Drugs for Cholesterol

Just as there are several types of cholesterol, there are also many different kinds of drugs that either lower low-density lipoprotein (LDL) cholesterol or raise high-density lipoprotein (HDL) cholesterol. Your doctor can help determine which class of medication is right for you. Talk to your doctor about any other medications you’re currently taking, as they may interact negatively with high cholesterol drugs.

Once you’ve received your prescription, it’s important for you to take your medication exactly as directed. Let your doctor know if you experience any side effects. Although cholesterol drugs can be very effective on their own, you should also adopt a healthy lifestyle that includes a heart-healthy diet and regular exercise to achieve the best results.

Statins

Also known as HMG-CoA reductase inhibitors, statins slow down your body’s production of cholesterol and help eliminate excess cholesterol from your arteries. While they’re primarily used to lower LDL cholesterol—the bad stuff—they may also slightly improve blood levels of triglycerides and high-density lipoprotein HDL cholesterol. Examples of statins include:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol)
  • lovastatin (Altoprev, Mevacor)
  • pravastatin (Pravachol)
  • rosuvastatin Calcium (Crestor)
  • simvastatin (Zocor)

Avoid taking statins if you have liver disease or if you are pregnant. Don’t drink grapefruit juice while on this medication. Side effects of statins include:

  • constipation
  • diarrhea
  • dizziness
  • gas
  • headache
  • upset stomach
  • muscle pain

Combination Statins

Some statin medications include an adjunct drug to help lower triglycerides or boost HDL cholesterol. Those include:

  • atorvastatin with amlodipine (Caduet)
  • lovastatin with niacin (Advicor)
  • simvastatin with ezetimibe (Vytorin)

You shouldn’t take Vytorin or Advicor if you’re pregnant or breastfeeding, or if you have liver disease. As with statins, don’t drink grapefruit juice while taking this medication. Side effects may include:

  • headache
  • upset stomach
  • flushing (redness)

Bile-Acid-Binding Resins

Also called bile acid sequestrants, resins help the body dispose of LDL cholesterol. Your body uses cholesterol to create bile, which is used in the digestive process. As the name suggests, this class of drugs binds to bile so that it can’t be used during digestion. The body responds by making even more bile, which requires more cholesterol. The more bile it makes, the more cholesterol the body uses, thereby lowering the amount of cholesterol in your bloodstream. People with liver or gallbladder problems should avoid using these medications. Examples of bile-acid-binding resins include:

  • cholestyramine (Locholest, Locholest Light, Prevalite, Questran, Questran Light)
  • colesevelam Hcl (WelChol)
  • colestipol (Colestid)

Side effects may include:

  • constipation
  • gas
  • heartburn
  • indigestion
  • nausea

Selective Cholesterol Absorption Inhibitors

Selective cholesterol absorption inhibitors help lower LDL cholesterol by preventing its absorption by the intestines. They may have a modest effect on boosting HDL as well. People with liver disease shouldn’t take this type of medication. An example of this type of cholesterol drug is ezetimibe (Zetia).

Side effects may include:

  • stomach pain
  • fatigue
  • joint pain
  • diarrhea
  • dizziness
  • headache
  • sore throat
  • runny nose
  • sneezing

Fibrates 

Used alone or in combination with other drugs, fibrates work by lowering triglycerides and, in some cases, by raising “good” HDL cholesterol. People with kidney problems, gallbladder disease, or liver disease shouldn’t use fibrates. Examples of fibrates include:

  • clofibrate (Atromid-S)
  • gemfibrozil (Lopid)
  • fenofibrate (Antara, Lofibra, Tricor, and Triglide)

Side effects may include:

  • constipation
  • diarrhea
  • dizziness
  • headache
  • stomach pain

Note: When taken with a statin, fibrates may increase the chance of muscle problems.

Omega-3 Fatty Acid (Fish Oil)

A prescription-strength fish oil (omega-3 fatty acid) called Lovaza is FDA-approved for the treatment of very high blood triglycerides (above 500 ml/dL). Omega-3 fatty acids are also available as supplements, but in lower doses. Side effects may include:

  • back pain
  • burping
  • flu-like symptoms
  • taste changes
  • upset stomach
  • skin rash
  • increased risk of infections

Niacin (Nicotinic Acid)

Prescription-strength niacin, also known as vitamin B3, helps improve cholesterol by boosting HDL and lowering LDL and triglycerides. When used in combination with statins, niacin could raise HDL levels by 50 percent or more. Although you can buy niacin without a prescription, over-the-counter doses aren’t effective in treating high cholesterol. Examples of prescription-strength niacin include:

  • Niacor
  • Niaspan
  • Slo-Niacin

Niacin may increase blood glucose levels in people with diabetes. Because side effects may occur, don’t take high doses of niacin without a prescription from your physician. Side effects may include:

  • flushing
  • headache
  • itching
  • tingling sensation in extremities
  • upset stomach