I have seen a patient with such significantly high trigs that did respond so quickly to fibrate, and remained low once treated. So, whilst there is a link with venlafaxine I would leave on the fibrate. After all, the link with venlafaxine is not necessarily truly due to the drug but could be due to alcohol consumption in mental health problems.
 
TIM
 

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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mohammad Al-Jubouri
Sent: 21 September 2012 3:41 PM
To: [log in to unmask]
Subject: Re: Friday afternoon challenge

Hi Danielle,
 
You probably would agree that neither simvastatin nor ciprofibrate has produced the reduction in TG levels in this patient. There are few case reports linking Venlafaxine to the development of severe hypertriglyceridaemia, so worth withdrawing this drug.
 
Regards
 
Mohammad
 
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
From: Freedman Danielle (RC9) Luton & Dunstable Hospital TR <[log in to unmask]>
To: [log in to unmask]
Sent: Friday, September 21, 2012 3:18 PM
Subject: Friday afternoon challenge

Any ideas please ??
I think I must be missing something....
 
I saw a new patient in clinic yesterday with a very odd series of lipid results
 
54 yr old Caucasian female( not from Luton, but Harpenden) non smoker, type 2 DM ( HbA1c never high according to GP), BMI 35, minimal alcohol consumption
No clinical stigmata of hyperlipidaemia
 
Drug History
Metformin
Amlodipine
Candesartan,
Venlafaxine
Femoston
Inhalers for asthma
No other real PMH
 
 
June 2011
Tg  45.0,   Chol 8.4 mmol/L
 
Gp started her on Simvastatin 40mg  !!
 
 
July 2011
 Tg  5.2 ,  Chol  4.1 mmol/L
 
 
No bloods for 12 months
 
21/8/12
Tg 29.6, Chol 15.2  HBA1c 51mmol/mol
 
30/8/12
 
Tg 93.0, Chol 20.4mmol/L
 
 
All above samples assayed at another lab using Vitros and GP lab reports say samples were lipaemic
She was still on Simvastatin 40mg
 
Gp phoned me on 13th Sept and I told her to stop Statin and give her Ciprofibrate 100mg nocte,( so had been taking it for 1 week) and saw her yesterday
 
Her fasting lipids today on Beckman
Tg 4.4, Chol 4.0, HDL 1.84 mmol/L
FBC ( and MCV),LFT and U and E normal
 
Patient denies any excessive indulgence in fatty foods.
 
 
Any ideas why this patient had 3 out of 4 such deranged results...?
 
My colleague suggested we give her a “ Pizza and chips challenge”.....
 
 
 
Many thanks
Regards
Danielle
 
Dr Danielle B. Freedman MB BS, FRCPath,EurClinChem
Divisional Director
Diagnostics, Therapeutics and Outpatients
Luton and Dunstable University Hospital NHS FT
Luton, LU4 0DZ
 
+441582 497212
 
 
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------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/