High cholesterol, medically known as hyperlipidemia, is a major risk factor for developing heart disease. Lowering your cholesterol decreases your risk for coronary artery disease and stroke. High cholesterol can be treated by simple lifestyle changes like eating a healthier diet -- low in fat and high in fiber-- increasing your physical activity and if you are overweight, losing weight. When these lifestyle modifications, alone, fail, cholesterol-lowering drugs may be added to help you reach your goal.
Statins
Statins are the first-line medications for treating high cholesterol. Generally well-tolerated, they may be used alone or in combination with other classes of cholesterol-lowering medications. Some commonly prescribed statins include atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) and lovastatin (Mevacor). Most side effects are minor and may include headache, muscle weakness/pain, back pain, joint pain, or abdominal pain. However, statins may potentially damage your liver. Periodic tests of liver function are required when you begin taking a statin and throughout your therapy.
Fibrates
Fibrates, also known as fibric acid derivatives, are also used to lower cholesterol. Fenofibrate (Antara, Lofibra, Ticor and Triglide), gemfibrozil (Lopid), and clofibrate (Atromid-S) are members of this class of cholesterol-lowering medications. They lower triglycerides, which are fats in the bloodstream, as well as raise the "good" cholesterol, or HDL. Side effects associated with the fibrates include muscle pain, indigestion, headache, nausea, constipation. Fibrates may also cause liver damage.
Bile Acid Sequestrants
Bile acid sequestrants are useful cholesterol-lowering medications. These agents form a complex with bile acids in the intestines, rendering them nonabsorbable. Inhibition of bile acid absorption results in a decrease in the "bad" cholesterol, or LDL. Colestipol (Colestid), cholestyramine (Questran) and colesevelam (Welchol) are all bile acid sequestrants. Common side effects associated with the use of these agents include constipation, nausea, and gas. To avoid developing fecal impaction, drink plenty of fluids. Bile acid sequestrants may also affect the absorption of other medications. Consult your pharmacist about how to space the administration of doses of these agents and your other medications.
Niacin
Niacin, a B vitamin, affects HDL and triglyceride levels. According to the Drug Information Handbook, it raises HDL by 20 to 35 percent and lowers triglycerides by 10 to 50 percent. It works by blocking the synthesis of LDL in the liver. Niacin is available over-the-counter and by prescription. Common side effects associated with its use are flushing, itching, nausea, vomiting, indigestion, and abdominal pain. Niacin may also adversely affect the liver.
Ezetimibe
Ezetimibe, or Zetia, exerts its effect by blocking the absorption of cholesterol in the small intestine. It's the lone member of the class of cholesterol-lowering medications called cholesterol absorption inhibitors. It may be used in combination with other cholesterol lowering medications or alone. Ezetimibe lowers total cholesterol, LDL and triglycerides, while increasing HDL. Common side effects associated with its use include joint pain, diarrhea, headache and abdominal pain.
References
- Pharmacy Times: Many Options Now Available to Treat Hyperlipidemia
- "Drug Information Handbook": Charles Lacy, RPh, Lora Armstrong, RPh., Morton Goldman, RPh. Leonard Lance, RPh.; 2008
