Commonly Prescribed Cholesterol-Lowering Drugs – Healthgrades

People with high or excess blood cholesterol (hypercholesterolemia) are at risk of severe health complications. Several medications, including statins and fibrates, are available to help lower cholesterol. Making changes to your diet and exercise regimen can also help. Blood cholesterol plays an essential role in your health. Cholesterol helps your body produce hormones and aids digestion.

However, having too much of a certain type of cholesterol is harmful. High levels of low-density lipoprotein (LDL), or “bad,” cholesterol in the blood can cause plaque to build up in the blood vessels, leading to life threatening strokes or heart attacks.

About 38% of adults in the United States have high cholesterol. High-density lipoprotein (HDL) is a “good” type of cholesterol because it helps clear LDL from the body. A diagnosis of high cholesterol only refers to the amount of LDL cholesterol.

For many people with high cholesterol, making lifestyle changes can help lower their LDL levels. These changes include eating a diet low in saturated and trans fats, avoiding smoking, and exercising more.

However, some people also need medications to treat their high cholesterol. People with a genetic condition called familial hypercholesterolemia (FH) inherit high cholesterol, and making lifestyle changes alone is often not enough to lower their LDL cholesterol levels.

This article looks at the most common cholesterol-lowering drugs that doctors prescribe, as well as potential side effects and treatment options other than statins.

Common cholesterol-lowering drugs

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Cholesterol-lowering drugs work to decrease LDL cholesterol, increase HDL cholesterol, decrease triglycerides, or a combination of all of these. The primary goal of treatment is to achieve healthy levels to lower the risk of atherosclerosis, which refers to a buildup of plaque in the blood that can lead to a heart attack or stroke.

There are several choices within most drug classes used to lower cholesterol. Finding the right one for you may involve some trial and error.

Here are 10 drugs that doctors commonly prescribe for high cholesterol:

There are several other medications 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 medications are currently in clinical trials.

Talk with your doctor about your treatment options, including potential side effects and your individual risk factors.

Classes of cholesterol-lowering drugs

The medications that doctors prescribe to treat high cholesterol fall into several different drug classes. Each type of drug works differently to lower LDL cholesterol levels in the body.

Your doctor will talk through your treatment options and discuss potential side effects and interaction warnings.

Classes of cholesterol-lowering drugs include:

Also known as HMG-CoA reductase inhibitors, statins are the most common medication that doctors prescribe to treat high cholesterol, according to the American Heart Association (AHA). These drugs work by reducing the amount of cholesterol your liver makes.

Statins primarily decrease LDL cholesterol, but they also have modest effects on triglycerides and HDL cholesterol. The Food and Drug Administration (FDA) reports that most people tolerate statins very well, but they note two primary side effects of statins: muscle symptoms and an increased risk of type 2 diabetes.

The AHA also warns that people who are pregnant or want to become pregnant, as well as those with chronic liver disease, should not take statins.

Common side effects of statins include:

The FDA also notes that drinking grapefruit juice can affect how statins work. Talk with your doctor about all possible interactions and instructions for taking statins.

Cholesterol absorption inhibitors

These drugs are the most common non-statin medication for high cholesterol. They work by preventing your intestines from absorbing the cholesterol you consume.

Doctors may prescribe a cholesterol absorption inhibitor, such as ezetimibe, if you are not able to tolerate statins or if statins and lifestyle changes have not been effective enough in lowering LDL levels.

The FDA advises that you should not take a cholesterol absorption inhibitor, such as ezetimibe, if you are pregnant or nursing. They go on to note that people with liver disease should not combine ezetimibe with other cholesterol medications and that people taking blood thinners (anticoagulants) should also use caution when taking ezetimibe.

The National Health Service (NHS) of the United Kingdom lists these common side effects of ezetimibe:

  • abdominal pain
  • diarrhea
  • bloating or gas
  • fatigue

The NHS advises that you contact a doctor as soon as possible if you experience:

  • muscle pain or cramps
  • weakness or tender muscles
  • yellowing of the skin or whites of the eyes (jaundice)
  • severe stomach pain

Fibrates work by speeding up processes in your body to get rid of triglycerides. They can also increase HDL cholesterol.

