If diet and lifestyle changes aren't enough to lower your blood cholesterol to healthy levels, your doctor may recommend a cholesterol-lowering drug. Knowing the pros and cons of the different types of medications used to lower cholesterol can lead to more informed decisions about your options.
These drugs, such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor), work by suppressing the activity of an enzyme that controls cholesterol production.
- Benefits. Statins lower low-density lipoprotein (LDL), or "bad," cholesterol by 20 to 55 percent — more than any other drug. They also raise high-density lipoprotein (HDL), or "good," cholesterol. LDL clogs the arteries, while HDL prevents cholesterol buildup in the arteries.
- Possible side effects. In rare instances, muscle pain and changes in liver enzyme levels may occur. People using statins have reported joint pain as well. Don't take statins if you're pregnant or have liver disease.
This drug lowers the amount of cholesterol absorbed by the body.
- Benefits. Ezetimibe lowers bad cholesterol by 18 to 25 percent. It can be taken in combination with statins to lower LDL levels even further. It can also raise good cholesterol.
- Possible side effects. Ezetimibe may cause diarrhea, joint pain and tiredness.
These drugs, such as cholestyramine (Prevalite), colestipol (Colestid) and colesevelam (Welchol), bind to bile acids in the intestine. These acids contain cholesterol, which are then eliminated from the body.
- Benefits. Bile acid resins can lower LDL cholesterol by 15 to 30 percent.
- Possible side effects. Bile acid resins may need to be taken in combination with other cholesterol-lowering drugs to effectively lower LDL levels. They may cause stomach and intestinal issues such as constipation.
Nicotinic acid (Niacin) is a water-soluble B vitamin that lowers bad cholesterol and increases good cholesterol.
- Benefits. Nicotinic acid reduces LDL levels by 5 to 15 percent, and up to 25 percent in some people.
- Possible side effects. Nicotinic acid may cause flushing, itchiness and upset stomach. Your doctor must monitor your liver function if you're taking this drug. Don't use it if you have diabetes because it can raise blood sugar levels.
Fibrates, such as gemfibrozil (Lopid) and fenofibrate (Tricor), can raise good cholesterol if you have low HDL levels.
- Benefits. Fibrates can improve HDL levels.
- Possible side effects. Among all cholesterol-lowering medications, fibrates are the least effective at lowering bad cholesterol. They can also cause muscle pain when prescribed with statins, as well as digestive problems.
A new class of drugs can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) are approved for people who have a genetic condition that causes very high levels of LDL. The drug also may be used if you have had heart attacks or strokes and need additional lowering of your LDL levels. The drug is administered by injection at home one or two times a month.
- Benefits. When taken with a statin, this drug may further reduce LDL cholesterol.
- Possible side effects. Common side effects include itching, swelling, pain or bruising at the injection site. Back pain, rash, hives, swelling of the nasal passages and flu also may occur.
Your doctor will recommend a specific choice of medication or combination of medications based on a variety of factors, such as your individual risk factors, your age, your current health and possible side effects. Your doctor will also monitor your medication regularly and recommend lifestyle changes that will allow you to take less medication and lower your risk of heart disease.
Sept. 03, 2015
- Your guide to lowering your cholesterol with TLC. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/cgi-bin/search?q=TLC&site=NHLBI_Public&client=NHLBI_Public_frontend&proxystylesheet=NHLBI_Public_frontend&output=xml_no_dtd&getfields=description.keywords&oe=ISO-8859-1&ie=ISO-8859-1 . Accessed Feb. 5, 2014.
- Drug therapy for cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp. Accessed Feb. 5, 2014.
- Third report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/cholesterol. Accessed Feb. 6, 2014.
- Zetia (prescribing information). Whitehouse Station, N.J. Merck and Co.; 2012. http://www.zetia.com/ezetimibe/zetia/consumer/prescribing-information/index.jsp?WT.svl=1. Accessed Feb. 6, 2014.
- How is high blood cholesterol treated? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbc/treatment.html. Accessed Feb. 5, 2014.
- High blood cholesterol: What you need to know. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm. Accessed Feb. 5, 2014.
- FDA approves Praluent to treat certain patients with high cholesterol. U.S. Food and Drug Administration. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm455883.htm. Accessed August 28, 2015.
- Praluent (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; Tarrytown, N.Y.: Regeneron Pharmaceuticals; 2015. http://www.regeneron.com/Praluent/Praluent-fpi.pdf. Accessed July 28, 2015.
- Robinson JG, et al. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. New England Journal of Medicine. 2015;372:1489.
- FDA approves Repatha to treat certain patients with high cholesterol. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm460082.htm. Accessed August 28, 2015.
- Repatha (prescribing information). Thousand Oaks, Calif.: Amgen; 2015. http://pi.amgen.com/united_states/repatha/repatha_pi_hcp_english.pdf. Accessed August 28, 2015.