Not every cholesterol-lowering drug on the market works for every type of cholesterol. Some are better for your low-density lipoprotein, or LDL, whereas others are more effective for increasing your high-density lipoprotein, or HDL. Other medications work better for lowering your triglycerides, another type of fat in your blood. Your doctor sometimes prescribes a combination of medications depending on your situation.
Statins
Statins are most commonly prescribed to lower your LDL cholesterol, and are more effective at doing so than any other cholesterol-lowering drug, according to the National Heart Lung and Blood Institute. Many patients' LDL cholesterol is lowered between 20 and 60 percent. Large reductions such as these contribute to a major drop in heart attacks and deaths due to heart disease.
Five statins exist, all of which work by blocking the enzyme that controls the rate of cholesterol production in the body. Statins also increase your liver's ability to remove existing LDL cholesterol in your blood. You take these drugs once a day in the evening when cholesterol production is at its highest.
Common side effects of statins include nausea, constipation, gas and abdominal pain. Mild joint or muscle tenderness is common as well.
Selective Cholesterol Absorption Inhibitors
This is a fairly new class of cholesterol-lowering drugs that are most effective for your LDL cholesterol, although they may slightly lower your triglycerides and increase your HDL cholesterol. The FDA approved the first medication in this class of drugs, ezetimibe, in 2002. It prevents the absorption of cholesterol from your intestines. Your doctor may prescribe this in combination with a statin for maximum cholesterol-lowering benefits. Its most common side effects include stomach pain and fatigue.
Bile Acid Sequestrants
Another class of LDL-lowering drugs, bile acid sequestrants, are not as effective as statins. These provide a 10 to 20 percent reduction when used alone; however, when your doctor prescribes them in combination with a statin, you can experience more than a 40 percent reduction. The drugs in this class -- cholestyramine, colestipol and colesevelam -- work in your intestines, binding to acids containing cholesterol, eliminating them through your stool. The National Heart Lung and Blood Institute explains that doctors do not prescribe these drugs as a sole treatment for high cholesterol, and do not prescribe them if you have high triglycerides or a history of constipation. They can also interfere with the absorption of other medications if taken at the same time.
Fibrates
Fibrates are the drug of choice if you have high triglyceride levels, providing a 20 to 50 percent reduction. They may also increase your HDL slightly -- 10 to 15 percent. They have no major impact on your LDL cholesterol, however. The most common fibrate in the Unites States is gemfibrozil, although two other medications are available in this class. The American Heart Association notes that these can be used in combination with statins when you require a reduction in your LDL cholesterol as well. The most common side effect is the development of cholesterol gallstones, but these drugs also can increase the effect of blood thinners.
Nicotinic Acid
Known also as niacin, nicotinic acid is a water-soluble B vitamin and is most effective for increasing your HDL cholesterol, although it has a positive effect on all cholesterol types and your triglycerides. It is available as an over-the-counter supplement and as a prescription. Your physician can provide you with the prescription form, which can increase your HDL between 15 and 35 percent. Flushing, or hot flashes, are the most common side effects of this medication, however, you might also experience nausea, vomiting, diarrhea and gas. This medication can increase blood sugar. It may also increase the effect of blood pressure medications.
