Lomitapide is a treatment for HoFH which works in a different way to other cholesterol-lowering medicines, and doesn’t rely on you having working LDL receptors. The brand name for lomitapide is Lojuxta®. It comes as a capsule that you take by mouth. You will need to eat a low fat diet too.
How does it work?
Lomitapide works by blocking a protein that is needed to transport fats from the gut into the blood and around the body. Lomitapide, combined with a low fat diet, has been shown to significantly lower cholesterol, by around half on average.
It may be possible to have LDL-apheresis less often if you’re having lomitapide (with or without evolocumab).
Who can have it?
Lomitapide should be considered for adults with HoFH who haven’t reached their cholesterol targets with LDL-apheresis and standard drug treatment, and have had a trial of evolocumab.
It is licensed for use in adults with HoFH, and is available on the NHS in England.
What are the side effects?
The main side effects are problems with digestion, such as diarrhoea and feeling sick. This is because lomitapide stops fat being absorbed from the gut. Eating a low-fat diet has been shown to help. You will also need to avoid certain drugs that may interact with lomitapide.
Avoid grapefruit and bitter (Seville) orange
Lomitapide can interact with grapefruit and grapefruit juice so you need to avoid these.
Lomitapide can also interact with bitter (Seville) oranges, for example in marmalade. If you do choose to eat some, it should be only a very small amount, and 12 hours apart from your medicine.
Eating a low fat diet with lomitapide
If you take lomitapide, you’ll need to eat a low fat diet with less than 20% of your energy coming from fat. This is to prevent side effects like diarrhoea and feeling sick. Most people start a low fat diet a couple of weeks before starting lomitapide to give themselves time to get used to the diet before starting the medicine.
Most people start a low fat diet a couple of weeks before starting lomitapide to give you time to get used to the medicine.
You will also need to avoid alcohol and take dietary supplements, in particular, vitamin E and essential fatty acids.
Getting support with your low fat diet
You will be offered a referral to a dietitian to help you plan a varied low fat diet that works for you.