- 4 Ways to Lower Triglycerides and Prevent Heart Disease
- Supplements and Medications to Lower Triglycerides
- What are triglycerides?
- Possible new treatment for high triglycerides
- Lowering triglycerides without medication
- Prescription Omega-3s Can Help Lower Triglyceride Levels, Heart Disease Risk
- 10 Steps to Lower Triglycerides
- Getting tested
- 4 high triglycerides treatment options
- What qualifies as high triglycerides?
- What causes high triglycerides?
- How to lower triglycerides
- High triglycerides treatment options
- High Triglycerides
- Treatment Overview
4 Ways to Lower Triglycerides and Prevent Heart Disease
Here are some of the reasons your doctor might discuss medications to lower triglycerides with you:
- You have metabolic syndrome. This condition includes a combination of abdominal obesity, high triglycerides, and high blood pressure. If you have metabolic syndrome and tried diet and lifestyle changes for three months without success, triglyceride-lowering medications may be needed.
- Previous medication lowered your total cholesterol but not your triglycerides. If your cholesterol is well controlled, but your triglyceride level is still too high, at or above 200 mg/dL, triglyceride-lowering medications may help.
- You have very high triglycerides. If your triglyceride level is at or higher than 500 mg/dL, you may need to start medications to lower triglycerides even before reaching lower cholesterol levels.
Supplements and Medications to Lower Triglycerides
- “Fish oil, in doses of 3.5 grams of omega-3 fatty acids per day, can effectively lower triglycerides. Lower doses are ineffective,” explains says Scott Shurmur, MD, cardiologist and professor of medicine at Texas Tech University Health Science Center School of Medicine in Lubbock. When prescription medication is needed, lowering triglycerides usually starts with medication that lowers LDL cholesterol levels — many of the same medications used to lower cholesterol will also lower triglycerides.
- Statins are usually effective and well tolerated, and are the most commonly prescribed drugs to lower cholesterol. Examples include Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), Lescol (fluvastatin), Pravachol (pravastatin), and Mevacor (lovastatin). Severe side effects that last are rare, but side effects may include forgetfulness, abdominal pain, constipation, and muscle aches. You shouldn’t take one of these medications if you are pregnant or have active liver disease. Statins may interact with other drugs, including antibiotics and antivirals, so be sure to discuss all your medications (and supplements) with your doctor.
- Niacin (nicotinic acid) comes as a prescription or a dietary supplement, and can help lower triglycerides. However, dietary supplements are not regulated and should not be substituted for a prescription from your doctor. Side effects may include itching, skin flushing, dizziness, muscle pain, and stomach upset. You may not be able to take niacin if you have diabetes, peptic ulcer, gout, or liver disease. “Niacin has some triglyceride lowering ability, but also can make blood sugar control worse,” says Dr. Shurmur.
- Fibrates like Tricor (fenofibrate) are used specifically to lower triglyceride levels. Side effects include stomach upset, gallstones, and muscle aches. You should not take fibrates if you have kidney disease or severe liver disease.
Some diabetes medications, Actos (pioglitazone), for example, will also lower triglycerides, says Shurmur. However, this drug may cause or worsen congestive heart failure, warns the FDA.
The best way to check for high triglycerides is to have your doctor do a lipid profile blood test.
If you are over age 20, you should have your lipid profile checked at least every five years, and more frequently if you have other risk factors like a family history of heart disease. The sooner you find out about your cholesterol and triglyceride levels, the sooner you can start to get them under control and lowering your risk for coronary heart disease.
When you think about fat circulating in the bloodstream, you might immediately think of cholesterol. But there’s another type of fat you shouldn’t ignore: triglycerides. As with cholesterol, high triglycerides can also increase the risk of having a heart attack. Existing drugs for lowering triglycerides aren’t that good at reducing heart attack risk. That’s why a report on a new way to lower triglycerides is generating some excitement among cardiologists.
What are triglycerides?
Triglycerides are a type of fat that circulates in the bloodstream. After you eat a snack or meal, your body breaks down the fats in the food, packages them with protein and cholesterol, and dumps them into the bloodstream. After an especially fatty meal, triglycerides can be so abundant that they give the blood a milky tint. Within a few hours after a meal, triglycerides have mostly cleared out of the bloodstream.
