If dietary changes alone aren’t effective enough, however, your doctor will probably prescribe medication to help lower your cholesterol. Otherwise, you could have an increased risk of heart disease.
Your doctor may prescribe you more than one medication. Or you might take one pill that is a combination of two different cholesterol medications. Your medicine will be most effective if you combine it with a cholesterol-lowering diet and exercise plan.
The following cholesterol medications are among the most commonly prescribed:
Statins are the most commonly-prescribed type of medication designed to help lower cholesterol. They prevent the liver from producing cholesterol by blocking the enzyme HMG-CoA reductase, which makes cholesterol. They lower “bad” cholesterol (LDL) and slightly raise “good” cholesterol (HDL). Statins are also effective in lowering triglycerides, a type of fat found in your blood. Statins may be prescribed by themselves or along with other cholesterol-fighting drugs. Statins also help reduce your chance of having a heart attack or dying from heart disease.
Possible side effects: Nausea, diarrhea, constipation, muscle inflammation, memory loss, confusion, and high blood sugar.
Other considerations: If you’re taking a statin, limit your consumption of fresh grapefruit and grapefruit juice. Grapefruit can interfere with the liver’s ability to metabolize this type of medication.
Niacin is a B vitamin that helps your body turn food into energy. You can get it through food and in multi-vitamins. If your doctor prescribes it, your medicine will have a higher amount of niacin than is found in other sources.
Niacin works in the liver by affecting the production of blood fats. HDL, also known as “good cholesterol,” picks up extra bad cholesterol in your blood and takes it back to your liver for disposal. Niacin can raise HDL by more than 30 percent.
Possible side effects: Flushing, itching, stomach upset and very serious side effects such as bleeding, diabetes, liver damage, stroke or infection.
Other considerations: Niacin isn’t usually doctors’ first choice for a cholesterol medication because its possible side effects can be quite serious. It’s sometimes used in patients who can’t tolerate statins.
Bile acid resins
Bile acid resins lower LDL by increasing your body’s disposal of cholesterol. These medications bind to bile, which is made mostly of cholesterol. Bile acid resins are eliminated in the stool, keeping bile from being reabsorbed into your circulatory system. Drugs in this class are sometimes combined with statins in patients with heart disease to increase cholesterol reduction.
Possible side effects: Constipation, upset stomach, bloating and gas.
Special considerations: Bile acid resins may increase your triglyceride levels, and may interfere with absorption of other medications (when they are taken together).
Fibric acid derivatives (or Fibrates) can be prescribed to prevent painful inflammation of the pancreas (pancreatitis) caused by very high triglyceride levels (usually over 1,000 mg/dl). They can increase HDL levels and also reduce particles that the liver produces which carry triglycerides.
Possible side effects: stomach pain, nausea, gallstones.
Special considerations: Fibrates don’t do a good job of lowering LDL levels, but may be prescribed along with statins for a combined effect.
Omega-3 Fatty Acids
Omega-3 Fatty Acids are found in oil from certain types of fish (such as anchovies, bluefish, herring and wild salmon), as well as vegetables and other plant sources. They work to lower the body’s natural production of triglycerides. Omega-3 polyunsaturated fatty acids are not made in the body, but rather, they must be consumed in the diet. In addition to natural food sources, Omega-3 fatty acids are also sold as supplements. They are sometimes prescribed in drug form to combat very high levels of triglycerides.
Possible side effects: Upset stomach, gas, loss of appetite, diarrhea, constipation, back pain, dry mouth/altered sense of taste. Serious side effects including bleeding, anaphylaxis, stroke, increased infection risk, and reduced blood sugar control in diabetics.
Special considerations: If you’re allergic to fish or shellfish, you may also be allergic to omega-3 fatty acids.
Another option to consider is a research study. Research studies may be a good fit for people who aren’t satisfied with their current treatment, or who are interested in accessing potential new drugs under development for high cholesterol. These studies are conducted all over the world to find out if potential new drugs are safe and effective. Studies rely on volunteers who are willing to participate in this research.
The bottom line: Cholesterol treatment is not “one size fits all.” Your doctor will determine what, if any, cholesterol medications you need. The decision will be based on how high your cholesterol is, and any other health issues you may have. If one medication doesn’t work well, your doctor may add another or try a different type of medicine altogether. It’s important to take medication as your doctor recommends and to report any serious side effects.