10 Drugs Commonly Prescribed for Cholesterol
Your body needs cholesterol for various functions, such as making hormones, but about 1 in 3 American adults has higher-than-normal cholesterol. High cholesterol puts you at risk for heart disease, heart attack, and stroke. Like high blood pressure, high cholesterol has no symptoms. But a simple blood test can tell you your level.
About 25% of cholesterol comes from your diet. Your body makes the remaining 75%. The first step in lowering your cholesterol is usually lifestyle and dietary changes. However, sometimes this isn’t enough. If your cholesterol is still too high after 6 to 12 months, your doctor will likely recommend cholesterol medication.
Classes of Cholesterol-Lowering Drugs
Cholesterol-lowering drugs work to decrease LDL (“bad cholesterol), increase HDL (“good” cholesterol), or decrease triglycerides. These are the three basic components of your cholesterol level.
Doctors have quite a number of drugs they can use to treat high cholesterol. There are many classes of cholesterol-lowering drugs and many drugs within each class.
Classes of cholesterol-lowering drugs include:
Statins—or HMG-CoA reductase inhibitors—are the gold standard for treating high cholesterol. They work by reducing the amount of cholesterol your body makes. This mainly decreases LDL, but statins also have modest effects on triglycerides and HDL. Side effects are usually mild and resolve with time, but liver and muscle problems are possible and can be serious. Periodic lab tests can check for these issues.
Cholesterol absorption inhibitors stop your intestines from absorbing cholesterol you eat. This mainly decreases your LDL, but has a modest effect on triglycerides and HDL. Doctors often combine this class with statins. The main side effects are stomach pain, diarrhea, fatigue, and joint pain.
Fibrates are very effective at lowering triglycerides. They do this by speeding up processes in your body to get rid of triglycerides. They can also increase HDL. This class can increase the risk of muscle problems in people who take statins. You will need close monitoring if you take both types of drugs.
Resins help your body get rid of extra cholesterol. They do this by binding bile in your intestines. Your body needs bile for digestion and it makes bile from cholesterol. When resins bind bile, your body can’t use it and must make more using cholesterol. This lowers your LDL. Doctors rarely use this class alone. Instead, they often combine them with statins. The main side effects are digestive problems, such as constipation, bloating and gas.
Niacin works in the liver to decrease LDL, increase HDL, and decrease triglycerides. Niacin comes as a vitamin supplement. However, prescription forms of niacin are also available. You should not substitute the vitamin for the prescription product. The prescription forms are formulated to reduce side effects, such as flushing, stomach upset, and itching.
Omega-3 fatty acids help decrease triglycerides. They come as an over-the-counter supplement and as a highly purified and concentrated prescription drug.
PCSK9 inhibitors increase the amount of LDL your body clears from your blood. The injection drugs treat a genetic form of high cholesterol and can further lower LDL in adults who have already had a heart attack or stroke. The main side effects are injection site reactions, flu-like symptoms, and allergic reactions.
Expert guidelines help doctors choose which cholesterol medicines to use. In most cases, statins are the treatment of choice. Studies have directly linked statins to a decrease in the risk of heart attack and stroke. However, your doctor will look at your specific circumstances and may choose other medicines.
After starting treatment, your doctor will monitor your cholesterol levels. It may be necessary to adjust your dose, change drugs, or add a second drug to reduce your cholesterol levels.
Common Cholesterol-Lowering Drugs
Your doctor has more choices to make within each class of cholesterol-lowering medicine. Finding the right one for you may involve some trial and error.
Here are 10 drugs commonly prescribed for high cholesterol:
Atorvastatin (Lipitor) is a high-potency statin. The usual dose is once daily. Liptruzet combines atorvastatin with ezetimibe to treat high cholesterol. Caduet combines atorvastatin with amlodipine for people who also have heart disease or high blood pressure.
Colesevelam (WelChol) is a resin. It comes as a tablet or a powder you mix with liquid. The usual dose is once or twice a day with meals. Colesevelam can also help control blood sugar levels in people with type 2 diabetes.
Ezetimibe (Zetia) is a cholesterol absorption inhibitor. It is currently the only member of this class. It is a tablet you take once a day. It is also available as Liptruzet in combination with atorvastatin and Vytorin in combination with simvastatin.
Fenofibrate (Tricor, Triglide, Trilipix, and others) is a fibrate that comes as a long-acting capsule and as a tablet for daily dosing. You need to take some fenofibrate products with food. For others, it doesn’t matter if you take them with food or not. Check with your doctor or pharmacist.
Gemfibrozil (Lopid) is a fibrate with twice daily dosing. You usually take this tablet 30 minutes before breakfast and 30 minutes before your evening meal.
Lovastatin (Altoprev, Mevacor) is a statin. It is available as a regular tablet and a long-acting one. The dose for the regular tablet can be once or twice a day. You take the long-acting tablet once daily at bedtime.
Niacin (Niacor, Niaspan, Nicolar, Slo-Niacin) comes as both regular tablets and extended-release tablets. You take the products differently. Be sure you understand how to take your specific niacin product. Also, do not change brands without notifying your doctor because it may be necessary to change your dose.
Pravastatin (Pravachol) is another statin. You take it once daily either with or without food.
Rosuvastatin (Crestor) is a high-potency statin. The usual dose for this tablet is once a day.
Simvastatin (Zocor) is another statin. You usually take it once daily in the evening. As noted, it comes as the combination product Vytorin.
There are several other cholesterol meds available for treating high cholesterol. Also, researchers continue to study new ways to reduce cholesterol levels. New drug molecules that will represent new classes of cholesterol-lowering medicines are currently in clinical trials.
Talk with your doctor if you are having side effects or other problems with your current treatment. It may be possible to switch to another drug and get better results.
Even if you need cholesterol medicine, healthy lifestyle habits like regular exercise and a heart-healthy diet still affect your cholesterol levels. You and your doctor can work together on an overall treatment plan for the biggest impact on your cardiovascular health.