Cholesterol medications: Types, benefits, and side effects - Medical News Today

People with high cholesterol can take several different medications and, in some cases, supplements to help lower their levels. However, a person should work closely with a doctor when taking these medications.

Cholesterol comes in two forms: low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol, and high-density lipoprotein (HDL) cholesterol, also known as "good" cholesterol.

Medications that target cholesterol levels help reduce the amount of bad cholesterol, often by blocking its creation or absorption.

There are several different cholesterol medications that doctors may prescribe. If a person does not find success with one medication, they can try another.

This article comprises a list of several different types of cholesterol-lowering medications, their generic and brand names, and possible side effects.

Statins are a class of medications that work by:

• reducing the amount of cholesterol the liver makes
• helping the liver remove excess cholesterol from the blood

Most people tolerate statins well. However, they can potentially cause side effects, including:

Examples of statins include:

Learn more about statins here.

As the name suggests, cholesterol absorption inhibitors work by blocking the absorption of cholesterol in the small intestine.

The Food and Drug Administration (FDA) approved ezetimibe (Zetia) in 2002. It may help lower a person's cholesterol by 18–25%. As with other medications, it works best in combination with weight management, diet, and exercise.

A person should also inform a doctor if they experience any unusual symptoms, such as muscle fatigue or weakness, dark-colored urine, or fever.

Combination cholesterol absorption inhibitor and statin

In some cases, a doctor may prescribe a combination of ezetimibe and a statin to help better control cholesterol. The combination both blocks the absorption of cholesterol and the production of cholesterol.

When someone takes both medications together, they will generally tolerate them well and experience few side effects.

Combination calcium channel blocker and statin

Combination calcium channel blockers and statins can help with both cardiovascular disease and cholesterol management.

Some benefits include lowering cholesterol, controlling angina, and treating hypertension (high blood pressure) and coronary artery disease.

The medications may be a combined pill or capsule or use of two different medications together. Examples include:

• amlodipine/atorvastatin (Caduet)
• amlodipine (Norvasc); atorvastatin (Lipitor)

Older studies have shown that this combination can be effective in treating high cholesterol levels and reducing the risk of cardiovascular issues. Side effects can be similar to taking statins or calcium channel blockers, such as:

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a role in regulating cholesterol levels.

Increased PCSK9 activity can lead to increased levels of LDL cholesterol and heart disease. Lower activity levels can help reduce cholesterol levels, particularly in people with familial hypercholesterolemia — significantly higher levels of bad cholesterol and cardiovascular risk.

PCSK9 inhibitors work by blocking PCSK9 activity. In the United States, only three types of these inhibitors have FDA approval. They are:

These medications can help reduce a person's cholesterol levels and decrease their risk of developing cardiovascular disease.

Some possible reactions include nasopharyngitis, which is inflammation of the pharynx and nasal passages, and injection site reactions.

Adenosine triphosphate lyase (ACL) inhibitors help block the production of cholesterol in the liver. A doctor may prescribe them alongside statins to help further reduce high levels of cholesterol. They will also likely recommend changes in diet and exercise.

There are two kinds of ACL inhibitors, they include:

Though most people tolerate these medications well, they can cause adverse reactions that may include:

Bile acid sequestrants are one of the older options for cholesterol reduction that doctors no longer frequently prescribe.

Bile acid sequestrants do not provide as effective control of cholesterol as newer medications, such as statins, and may have unwanted side effects. They work by blocking bile acid in the intestines from absorbing food that may turn into cholesterol.

There are three versions with FDA approval:

Doctors observed that bile acid sequestrants can bind to medications, hormones, and vitamins, causing their effectiveness and absorption to decline.

Fibrates have a generally mild effect on lowering cholesterol levels. Their main effect is lowering a person's amount of blood fat.

Examples of fibrates include:

• fenofibrate (Tricor, Antara, Triglide, and Lofibra)
• gemfibrozil (Lopid)
• clofibrate (Atromid-S)

Side effects tend to be mild and can include:

• nausea
• diarrhea
• stomach upset

Niacin is a type of vitamin B. It has a mild effect on bad cholesterol and can help lower triglycerides. However, due to its potential to cause liver toxicity, a person should only take niacin when a doctor prescribes it.

Some possible side effects include:

• upset stomach
• flushing
• itching

The American Heart Association (AHA) warns that a person should never take niacin supplements due to the potential for serious side effects. The reason is that supplements can vary widely in how much is in each pill or batch, even within the same company.

Omega-3 fatty acid ethyl esters derive from fish oils. Companies use chemicals to change and purify them to help lower triglyceride levels.

Some examples available in the United States include:

Some common side effects include an odd taste in mouth, upset stomach, and excess gas.

People typically refer to these supplements as omega-3 fish oils or omega-3 fatty acids. Large amounts of omega-3 may help lower cholesterol levels. However, the amount is more than a person can typically get from their diet.

To have a significant effect, a person would need to consume around 2–3 grams of omega-2 fatty acid, which is only achievable with supplements.

A person should only take them under doctor supervision due to the potential for serious side effects at higher doses, such as:

• reduced blood sugar control
• increased bleeding
• interactions with other medications
• hemorrhagic stroke

In most cases, doctors consider statins the first-line medication when treating elevated or high cholesterol levels.

They may prescribe other medications first if the person has familial hypercholesterolemia.

Otherwise, they will likely prescribe other medications if statins do not work or do not work well enough for the person.

People should use caution when taking cholesterol-lowering medication. Certain medications can interact with each other or, in some cases, the food a person eats.

For example, when taking certain statins, grapefruit juice and fresh grapefruit may interact with them.

It is important for a person to review all their current medications and supplements. They should also ask a doctor about any dietary restrictions they should be aware of when taking their medication to avoid potential complications.

Several different medications and combinations can help lower cholesterol in a person with high amounts of bad cholesterol. They work by blocking the absorption or creation of cholesterol in the body.

A person taking any of these medications should work with a doctor and get regular screening to check the effectiveness of the medications.

If they do not appear to help, a doctor can likely prescribe a different medication that may work better for the individual.