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Cholesterol medications: Consider the options
By Mayo Clinic staffA healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may 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 may 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 Altoprev (lovastatin) Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor (lovastatin) Pravachol (pravastatin) Zocor (simvastatin) |
Decrease LDL and triglycerides; slightly increase HDL | Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice |
| Bile acid binding resins Colestid (colestipol) Questran (cholestyramine/ sucrose) Welchol (colesevelam) |
Decrease LDL | Constipation, bloating, nausea, gas; may increase triglycerides |
| Cholesterol absorption inhibitor Zetia (ezetimibe) |
Decreases LDL; slightly decrease triglycerides; slightly increase 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 Lofibra (fenofibrate) Lopid (gemfibrozil) TriCor (fenofibrate) |
Decrease triglycerides; increase HDL | Nausea, stomach pain, gallstones |
| Niacin Niaspan (prescription niacin) |
Decreases LDL and triglycerides; increases HDL | Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers |
| Combination statin and niacin Advicor (niacin-lovastatin) |
Decreases LDL and triglycerides; increases HDL | Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills; possible interaction with grapefruit juice |
| Omega-3 fatty acids Lovaza (prescription omega-3 fatty acid supplement) Vascepa (Icosapent ethyl) |
Decrease triglycerides | Belching, fishy taste, increased infection risk |
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 may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.
References
- Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/cholesterol/. Accessed Aug. 22, 2012.
- What is cholesterol-lowering medicine? American Heart Association. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300433.pdf. Accessed Aug. 22, 2012.
- Drug therapy for cholesterol. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp. Accessed Aug. 22, 2012.
- Rosenson RS. Statins: Actions, side effects and administration. http://www.uptodate.com/index. Accessed Aug. 22, 2012.
- Rosenson RS. Lipid lowering with fibric acid derivatives. http://www.uptodate.com/index. Accessed Aug. 22, 2012.
- Rosenson RS. Lipid lowering with drugs other than statins and fibrates. http://www.uptodate.com/index. Accessed Aug. 22, 2012.
- Koski RR. Omega-3-acid ethyl esters (Lovaza) for severe hypertriglyceridemia. Pharmacy and Therapeutics. 2008;33:271.
- Vascepa (prescribing information). Dublin, Ireland: Amarin Pharmaceuticals.; 2012. http://www.vascepa.com/. Accessed Aug. 22, 2012.
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