Which combination of drugs may be added if HMG CoA reductase inhibitors are insufficient?

The addition of gemfibrozil and cholestyramine to the treatment regimen is appropriate when HMG CoA reductase inhibitors (statins) alone are not sufficient for managing hyperlipidemia. Gemfibrozil is a fibrate that primarily reduces triglyceride levels and can also modestly increase HDL cholesterol. It is beneficial for patients who have high triglyceride levels that are not adequately controlled by statins. Cholestyramine, a bile acid sequestrant, binds bile acids in the intestine and prevents their reabsorption, leading the liver to use more cholesterol to produce new bile acids, ultimately lowering LDL levels.

Combining these two agents can provide a synergistic effect in lowering cholesterol levels, particularly when statin monotherapy doesn't achieve the desired outcome. This combination is effective because they work through different mechanisms: one reduces triglycerides significantly, while the other primarily lowers LDL cholesterol.

Other options do not pertain to lipid management in the same context. For instance, anticoagulants like warfarin and antiplatelet agents like aspirin are used for preventing thromboembolic events rather than treating hyperlipidemia. Anti-inflammatory medications like ibuprofen and naproxen do not target lipid levels but instead relieve pain and reduce