The American Heart Association sets out four main categories of triglyceride levels:
- healthy: below 100 milligrams per deciliter of blood (mg/dL)
- borderline high: 150 to 199 mg/dL
- high: 200 to 499 mg/dL
- very high: 500 mg/dL and above.
“High” or “very high” levels of triglycerides are associated with an increased risk of heart disease. When the triglyceride level nears 1,000 mg/dL, individuals can develop pancreatitis, a serious inflammation of the pancreas, in addition to heart disease.
High triglyceride levels also may be associated with obesity, type 2 diabetes, and a cluster of heart disease risk factors known as the metabolic syndrome. Together, these features put a person at especially high risk of heart disease.
Possible new treatment for high triglycerides
In the report in The New England Journal of Medicine, an international team of researchers describe a new therapy for high triglycerides. It involves a weekly injection of “antisense oligonucleotides” (ASOs), pieces of DNA that short-circuit the liver’s production of triglycerides. The new report shows that ASOs can reduce triglyceride levels by as much as 70%.
Keep in mind that this was a phase 2 trial, which is designed to test whether a drug does what it is supposed to do (in this case, lower a person’s triglyceride levels). Larger, longer-term studies will be needed to see whether ASOs actually reduce the risk of heart disease, and what sorts of side effects they cause.
Many experimental medications that sparkle in early testing never become FDA-approved drugs. We won’t know for several years whether ASOs will become available for individuals with high triglycerides.
Lowering triglycerides without medication
Unless your triglycerides are extremely high, lifestyle changes are the best place to start. These simple steps can significantly lower triglyceride levels.
- Beware of bad fats. Cutting back on saturated fat (in red meat and full-fat dairy foods) and trans fats (in restaurant fried foods and commercially prepared baked goods) can lower triglycerides.
- Go for good carbs. Easily digested carbohydrates (such as white bread, white rice, cornflakes, and sugary sodas) give triglycerides a definite boost. Eating whole grains and cutting back on soda can help control triglycerides.
- Check your alcohol use. In some people, alcohol dramatically boosts triglycerides. The only way to know if this is true for you is to avoid alcohol for a few weeks and have your triglycerides tested again.
- Go fish. Omega-3 fats in salmon, tuna, sardines, and other fatty fish can lower triglycerides. Having fish twice a week is fine.
- Aim for a healthy weight. If you are overweight, losing just 5% to 10% of your weight can help drive down triglycerides.
- Get moving. Exercise lowers triglycerides and boosts heart-healthy HDL cholesterol.
- Stop smoking. It isn’t good for triglyceride levels — or for anything else.
Prescription Omega-3s Can Help Lower Triglyceride Levels, Heart Disease Risk
Although omega-3 can be found in fatty fish such as salmon, most people would not eat enough fish daily to receive the same benefit as prescription omega-3.
“Prescription omega-3 fatty acids are highly concentrated forms of the omega-3 fatty acids EPA and DHA. Like dietary supplements, they are derived from fish oil, but they are subject to more oversight as FDA-regulated medications. Taking omega-3 fatty acids affects multiple risk pathways in the body, including how fat and cholesterol is transported is the blood. They help this process work more efficiently and decrease the amount of fat (triglyceride) in the blood,” Skulas-Ray told Healthline.
Although prescription omega-3 is effective, experts advise against using similar non-prescription supplements.
“Because non-prescription fish oils do not undergo the same rigorous testing and do not all have the same active and inactive ingredients we cannot know for certain if they will lead to the same outcomes, so for people with very high triglycerides we only recommend the prescription forms,” Karol Watson, PhD, a professor of cardiology and co-director of the UCLA Program in Preventive Cardiology, told Healthline.
The reason why omega-3 fatty acids work at lowering triglycerides is not yet fully understood, but experts say the drug has a number of benefits.
“What’s happening in the body is anyone’s guess. We do know that at least in a test tube… it lowers markers of inflammation, it makes platelets less sticky, so less likely to clot, it stabilizes cell membranes, it makes them less excitable so there’s less arrhythmogenic potential. There’s a whole host of things, anti-inflammatory, anti-thrombotic, anti-arrhythmic and, of course, they have this triglyceride effect,” Shapiro said.
He advises that those concerned about their heart health should see their doctor.
