Talk to your doctor about the possible side effects before starting statins. Most side effects are mild and go away as your body adjusts. Muscle problems and liver abnormalities are rare, but your doctor may order regular liver function tests.

Women who are pregnant or people who have active or chronic liver disease should not take statins. If you have CVD and are already taking the highest tolerated statin and your LDL-C is still 70 or above, one or more of the following medicines may be prescribed.

They all can be taken in combination with a statin. Prevents cholesterol from being absorbed in the intestine. PCSK9 inhibitors are powerful LDL-lowering drugs.

They bind to and inactivate a protein on cells found in the liver to lower LDL bad cholesterol. Some names are alirocumab and evolocumab. ACL inhibitors work in the liver to block the production of cholesterol.

They are used in combination with lifestyle changes and statins to further decrease LDL cholesterol in adults with familial heterozygous hypercholesterolemia and patients with heart disease that need to further lower their LDL.

For more information on ACL inhibitors visit the National Library of Medicine link opens in new window.

Fibrates are especially good for lowering triglyceride blood fat levels and have a mild LDL-lowering action.

Niacin is a B vitamin that limits the production of blood fats in the liver. Take this only if your doctor has prescribed it. It lowers triglycerides and has mild LDL-lowering action. Niacin side effects may include flushing, itching and upset stomach. Your liver functions may be closely monitored because niacin can cause toxicity.

Nonprescription immediate-release forms of niacin usually have the most side effects, especially at higher doses. Niacin is used cautiously in diabetic patients because it can raise blood sugar levels. Niacin comes in prescription form and as a dietary supplement.

Dietary supplement niacin must not be used as a substitute for prescription niacin because of potentially serious side effects. Dietary supplement niacin is not regulated by the Food and Drug Administration and may contain widely variable amounts of niacin — from none to much more than the label states.

The amount of niacin may even vary from lot to lot of the same dietary supplement brand. Consult your doctor before starting any niacin therapy. These are derived from fish oils that are chemically changed and purified.

Skip directly to site content Skip directly to search. Español Other Languages. Cholesterol-Lowering Medicines. Minus Related Pages. What are the types of medicines that treat high cholesterol?

The body needs bile acids and makes them by breaking down LDL cholesterol. Niacin, or nicotinic acid Niacin is a B vitamin that can improve all lipoprotein levels. Nicotinic acid raises high-density lipoprotein HDL cholesterol levels while lowering total cholesterol, LDL cholesterol, and triglyceride levels.

They may also increase removal of LDL particles and increase apoA-I and apoA-II in the liver which may contribute to increase in HDL cholesterol levels. This results in a decrease in LDL cholesterol circulating in the bloodstream.

These patients often have a genetic factor that leads to a change in how cholesterol is processed in the body, and they have high levels of cholesterol from birth.

As such, their risk of developing heart disease is much higher. These patients are recommended for treatment regardless of the risk score, with treatment often started in late teenage years. You can help lower your lipid levels with lifestyle changes, medications, or a combination of both.

In certain cases, a health care provider will recommend a trial of lifestyle changes before recommending a medication. The best approach for you will depend on your individual situation, including your lipid levels, health conditions, risk factors, medications, and lifestyle. Lifestyle changes — If you have high low-density lipoprotein LDL cholesterol, you should try to make some changes in your day-to-day habits, including reducing the amount of total and saturated fat in your diet, losing weight if you are overweight or obese , getting regular aerobic exercise, and eating plenty of fruits and vegetables see "Patient education: Exercise Beyond the Basics " and "Patient education: Diet and health Beyond the Basics ".

A plant-based diet is an effective strategy to lowering LDL cholesterol. The benefits of these lifestyle changes usually become evident within 6 to 12 months. However, the success of lipid lowering with lifestyle modification varies widely, and health care providers sometimes recommend beginning medication sooner.

Medications — There are many medications available to help lower elevated levels of LDL cholesterol. Each category of medication varies in how it works, how effective it is, and how much it costs.

Your health care provider will recommend a medication or combination of medications based on your blood lipid levels and other individual factors.

Statins — Statins are one of the best-studied classes of medications and the most commonly used drugs for lowering LDL cholesterol. They are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death.

Available statins include atorvastatin former brand name: Lipitor , rosuvastatin former brand name: Crestor , and several other similar medications table 1. Statins decrease the body's production of cholesterol and increase removal of cholesterol by the liver, so they reduce LDL cholesterol levels by as much as 25 to 55 percent.

