What Is Juxtapid?
Juxtapid (lomitapide) is an oral prescription drug used to treat a rare genetic condition called homozygous familial hypercholesterolemia (HoFH), which causes very high levels of LDL cholesterol. It is available as an oral capsule.
Juxtapid is in a drug class called lipid-lowering agents. More specifically, it is a microsomal triglyceride transfer protein (MTP) inhibitor. Juxtapid works by slowing down the body’s production of cholesterol. However, it is not known if Juxtapid will lower the risk of heart attack, stroke, death, or other health problems.
Juxtapid should not be used in people who do not have HoFH.
Generic Name: Lomitapide
Brand Name(s): Juxtapid
Administration Route(s): Oral
Drug Availability: Prescription
Therapeutic Classification: Antihyperlipidemic
Available Generically: No
Controlled Substance: N/A
Active Ingredient: Lomitapide
Dosage Form(s): Capsule
What Is Juxtapid Used For?
The Food and Drug Administration (FDA) approved Juxtapid to be used along with a low-fat diet and other treatments in adults with HoFH to lower:
HoFH is a rare genetic condition that causes very high LDL levels and can lead to early cardiovascular events such as a heart attack or stroke.
Because Juxtapid is associated with liver toxicity, the drug is only available through a restricted program called the Juxtapid Risk Evaluation and Mitigation Strategy (REMS) program. Juxtapid can only be prescribed by certified healthcare providers enrolled in the program and can only be distributed by certified pharmacies that are enrolled in the program. Juxtapid can only be prescribed to adults with a diagnosis of HoFH who are enrolled in the program and understand the risks and benefits.
Juxtapid should not be prescribed to people with high cholesterol who do not have HoFH.
How to Take Juxtapid
Read the prescription label and the information leaflet that comes with your prescription. Consult your healthcare provider if you have any questions. Use Juxtapid exactly as directed by your provider.
If you are prescribed Juxtapid:
- Take Juxtapid once daily with water, at least two hours after the evening meal. Do not take Juxtapid with food. Taking it with food may cause stomach problems.
- Swallow the capsule whole. Do not chew, crush, dissolve, or open the capsule. If you cannot swallow the capsule whole, consult your healthcare provider.
- If you take a cholesterol medicine that binds bile acids (for example colesevelam or cholestyramine), take it at least four hours before or after Juxtapid.
- Eat a low-fat diet. This helps lower the chance of stomach problems. Talk to your healthcare provider or a registered dietician to determine what you should eat while taking Juxtapid. You may also need to take vitamin E and fatty acids while you take Juxtapid. Your healthcare provider or dietician can guide you on how to take these.
- Do not stop taking Juxtapid unless your healthcare provider tells you to stop.
Ask your healthcare provider if you have any questions or concerns about your medication.
Store at room temperature, away from heat, direct light, and moisture. Keep this medication in its original labeled container and out of the reach and out of sight of children and pets. Keep the bottle tightly closed when not in use.
How Long Does Juxtapid Take to Work?
Juxtapid may start working right away, but in some cases, the dosage may need to be gradually increased before results are seen. Your healthcare provider will adjust your dose as needed to reach your cholesterol goals.
What Are the Side Effects of Juxtapid?
Like other medications, Juxtapid can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
The most common side effects of Juxtapid are:
- Stomach problems: Stomach pain, bloating, nausea, vomiting, diarrhea, indigestion, constipation, gas, stomach “bug”, reflux (following a low-fat diet helps lower the chance of having some of these side effects)
- Urgency or uncomfortable sensation of needing to have a bowel movement
- Weight loss
- Chest pain
- Symptoms of the cold or flu, such as throat pain or fever
- Back pain
- Palpitations (feeling like the heart is racing, pounding, or fluttering)
- Increased levels of ALT or AST (tests of liver function)
- Fatty liver disease
Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Severe vomiting
- Severe diarrhea
- Liver toxicity
Long-Term Side Effects
While many people tolerate Juxtapid well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:
- Weight loss
- Sore throat
- Back pain
- Feeling like you need to have a bowel movement (even if your bowels are empty)
- Hair loss
- Vitamin deficiency
Moderate long-term side effects can include:
Severe long-term side effects may include:
- Increased liver enzyme levels
- Liver toxicity
Dosage: How Much Juxtapid Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (capsules):
For lowering bad cholesterol:
- Adults—At first, 5 milligrams (mg) once a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 60 mg per day.
- Children—Use and dose must be determined by your doctor.