He argues that for most people, lifestyle interventions are a good starting point to lower triglycerides.
“For the vast majority, between 200 mg/dl and 500 mg/dl, we definitely want to give lifestyle a go before we move on to the addition of medical therapies. In people who really give it a good effort we can see very significant lowering of triglycerides,” he said.
“When you look at the three major lipid fractions on the standard lipid panel which are the LDL cholesterol; the bad cholesterol, the HDL cholesterol; the healthy cholesterol and triglycerides, the fraction that’s most amenable to lifestyle changes is triglycerides, they can simply melt away with good behavior,” he added.
Do you know how to manage your triglyceride level? These fatty type of lipids, found in your blood, can be burned away in the process of losing weight, but they can also be dangerous for your health. Similar to LDL (the bad form of cholesterol), high levels of triglycerides can increase the risk of heart disease and stroke, even when LDL levels are regulated.
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“We are increasingly recognizing that elevated triglycerides represent a major issue and should not be ignored,” says cardiologist Steven Nissen, MD.
You are what you eat
Similar to cholesterol, triglycerides come from the food we eat and our liver. When levels are normal, triglycerides are used for energy. The problems arise when levels are high, explains Dr. Nissen. When we make more triglycerides than we use, the rest are stored as fat. That’s why many people who are overweight or type 2 diabetes have high levels.
“Poor diabetes control is a major factor in causing high triglyceride levels,” Dr. Nissen says. He stresses the importance of watching your carbohydrate consumption. “Eating a low-carb diet and getting plenty of exercise are often effective in lowering triglyceride levels.”
Is there such a thing as good carbs?
Different carbohydrate-loaded foods also contain very different nutritional levels.
Dr. Nissen recommends scaling back or eliminating:
- Refined grains.
- White rice.
- Starchy vegetables (like white potatoes).
“It’s particularly important to reduce the consumption of sugar and foods with high-fructose corn syrup,” he says.
Foods that contain good carbs and plenty of fiber include:
- Apples (with skin).
- Sweet potatoes.
- Whole grains.
- Brown rice.
Dr. Nissen advises that increasing your fiber intake may lower triglyceride levels. “If you have high triglyceride levels, there’s a good chance you don’t ingest close to the recommended 25 to 30 grams of fiber a day,” he says.
Weight gain isn’t just from food
High triglyceride levels can be caused by excessive alcohol consumption as well. So if your levels are higher than normal, it might be a good idea to eliminate alcohol completely.
“Weight has a profound impact on triglycerides,” says Dr. Nissen. “If you lose as little as 5 to 10% of body weight, your triglycerides can drop as much as 20%.”
This article was adapted from Cleveland Clinic Heart Advisor.
10 Steps to Lower Triglycerides
Many of the same things you do to improve your overall health can dramatically lower your triglycerides. Lifestyle changessuch as modifying your diet and losing weightcan potentially cut your triglyceride levels in half.
1. Lose weight. If you’re overweight, losing 5 to 10 percent of your body weightjust 10 to 20 pounds for someone who weighs 200 poundswill reduce your triglycerides by about 20 percent.
2. Cut the sugar. Individuals whose added sugar intake is less than 10 percent of daily calories have the lowest triglyceride levels. The AHA recommends that only 5 percent of your daily calories come from added sugars. That means no more than 150 grams (9 teaspoons) for men and 100 grams (6 teaspoons) for women per day. Because the biggest sources of sugar in the American diet are soda and other sugar-sweetened beverages, one way to restrict your sugar intake is to drink no more than three 12-ounce cans a week.
3. Stock up on fiber. Instead of consuming sugar and other refined carbohydrates, focus on more fiber-rich foods, such as vegetables, fruits and whole grains.
4. Limit fructose. Studies have found that consuming too much fructosea type of sugarleads to high triglycerides. High-fructose corn syrup is a major source of fructose. Because regular table sugar contains about the same amount of fructose as high-fructose corn syrup (50 percent versus 42 to 55 percent), you’ll need to limit both in order to lower your triglycerides. You can determine whether a food contains sugar or high-fructose corn syrup by reading the ingredients list.
Even the fructose that’s found naturally in fruit can increase triglycerides, so if you have high triglycerides you should watch the types of fruit you eat. Dried fruits, such as raisins and dates, have the most fructose, whereas peaches, cantaloupe, grapefruit, strawberries and bananas are relatively low in fructose.