In addition, they can lower triglycerides. Statins may also reduce inflammation and may prevent heart attacks and strokes through this mechanism. While most people tolerate statins well, there are some potential side effects, mainly muscle pain, aches, or weakness.

Use of statins may also increase the risk of developing diabetes, although the risk is seen mostly in those with prediabetes, and the benefit in reduction on heart attack and stroke is about four times that of the risk of developing diabetes.

Changing statins and using low doses often can avoid these issues, but if not, non-statin medications can be used to lower LDL cholesterol.

It is important to closely follow the dosing instructions for when to take statins; some are more effective when taken before bedtime while others should be taken with a meal. In addition, some foods, such as grapefruit or grapefruit juice, can increase the risk of side effects of statins.

Most manufacturers recommend that people who take lovastatin, simvastatin, or atorvastatin consume no more than one-half of a grapefruit or 8 ounces of grapefruit juice per day. Ezetimibe — Ezetimibe brand name: Zetia blocks the body's ability to actively transport cholesterol from food as well as cholesterol that the body produces internally.

It lowers LDL cholesterol levels by 20 to 25 percent and has relatively few side effects. It is usually prescribed in combination with a statin but is also used alone in patients who cannot tolerate a statin. When used in combination with a statin after an acute coronary syndrome eg, heart attack , ezetimibe provides a small additional reduction in the risk of having another cardiovascular event.

PCSK9 inhibitors — PCSK9 monoclonal antibody inhibitors are another class of drugs that lower LDL cholesterol levels sample brand names: Praluent, Repatha table 1 ; they are given by injection under the skin every two to four weeks.

They reduce cardiovascular events such as heart attack or stroke and potentially death. Aside from mild skin reactions at the site of injection, they have few side effects. Inclisiran brand name Leqvio is a PCSK9 inhibitor that is given by injection once, 90 days later, and then every six months.

However, they are expensive and their use is limited to patients treated with maximal tolerated statins who have persistent elevations of LDL cholesterol. Bile acid sequestrants — The bile acid sequestrants include colesevelam brand name: Welchol , colestipol brand name: Colestid , and cholestyramine sample brand names: Prevalite, Questran table 1.

These medications bind to bile acids in the intestine, reducing the amount of cholesterol the body absorbs from foods.

They are used only occasionally. They lower LDL cholesterol only modestly 10 to 15 percent. Side effects can be bothersome and may include nausea, bloating, cramping, and liver damage. Taking psyllium a fiber supplement, such as Metamucil can sometimes reduce the dose required and the side effects.

Bile acid sequestrants can interact with some medications, including as digoxin brand name: Lanoxin and warfarin brand name: Jantoven , and with the absorption of fat-soluble vitamins including vitamins A, D, K, and E. Taking these medications at different times of day can solve these problems in some cases.

Bempedoic acid — Bempedoic acid brand name: Nexletol is the newest lipid-lowering agent, and it is approved for lowering LDL cholesterol. It works by inhibiting cholesterol synthesis at a step before the HMG-CoA reductase or the enzyme inhibited by statin therapy. Bempedoic acid alone or in combination with a statin or ezetimibe brand name: Nexlizet lowers LDL cholesterol as well as other atherogenic proteins.

Bempedoic acid can reduce the risk of cardiovascular events such as heart attacks. Side effects include an increase in the incidence of gout, gallstones, kidney damage, and small increases in liver enzymes.

Early studies reported Achilles tendon rupture as a rare side effect; however, this effect was not seen in a recent large trial. Omega-3 — Oily fish, such as mackerel, herring, bluefish, sardines, salmon, and anchovies, contain two important fatty acids called docosahexaenoic acid DHA and eicosapentaenoic acid EPA.

Eating a diet that includes one to two servings of oily fish per week can lower triglyceride levels and reduce the risk of death from coronary heart disease. Fish oil supplements, supplements with low-dose mixed fish oils usually approximately 1 gram per day of combined DHA and EPA , had been thought to provide cardiac benefit, but large trials have found no significant benefit.

As such, they are no longer recommended. A second study of a high-dose agent that had both EPA and DHA failed to provide benefit, suggesting that the EPA only preparation at the 4 g dose is important. However, the trials found that omega-3 fatty acid medications increase the risk of atrial fibrillation.

Therefore, a discussion with your cardiologist on the net benefit or harm from taking fish oil supplements including icosapent ethyl is needed before starting this treatment.