- For lowering bad cholesterol:
Your healthcare provider may need to modify your treatment plan if you have liver, heart, or kidney problems. People with kidney problems or mild liver problems can use Juxtapid with caution and will require a lower dosage. However, people with moderate or severe liver problems should never take Juxtapid.
Juxtapid should never be prescribed during pregnancy because it can harm the fetus. Breastfeeding is also not recommended during treatment with Juxtapid because of the possibility of serious reactions, including liver toxicity.
Women of childbearing age should have a negative pregnancy test before starting Juxtapid. Use effective contraception during your treatment and for two weeks after your final dose. You can consult your provider if you need guidance with contraception. If you take oral birth control pills, be mindful that vomiting or diarrhea can make them less effective. If you have these symptoms, use an effective alternative method of contraception until seven days after diarrhea or vomiting goes away.
If you already take Juxtapid and find out that you are pregnant, stop taking Juxtapid and call your healthcare provider.
If you miss a dose of Juxtapid, take the usual dose the next day, at the regular time. If you stop taking Juxtapid for more than seven days, consult your healthcare provider before restarting.
Overdose: What Happens If I Take Too Much Juxtapid?
If you take too much Juxtapid, contact your healthcare provider for the next steps. There is no specific treatment for an overdose of this medication. You may be treated for your symptoms and require monitoring of liver-related tests.
What Happens If I Overdose on Juxtapid?
If you think you or someone else may have overdosed on Juxtapid, call a healthcare provider or the Poison Control Center (1-800-222-1222).
If someone collapses or isn’t breathing after taking Juxtapid, call 911 immediately.
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It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly to lower your bad cholesterol levels and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant during treatment and for at least 2 weeks after your last dose. If you think you have become pregnant while using the medicine, tell your doctor right away.
You must have a negative pregnancy test before you will be allowed to take this medicine. If you miss a period while you are using this medicine, tell your doctor right away.
Do not use this medicine if you also use any of the following: aprepitant (Emend®), boceprevir (Victrelis®), conivaptan (Vaprisol®), crizotinib (Xalkori®), diltiazem (Cardizem®), imatinib (Gleevec®), mibefradil (Posicor®), nefazodone (Serzone®), telaprevir (Incivek®), verapamil (Calan®), medicine to treat infections (such as ciprofloxacin, clarithromycin, erythromycin, fluconazole, itraconazole, ketoconazole, posaconazole, telithromycin, voriconazole, Nizoral®), or medicine to treat HIV/AIDS (such as amprenavir, atazanavir, darunavir/ritonavir, fosamprenavir, indinavir, lopinavir/ritonavir, nelfinavir, ritonavir, saquinavir, tipranavir/ritonavir, Crixivan®, Kaletra®, Norvir®, Reyataz®). Using these medicines together can cause serious side effects.
Call your doctor right away if you have severe diarrhea, decrease in how much or how often you urinate, lightheadedness, or tiredness after using this medicine.
Using this medicine together with lovastatin or simvastatin may increase risk of a serious muscle problem called myopathy. Check with your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have unusual tiredness or a fever.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem (including fatty liver). Do not use other medicines to lower cholesterol that can increase liver fat. Ask your doctor about these medicines.
Do not change your dose or stop taking this medicine without first talking with your doctor.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Juxtapid?
Juxtapid is not appropriate for everyone.
You should not take this medication if you:
- Are allergic to Juxtapid or any of its ingredients
- Have moderate to severe liver impairment, active liver disease, or unexplained increased liver function tests
- Have galactose intolerance hereditary disorder
- Are pregnant
Juxtapid may be prescribed with caution in some people, only if the healthcare provider determines it is safe. This includes people who are on dialysis, people who abuse alcohol, and females of reproductive potential.
What Other Medications May Interact With Juxtapid?
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, and vitamins or supplements.
If taken with Juxtapid, drugs that are known as moderate or strong CYP3A4 inhibitors can cause very high levels of Juxtapid in the body. This can increase the risk for side effects and toxicity. For this reason, these medications should not be taken with Juxtapid.
Moderate or strong CYP3A4 inhibitors include:
- Biaxin (clarithromycin)
- Calan, Verelan (verapamil)
- Cipro (ciprofloxacin)
- Diflucan (fluconazole)
- Emend (aprepitant)
- Ery-tab (erythromycin)
- Invirase (saquinavir)
- Kaletra (lopinavir/ritonavir)
- Nizoral (ketoconazole)
- Norvir (ritonavir)
- Noxafil (posaconazole)
- Sporanox (itraconazole)
- Vfend (voriconazole)
- Viracept (nelfinavir)
Grapefruit or grapefruit juice and any products that contain grapefruit should be avoided when taking Juxtapid because they can also cause very high Juxtapid levels in the body.