To reduce your triglycerides, limit the total amount of fructose you consume to less than 100 grams per daypreferably less than 50. To learn about the fructose content of specific foods, visit the USDA nutrient database at www.nal.usda.gov/ fnic/foodcomp/search.
5. Eat a moderately low-fat diet. You may be surprised to learn that diets that are very low in fat are not as effective at lowering triglycerides as diets moderately low in fat. The AHA recommends that people with high triglycerides get about 25 to 35 percent of their daily calories from fat. That’s only slightly lower than the average American diet, which is about 37 percent. Replacing your regular dairy products with those marked “low-fat” may help lower your triglyceride levels.
How do you know whether you’re getting the right amount of fat? For someone who eats 2,000 calories a day, 30 percent is 600 calories. At 9 calories a gram, that’s about 67 grams of fat a day. You can learn the number of grams in a single serving of packaged food by reading the “Nutrition Facts” label.
6. Watch the type of fat you eat. Cut back on saturated fats, which are found in red meat, poultry fat, butter, cheese, milk, and coconut and palm oils, and keep trans fats, found in shortening and stick margarine, to a minimum. Replace trans fats with healthier polyunsaturated and monounsaturated fats. Examples of polyunsaturated fats include safflower, corn and soybean oils. Examples of monounsaturated fats include canola and olive oils. Although unsaturated fats are better for you in terms of cholesterol and triglyceride counts, they’re high in calories, so go gentle on the amount you cook with or you may gain weight.
7. Add omega-3 fatty acids. Fatty fish such as salmon, herring, sardines, lake trout and albacore tuna are abundant in omega-3 fatty acidsa type of fat that is actually good for you. To reap the benefits, the AHA recommends that you eat fatty fish at least twice a week. If you already have high triglycerides, you can take omega-3 capsules to supply the extra boost that food alone can’t provide. The capsules must be taken under your doctor’s supervision, as too much omega-3 can interfere with your blood clotting ability.
8. Exercise. If you have high triglycerides, getting at least 30 minutes of moderate-intensity physical activity most days of the week may lower your triglyceride levels. Exercise is also an important part of keeping your weight under control.
9. Limit alcohol. Some studies have linked even small amounts of alcohol to modest increases in triglycerides, although others have found no association at all. The AHA recommends that people with very high triglycerides avoid alcohol entirely.
10. Take triglyceride-lowering drugs. If your triglycerides are very high (500 mg/dL or above), your doctor might recommend a medication shown to lower triglycerides, such as fibrates, niacin, omega-3s (a prescription form called Lovaza is approved for lowering triglycerides) or statins. But lowering triglycerides with medication alone has never been shown to reduce the risk of heart attack or stroke, so be sure to watch your diet and continue exercising as well.
If you’re healthy, your doctor will perform a simple blood test every five years to measure your levels of cholesterol and triglycerides. You may need more frequent testing if you’re at high risk for heart attack or stroke.
Doctors have traditionally required that you fast the night before the test. According to the AHA statement, you may no longer have to do that. However, if your test results show triglyceride levels of 200 mg/dL or higher, you’ll need to be tested againand you’ll need to fast first.
If your fasting triglycerides are 150 mg/dL or higher, the message is clear: It’s time to start eating better and exercising more.
Publication Review By: the Editorial Staff at Healthcommunities.com
Published: 07 Jul 2013
Last Modified: 28 Aug 2013
4 high triglycerides treatment options
Cardiovascular disease is the leading cause of death for men and women in the United States. Almost half of all Americans (47%) have one of the three risk factors for heart disease: high blood pressure, high cholesterol, or smoking, according to the CDC. It’s such a common—and dangerous— problem that many organizations exist only to promote heart-healthy living, from the American Heart Association to the World Heart Federation. They encourage people to protect their own hearts and inspire others (family, friends, colleagues) to do the same. The good news is that one health threat is highly treatable. There are many high triglycerides treatment options (and preventions)—from statins to supplements.
High cholesterol affects more than 102 million Americans. While there are no symptoms associated with this condition, it’s tracked regularly in your annual physical. A complete blood cholesterol test (otherwise referred to as a lipoprotein or lipid profile) provides the various types of cholesterol levels measured in milligrams per deciliter of blood (mg/dL). One cholesterol it tracks is triglyceride levels.
