High cholesterol can be managed with the right medications. In this guide, we'll look at some of the top medicines for reducing high cholesterol levels, their side effects and how they work.
Get to Know the Different Types of Cholesterol-Lowering Drugs.
Cholesterol-lowering drugs work in different ways. The most common are statins, which reduce the amount of low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, in your blood. There are also other medicines such as bile acid sequestrants and fibrates that block the absorption of cholesterol in the intestines and raise HDL (“good”) cholesterol. Other medications used to treat high cholesterol include injectable drugs that can lower “bad” LDL cholesterol as well as apheresis treatments which remove certain substances from your bloodstream.
Your doctor will work with you to determine which medication is best for you. Your risk factors, such as age and family history, lifestyle choices and other medications you are taking will all influence your doctor’s opinion about which medicine is most appropriate for you. And depending on the other medicines that you take and your health conditions, certain cholesterol drugs may interact with them in a negative way. Therefore it is important for you to share all of this information with your healthcare provider so that they can make the best decision about what type of cholesterol-lowering drug is best for you.
Understand How Statins Work.
Statins are a group of medications that block the chemical in your body that makes cholesterol. This reduces the amount of low-density lipoprotein (LDL) or “bad” cholesterol in your blood. Some common statins include atorvastatin, lovastatin and simvastatin. While all statins lower cholesterol, each one works differently, so it is important for you to discuss with your doctor about which one is best for you. It is also important to keep in mind that statins can have side effects including nausea, headache and muscle aches.
To ensure that statins are effective, it’s important to understand how to take statins correctly. The most common instructions from a doctor include taking them with or without food and specific instructions about when to take this medication. Some people require more frequent dosing for their particular medical condition in order for the statin to effectively lower cholesterol. It is otherwise beneficial for you to discuss other possible lifestyle changes that can help reduce bad cholesterol, such as increasing physical activities and applying a healthy diet.
Explore Bile Acid Sequestrants and Other Medications.
Bile acid sequestrants are medications that bind with bile acids in your intestines, blocking their reabsorption into the body and helping to reduce cholesterol levels. Commonly prescribed bile acid sequestrants include colestipol and cholestyramine. These medications can be used alone or as a supplement to statins. Other medications that can reduce cholesterol include fibrates and niacin, which are types of drugs that help lower triglycerides while raising high-density lipoprotein (HDL) or “good” cholesterol. It is important to note any over-the-counter supplements you may take to ensure they do not interact with your medication regimen.
When making lifestyle changes to reduce cholesterol levels, such as eating a healthy diet and exercising regularly, are not enough, a healthcare provider may prescribe medications to help. These can include bile acid sequestrants, statins, fibrates and niacin. It is important to take any prescription medication exactly as instructed by the doctor and visit regularly for check-ups. If you notice any side effects related to your prescription medications it is important that you discuss this with your physician right away.
Consider Niacin, Fibrates, PCSK9 Inhibitors, and Combination Therapies.
While statins are the most commonly prescribed medication for high cholesterol, other drugs or therapeutics have proven to be successful in lowering LDL-C. Niacin, also known as Vitamin B3, is an effective but often overlooked drug that has been used since the 1950s. Fibrates can increase HDL and help lower triglycerides, while PCSK9 inhibitors like Praluent (alirocumab) and Repatha (evolocumab) can also be effective when a patient needs additional cholesterol-lowering. For those patients who need more aggressive treatments to combat hard-to-treat cholesterol levels, a combination of therapy with several different drugs may offer the best outcome.
Niacin is usually best-suited for those who are unable to tolerate the side effects of statins. Fibrates can also improve triglyceride levels and raise HDL cholesterol at high doses, but they can increase the risk of muscle damage. PCSK9 blockers help those with familial hypercholesterolemia or coronary heart disease, but their cost can be prohibitive. For some patients, combination therapies may be necessary for maximum reduction of LDL-C due to drug interactions; this approach has been shown to have beneficial outcomes in studies. Whichever option a physician considers, regular monitoring is needed to ensure continued safety and effectiveness.
For patients with stubbornly high LDL-C levels and/or those who cannot tolerate statins, there are several other long-term medications to discuss with a physician. Niacin is derived from Vitamin B3 and has been shown to lower LDL-C levels by around 10% when combined with a statin. Fibrates act by stimulating the nuclear receptors that increase the production of lipoprotein lipase and aid in fat breakdown; however, they can also decrease HDL-cholesterol levels at higher doses. PCSK9 inhibitors are newly developed drugs that have been found to be effective in reducing damage cardiac checkup due to plaque buildup along with other cholesterol-lowering agents. Unfortunately, they may not be possible for those with tight budgets due to their exorbitant cost. Combination therapies can either combine any two or more of these drugs or add one drug class (such as omega-3 fatty acids) on top of another—all depending on the patient’s changing needs.
Discuss Side Effects with Your Doctor and Monitor Liver Function.
As with any medication, it is important to discuss with your doctor the possible side effects of each drug prescribed for high cholesterol. Some of the common ones include nausea, diarrhea, and constipation. Statins may cause more serious side effects like muscle pain or liver damage. It is important to share any other medications you are taking as well in order for your doctor to assess potential interactions between drugs. Your doctor may also monitor your liver function periodically while you are taking certain types of drugs to help minimize the risk from any side effects.
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