If you are also taking a drug known as a weak CYP3A4 inhibitor, your dose of Juxtapid should be decreased by half. Examples of weak CYP3A4 inhibitors include:
Weak CYP3A4 inhibitors also include certain supplements such as ginkgo and goldenseal. People who take Coumadin (warfarin) will need regular monitoring of INR levels and may need a warfarin dosage adjustment. Certain cholesterol medications, such as Zocor (simvastatin) or Mevacor (lovastatin), will require a lower dose when combined with Juxtapid.
Drugs known as P-glycoprotein substrates may require a lower dosage when taken together with Juxtapid. Some examples include:
- Colcrys (colchicine)
- Gleevec (imatinib)
- Januvia (sitagliptin)
- Lanoxin (digoxin)
- Onglyza (saxagliptin)
- Pradaxa (dabigatran)
- Ranexa (ranolazine)
- Tekturna (aliskiren)
People who take cholesterol drugs known as bile acid sequestrants, such as colesevelam or cholestyramine, should separate the drug from Juxtapid by at least four hours.
Other drug interactions may occur with Juxtapid. Consult your healthcare provider for a complete list of drug interactions.
What Medications Are Similar?
Currently, Juxtapid is the only MTP inhibitor prescribed for HoFH, although others may be in development. People with HoFH generally take other medications for their condition, in addition to Juxtapid. Examples of other medications commonly prescribed for HoFH include:
- High-dose statins, such as Crestor (rosuvastatin), Lipitor (atorvastatin), or Zocor (simvastatin)
- Zetia (ezetimibe)
- PCSK9 inhibitors (injections), such as Praluent (alirocumab) or Repatha (evolocumab)
People with HoFH may undergo a procedure regularly, called LDL apheresis. In this procedure, LDL is removed through the blood. In certain cases, a liver transplant may be needed, as a last resort.
This list is a list of drugs/procedures also used in HoFH. It is NOT a list of drugs recommended to take with Juxtapid. Ask your pharmacist or a healthcare practitioner if you have questions.
Frequently Asked Questions
What is Juxtapid used for?
Juxtapid is used to treat a rare genetic condition called homozygous familial hypercholesterolemia (HoFH). HoFH causes very high levels of LDL cholesterol.
How does Juxtapid work?
Juxtapid works by slowing down cholesterol production.
What drugs should not be taken with Juxtapid?
Juxtapid interacts with many different drugs, as well as grapefruit juice, and certain supplements such as ginkgo and goldenseal. Before taking Juxtapid, review your medication list with your healthcare provider. Tell your provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements.
How long does it take for Juxtapid to work?
Juxtapid may start to work right away. However, in some cases, your healthcare provider may need to adjust the dosage gradually to a dose that is effective.
What are the side effects of Juxtapid?
The most common side effects of Juxtapid are stomach-related and include pain, bloating, nausea, vomiting, diarrhea, indigestion, gas, reflux, feeling like you need to move your bowels, and constipation. A strict low-fat diet can help lower the chance of these side effects.
Severe side effects can include severe vomiting and diarrhea, and liver toxicity. Your healthcare provider will monitor your liver function before you start taking Juxtapid, and regularly during treatment.
How do I safely stop taking Juxtapid?
Your healthcare provider will advise you on how long to take Juxtapid. Do not stop taking the medication without guidance from your provider.
How Can I Stay Healthy While Taking Juxtapid?
Before taking Juxtapid, discuss your medical history and all medications you take with your healthcare provider. Many drugs and supplements interact with Juxtapid. Consult your healthcare provider before taking any new medication.
If you are diagnosed with HoFH, there is support available. For example, a registered dietician can advise you on dietary changes, exercise, and supplements. In addition to a healthy diet, note that grapefruit products can interact with Juxtapid, so avoid grapefruit when taking this medication.
Juxtapid can cause liver problems. Your healthcare provider will order blood work before you start taking Juxtapid, and regularly during treatment. Do not drink more than one alcoholic beverage per day while taking Juxtapid, because alcohol can increase the risk of liver injury. If you take other medications that increase the risk of liver problems, such as Tylenol (acetaminophen), your healthcare provider may order blood work more often.
When taking Juxtapid, follow your healthcare provider’s instructions for use. Read the patient information leaflet that comes with your prescription and ask your healthcare provider if you have any questions.
Verywell Health’s drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.