“Triglycerides are a type of fat and the most common type of fat in your body,” states Roshini Malaney, DO, a board certified cardiologist with Manhattan Cardiology in New York City. Similar to cholesterol, triglycerides are made in the liver and exist in certain foods, including butter, margarine and oils, as well as other high fat or high carbohydrate foods. “When we consume extra calories, the body converts the calories it doesn’t need to use right away into triglycerides, which are then stored in fat cells,” she adds.
What qualifies as high triglycerides?
According to MedlinePlus (the website powered by the United States National Library of Medicine), blood levels less than 150 mg/dL fall under the triglycerides normal range, while anything higher—known as hypertriglyceridemia—can increase risk for heart disease. “Elevated triglycerides can also be a very early sign of diabetes,” states Kristin Thomas, MD, a board-certified internist and co-founder of Foxhall Medicine in Washington, DC. (She adds that a high-fasting triglyceride level should prompt additional testing, including a fasting blood sugar and hemoglobin A1c.)
Extremely high triglycerides—blood levels over 500 mg/dL—may be due to a genetic disorder and can increase the risk of pancreatitis, along with heart disease, including atherosclerosis (hardening of the arteries), Dr. Thomas, co-author of You Can Prevent A Stroke, explains. “It can be seen alone or in association with many other conditions, as well, such as metabolic syndrome, hypothyroidism, fatty liver disease and kidney disease,” Dr. Malaney says.
Triglycerides level chart
Are your triglyceride levels in the normal range? Refer to this triglycerides level chart.
|Risk level||Triglyceride level|
|Normal||Less than 150 milligrams per deciliter (mg/dL)|
|Borderline high||150 to 199 mg/dL|
|High||200 to 499 mg/dL|
|Very high||500 mg/dL or higher|
What causes high triglycerides?
Aside from consuming a high-fat and/or high-carb diet, other lifestyle factors can contribute to high triglycerides, specifically excess weight, lack of exercise, drinking too much alcohol and smoking. Dr. Malaney adds that it can also be a side effect of certain medications, such as some birth control pills, beta blockers, antipsychotics medications, and corticosteroids.
How to lower triglycerides
There are several natural high triglycerides treatment options—like diet and lifestyle changes—that your physician may recommend trying first, before prescriptions.
Triglycerides come from the food we eat, and occur naturally in the liver. Eating a low sugar, low carbohydrate diet, with lots of high fiber foods rich in omega-3s can help.
What are the best foods to eat to lower triglycerides?
Use the Mediterranean diet as a guide. Look for foods like:
- omega-3 rich fish (e.g., salmon, sardines, tuna, halibut)
- whole grains
Substitute olive oil for butter or lard, when possible. Choose complex over simple carbs, like brown rice instead of white. Limit your sugar intake. Avoid trans and saturated fats.
Some recommend completely giving up alcohol to lower triglycerides, especially if your levels are very high. Reducing consumption can help if your cholesterol is borderline.
Losing weight can help eliminate triglycerides stored in fat. Increasing physical activity is a great way to start.
High triglycerides treatment options
If lifestyle modifications fail to lower triglyceride levels, your physician may give you one of the following four prescriptions:
“Statins, such as Atorvastatin or Rosuvastatin, are medications typically used to treat high cholesterol levels, as well as other risks for cardiovascular disease,” Dr. Malaney says. She further explains that these drugs work by decreasing the liver’s production of cholesterol, and at certain doses can decrease triglyceride levels by 50 percent. “And with these newer, more potent statins, both LDL (“bad” cholesterol) targets and triglyceride targets can be reached,” Dr. Thomas adds.
Even more encouraging: According to a December 2018 scientific statement released by the American Heart Association, side effects from statins tend to be rare, and their benefits outweigh any possible risks.
RELATED: Read more about the side effects of statins
Also known as vitamin B3, niacin can decrease triglycerides by blocking the release of free fatty acids from fat while increasing the clearance of triglycerides from the blood, Dr. Malaney explains. “In addition, it can boost levels of HDL (“good”) cholesterol and lower levels of LDL (“bad”) cholesterol, so it’s commonly used for adults who have both heart disease and high cholesterol,” she says.
