If making lifestyle changes doesn’t lower your cholesterol enough, or you have experienced a heart attack, these treatments can help.
If you have duly been following your doctor’s counsel to lower your cholesterol levels, but workout and a healthy diet isn’t working, they may prescribe a cholesterol-lowering drug.
But if you’ve had a heart attack, or if you have familial hypercholesterolemia (FH), cholesterol-lowering medication will likely be the first step in your treatment plan.
Prior to prescribing a drug, your doctor will most likely set a goal for your cholesterol levels. This target number will factor in your age, overall health, risk factors (especially those for heart disease), medical history, and other considerations.
According to your condition, you may need one or more drugs to get your cholesterol levels to a healthy range.
The most commonly recommended types of cholesterol-lowering drugs include:
Statins These drugs function by blocking a substance your liver needs to make cholesterol, which in turn causes your liver to remove cholesterol from your blood.
Statins could also potentially reverse coronary artery disease by helping your body reabsorb cholesterol from built-up deposits along the walls of your arteries.
Commonly prescribed statins include:
- Pravachol (pravastatin)
- Zocor (simvastatin)
- Altoprev or Mevacor (lovastatin)
- Crestor (rosuvastatin)
- Lescol (fluvastatin)
- Lipitor (atorvastatin)
- Livalo (pitavastatin)
Bile-Acid-Binding Resins Your body needs cholesterol to make bile acids, which aid in digestion.
As the name implies, these drugs bind to bile acids, causing your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
Bile-acid-binding drugs are typically prescribed along with a statin. They include:
Cholesterol Absorption Inhibitors This type of drug limits the amount of dietary cholesterol your small intestine absorbs, so that it can’t be released into your bloodstream.
The drug Zetia (ezetimibe), the only cholesterol absorption inhibitor on the market at the moment, can be used in combination with any of the statin drugs.
Combination Cholesterol Absorption Inhibitor and Statin This combination drug limits the absorption of dietary cholesterol by your small intestine and the production of cholesterol by your liver.
Two such combination drugs are:
If you have high triglycerides — another type of fat found in the blood that’s similar to cholesterol — in addition to high cholesterol, your doctor may also prescribe:
Fibrates These medications reduce your liver’s production of very-low-density lipoprotein (VLDL), which is made up mostly of triglycerides. They also increase the removal of triglycerides from your blood.
Two commonly prescribed fibrates are:
Omega-3 Fatty Acid Supplements Omega-3 fatty acid supplements — the most common of which is fish oil — can help lower your triglycerides.
You can take these supplements in conjunction with a statin. and they are available over-the-counter or by prescription, under several brand names:
If you choose to take over-the-counter fish oil or omega-3 supplements, be sure to let your doctor know. Even OTC varieties of fish oil may affect other medications you’re taking.
Niacin Also known as vitamin B3 (and sold under several brand names), niacin limits your liver’s ability to produce low-density lipoprotein (LDL) and VLDL cholesterol. It also reduces the production of triglycerides and raises HDL (“good”) cholesterol.
But niacin hasn’t been shown to provide any additional benefit over using statins alone, and it’s been linked to liver damage and increased risk of stroke.
Because of these risks, most doctors recommend niacin only for people who can’t take statins.
Side Effects of Cholesterol Medications
The major side effects of these cholesterol-lowering medications include:
- Muscle pain and weakness
- Stomach pain
To limit the side effects and increase the performance of cholesterol-lowering drugs, it’s vital to take them exactly as your doctor prescribes.
Inform your doctor immediately if you’re experiencing any problems since starting on a drug for cholesterol.
Your doctor should be able to change your dosage or suggest an alternative medication.
Always call your doctor immediately if your symptoms are severe.
Because some cholesterol-lowering drugs affect your liver, you may need to have your liver function tested occasionally.
Injectable Biologic Medications for High Cholesterol
In addition to oral medicines, injectable drugs are now available that can help some people lower their high cholesterol levels.
Praluent (alirocumab) and Repatha (evolocumab) are FDA-approved treatments that are part of a class of drugs known as PCSK9 inhibitors.
Drugs in this class work by inhibiting an enzyme (PCSK9) that leads to increase in LDL cholesterol levels.
Praluent is used along with diet and statins to treat people with heterozygous familial hypercholesterolemia (an inherited form of high cholesterol).
Side effects of Praluent may include itching or soreness at the injection site; flu-like symptoms such as fever or chills; or cold symptoms, including a stuffy nose, sneezing, or a sore throat.
Repatha is approved for people with high cholesterol levels due to homozygous or heterozygous familial hypercholesterolemia.
Repatha side effects can include pain or bruising at the injection site, back pain, cold or flu symptoms, and dizziness.