Nicotinic acid niacin — Nicotinic acid is a vitamin that is available in immediate-release, sustained-release, and extended-release formulations table 1. Nicotinic acid is rarely used for a high cholesterol. In most situations, ezetimibe or a PCSK9 inhibitor is tried before nicotinic acid.

Historically, this agent used to be used to raise HDL cholesterol levels, but that is no longer recommended. It is sometimes used for patients with high lipoprotein a levels and LDL cholesterol that is refractory to more effective and better-tolerated medications statins, ezetimibe and PCSK9 inhibitors.

Nicotinic acid is associated with many side effects, including flushing when the face or body turns red and becomes warm , itching, nausea, numbness and tingling, and worsening of gout. This medication can also cause liver damage; people who use it require regular blood tests to monitor their liver function.

Red yeast rice — Red yeast rice is a fermented rice product that can lower serum cholesterol. Red yeast rice contains naturally occurring substances called monacolins that act to reduce cholesterol by a mechanism similar to that of statins.

Although red yeast rice is effective for lowering total and LDL cholesterol, there is not evidence that it decreases rates of cardiovascular events or that it is safe to take long-term.

Rather than focusing simply on cholesterol levels, the researchers were looking at data that might be more meaningful to patients — the risk of heart attacks, for example — which Nissen hopes will encourage more patients to take a cholesterol-lowering drug.

Esperion, the company that makes and markets bempedoic acid, sells it alone or coupled with a second cholesterol-lowering medication, called ezetimibe. JoAnne Foody, a cardiologist and chief medical officer at Esperion.

Anyone who can get on statins, should. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at the Leon H.

Cheney Division of Cardiology at NYU Langone Health. Robert Rosenson cautioned against doctors and patients seeing bempedoic as equivalent to statins. Linda Carroll is a regular health contributor to NBC News. She is coauthor of "The Concussion Crisis: Anatomy of a Silent Epidemic" and "Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings.

IE 11 is not supported. For an optimal experience visit our site on another browser. SKIP TO CONTENT. NBC News Logo. Kansas City shooting Politics U. Nicotinic acid niacin , which lowers LDL bad cholesterol and triglycerides and raises HDL good cholesterol.

Even though you can buy niacin without a prescription, you should talk to your health care provider before taking it to lower your cholesterol. High doses of niacin can cause serious side effects.

PCSK9 inhibitors, which block a protein called PCSK9. This helps your liver remove and clear LDL cholesterol from your blood. Fibrates, which lower triglycerides. They may also raise HDL good cholesterol. If you take them with statins, they may increase the risk of muscle problems.

Combination medicines, which include more than one type of cholesterol-lowering medicine There are also a few other cholesterol medicines lomitapide and mipomersen that are only for people who have familial hypercholesterolemia FH. How does my health care provider decide which cholesterol medicine I should take?

When deciding which medicine you should take and which dose you need, your health care provider will consider: Your cholesterol levels Your risk for heart disease and stroke Your age Any other health problems you have Possible side effects of the medicines.

Higher doses are more likely to cause side effects, especially over time. Start Here. Cholesterol Medications American Heart Association Cholesterol Medications: Consider the Options Mayo Foundation for Medical Education and Research Also in Spanish. Diagnosis and Tests. Pharmacogenetic Tests National Library of Medicine Also in Spanish.

Learn More. Bile acid sequestrants for cholesterol Medical Encyclopedia Also in Spanish Cholesterol - drug treatment Medical Encyclopedia Also in Spanish Cholesterol-Lowering Medicines Centers for Disease Control and Prevention Fibrates Medical Encyclopedia Also in Spanish How to take statins Medical Encyclopedia Also in Spanish Niacin for cholesterol Medical Encyclopedia Also in Spanish Statins: MedlinePlus Health Topic National Library of Medicine Also in Spanish.

Statistics and Research. What are the types of medicines that treat high cholesterol? The body needs bile acids and makes them by breaking down LDL cholesterol.

Niacin, or nicotinic acid Niacin is a B vitamin that can improve all lipoprotein levels. Nicotinic acid raises high-density lipoprotein HDL cholesterol levels while lowering total cholesterol, LDL cholesterol, and triglyceride levels.

They may also increase removal of LDL particles and increase apoA-I and apoA-II in the liver which may contribute to increase in HDL cholesterol levels.

This results in a decrease in LDL cholesterol circulating in the bloodstream. Last Reviewed: May 15, Source: National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention. Facebook Twitter LinkedIn Syndicate. home Cholesterol Home.

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