucan)
Homozygous familial hypercholesterolemia (HoFH, genetic condition that causes high cholesterol)
Lower the risk of heart or blood vessel problems (e.g., heart attack, stroke) in people at risk for heart disease
Lower "bad" cholesterol and triglyceride levels in certain people
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