Dr. Thomas states that patients tend to prefer statins over niacin since statins are more tolerable. “And niacin has no demonstrable benefit over a statin,” she says.
3. Omega-3 fatty acids
Fish oil tablets—2 grams per day—have been shown to decrease triglyceride levels by up to 30 percent, Dr. Malaney says. “These pills work by inhibiting the release of triglycerides from the liver and by stimulating the enzyme that clears triglycerides from the blood,” she continues. Dr. Malaney further adds that prescription fish oil preparations, such as Lovaza, contain more active fatty acids than most non-prescription supplements.
Medications, such as such as Fenofibrate and Gemfibrozil, can lower triglyceride levels similarly to fish oil tablets. “Fibrates reduce the liver’s production of VLDL (the particle that circulates in the blood carrying triglycerides) while speeding up the removal of triglycerides from the blood,” Dr. Malaney explains. However, she warns that this medicine should not be prescribed for patients with severe kidney or liver disease.
You can use diet and lifestyle changes to lower triglyceride levels.
Diet and lifestyle changes include:
- Losing weight and staying at a healthy weight.
- Limiting fat and sugars.
- Being more active.
- Limiting alcohol.
You may also take medicines to lower triglyceride levels. Medicines may be used if you have risk factors for coronary artery disease (CAD).
For more information on cholesterol treatment, see the topic High Cholesterol.
Diet and lifestyle changes are the first steps you will take to lower triglyceride levels.
Diet and lifestyle changes include:
- Losing weight and staying at a healthy weight.
- Limiting the amount of carbohydrate and unhealthy fat that you eat.
- Being more active.
- Limiting alcohol.
- Not smoking.
- Keeping blood sugar in a target range if you have diabetes.
Eat a heart-healthy diet that is rich in fruits, vegetables, whole grains, fish, lean meats, and low-fat or nonfat dairy foods. Limit saturated fat and avoid trans fat. Limit sodium and sugar.
Eating fish may lower triglyceride levels. Eating at least 2 servings of fish each week is part of a heart-healthy diet. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include salmon, mackerel, lake trout, herring, and sardines.
Fish oil supplements can also lower triglycerides. But doctors do not agree about whether these supplements can help protect your heart. If you have very high triglycerides, your doctor may recommend you take fish oil to try to prevent pancreatitis.
To reduce carbohydrate in your diet, you may want to learn about the amount of carbohydrate in various foods.
Alcohol has a particularly strong effect on triglycerides. Regular, excessive use of alcohol or even a one-time drinking binge can cause a significant increase in triglycerides. Binge drinking can cause a spike in your triglycerides that may trigger pancreatitis. Your doctor will want you either to stop or to limit the amount of alcohol you drink.
Before you increase your activity, check with your doctor to be sure it is safe. You may also want to talk with a dietitian to design a nutrition program that is right for you.
Your doctor will also look for anything else that might be causing your high triglycerides, such as hypothyroidism, poorly controlled diabetes, kidney disease, or medicines. Your doctor may adjust or stop any medicines that might raise your triglyceride level.
If your triglycerides are still high after you make lifestyle changes, you may need to take medicine as well. Whether your doctor prescribes medicine for high triglycerides depends on more than just your triglyceride number. Your doctor will also look at your cholesterol levels and other risk factors (things that increase your risk) for heart disease before prescribing a medicine for high triglycerides.
If you have high cholesterol and other risk factors for heart disease, you may need a combination of medicines that target the different types of cholesterol. The medicines that you might take are:
- Nicotinic acid (niacin).
- Omega-3 fatty acids (fish oil).
Statins are used to lower LDL (bad) cholesterol. Statins may also lower triglycerides. If you have both high LDL cholesterol and high triglycerides, your doctor may first prescribe statins to lower your LDL and later prescribe a medicine to lower your triglycerides.
If your triglycerides are very high even after lifestyle changes, your doctor may first use medicine to lower your triglycerides to prevent damage to your pancreas.
Fibrates (fibric acid derivatives) should be used with caution by people who are also taking statins. There is a greater risk for a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. So it is important that your kidneys and liver are healthy before you take this combination of medicines. If you have any muscle problems or pain, report it immediately to your doctor.