Cholesterol medications: Consider the options

By Mayo Clinic Staff

A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you might need to take cholesterol medications. Cholesterol medications might help:

  • Decrease your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol that increases the risk of heart disease
  • Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
  • Increase your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol that offers protection from heart disease

Your doctor might suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.

Drug class and drug names Benefits Possible side effects and cautions
Statins
Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Lovastatin (Altoprev)
Pitavastatin (Livalo)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Decrease LDL and triglycerides; slightly increase HDL Muscle soreness, and pain, increased blood sugar levels; possible interaction with grapefruit juice, constipation, nausea, diarrhea, stomach pain, cramps
Bile acid binding resins
Cholestyramine (Prevalite)
Colesevelam (Welchol)
Colestipol (Colestid)
Decrease LDL Constipation, bloating, nausea, gas, heartburn
Cholesterol absorption inhibitor
Ezetimibe (Zetia)
Decreases LDL; slightly decreases triglycerides; slightly increases HDL Stomach pain, fatigue, muscle soreness
Combination cholesterol absorption inhibitor and statin
Vytorin (ezetimibe-simvastatin)
Decreases LDL and triglycerides; increases HDL Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice
Fibrates
Fenofibrate (Antara, Lipofen, others)
Gemfibrozil (Lopid)
Decrease triglycerides; possibley increase HDL Nausea, stomach pain, headaches, dizziness
Niacin
Prescription niacin (Niacor, Niaspan)
Decreases LDL and triglycerides; increases HDL Facial and neck flushing, itching, stomach upset, blood sugar increase
Omega-3 fatty acids
Prescription omega-3 fatty acid supplement (Lovaza)
Icosapent ethyl (Vascepa)
Decrease triglycerides; may increase HDL Belching, fishy taste, indigestion
Combination statin and calcium channel blocker
Amlodipine- atorvastatin (Caduet)
Decreases LDL and triglycerides; lowers blood pressure Facial and neck flushing, dizziness, heart palpitations, muscle pain and weakness; possible interaction with grapefruit juice
Injectable medications
Alirocumab (Praluent) Evolocumab (Repatha)
Decreases LDL, often used in people who have a genetic condition that causes very high LDL levels or who have heart disease and whose cholesterol is difficult to control with other medications Itching, swelling, pain or bruising at injection site; rash; hives; swelling of nasal passages

Most cholesterol medications lower cholesterol with few side effects, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor might recommend periodic liver function tests to monitor the medication's effect on your liver. However, the U.S. Food & Drug Administration no longer recommends routine monitoring for statin users.

Remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.

Nov. 20, 2018 See more In-depth