Doctors may prescribe fibrates in combination with statins. However, some studies suggest that taking certain fibrates along with statins may not be any more effective for reducing the risk of heart attack or stroke than taking statins alone.

The FDA warns that people who have kidney conditions, gallbladder disease, or liver disease should not take fibrates. They also suggest that people who are pregnant or breastfeeding speak with a doctor before taking fibrates.

Possible side effects of fibrates include:

  • headache
  • constipation or diarrhea
  • dizziness
  • stomach pain

Contact a doctor right away if you experience:

  • muscle pain or tenderness
  • weakness
  • abdominal pain
  • yellowing of the skin or whites of the eyes
  • skin rash
  • other new symptoms that concern you

Resins or bile acid sequestrants

This class of drugs helps your body remove extra cholesterol by blocking the absorption of bile acid in your stomach.

Your liver uses cholesterol to make bile, which the body needs for digestion. When resins prevent bile from entering your bloodstream, your liver takes cholesterol from your bloodstream in order to make more bile. This lowers your LDL cholesterol.

Side effects of bile acid sequestrants include:

Contact a doctor if you experience:

  • bloody stools
  • vomiting
  • bleeding gums
  • severe constipation
  • sudden and unexpected weight loss

Niacin is a B vitamin that works in the liver to decrease LDL cholesterol, increase HDL cholesterol, and reduce triglycerides. Although niacin comes as a vitamin supplement, it is not a substitute for the prescription niacin given to manage high cholesterol.

The National Library of Medicine notes that it is essential to take niacin exactly as your doctor prescribes it.

They also advise contacting a doctor for side effects including:

  • severe or chronic diarrhea
  • a cough that gets worse or does not go away
  • dizziness
  • rapid heartbeat
  • nausea and vomiting
  • pale stools
  • yellowing of the skin or whites of the eyes
  • skin rash or hives
  • difficulty breathing or swallowing
  • muscle pain, weakness, or tenderness
  • dark urine
  • extreme fatigue

Omega-3 fatty acids 

Omega-3 fatty acids help decrease triglycerides and other fats produced by the liver. They come as an over-the-counter supplement and as a more purified and concentrated prescription formulation.

Before taking this medication, it is important to talk with your doctor if you:

  • have an allergy to fish
  • plan on becoming pregnant, are pregnant, or are nursing
  • drink two or more glasses of alcohol each day
  • have diabetes or a condition that affects your liver, thyroid, or pancreas
  • take blood thinners, including aspirin

The most common side effects of omega-3 fatty acids include:

PCSK9 inhibitors 

This injected medication helps lower LDL cholesterol levels by stopping the PCSK9 protein from breaking down receptors that help clear LDL cholesterol from the body.

These drugs can help treat FH and further lower LDL cholesterol in adults who have already had a heart attack or stroke.

Monitoring your treatment

After you start treatment, your doctor will monitor your cholesterol levels. It may be necessary for them to adjust your dosage, change drugs, or add a second drug to reduce your cholesterol levels.

Talk with your doctor if you have 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 medications, adopting healthy lifestyle habits like getting regular exercise and following a heart-healthy diet still affects your cholesterol levels.

In addition, you and your doctor can work together on an overall treatment plan for the most significant impact on your cardiovascular health.

Having high levels of LDL cholesterol can increase your risk of atherosclerosis, which refers to a buildup of plaque in the blood vessels that can cause a heart attack or stroke.

In addition to eating a heart-healthy diet and exercising, taking cholesterol-lowering medications may be necessary for people with high LDL levels.

Statins are the most common medication for high cholesterol. They tend to have mild side effects, but you should not take them if you are pregnant or breastfeeding. Statins also can cause muscle symptoms and an increased risk of type 2 diabetes.

Non-statin treatment options for high cholesterol include cholesterol absorption inhibitors, fibrates, resins or bile acid sequestrants, niacin, omega-3 fatty acids, and PCSK9 inhibitors.

Your doctor will discuss all of your treatment options, including potential risks and side effects, to determine the right treatment plan for you.