High cholesterol levels increase the odds of heart attack, stroke and vascular disease. There is an abundance of medications available to lower cholesterol. Several different classes of drugs have varying potency and effects on the lipid profile, a group of tests that measure cholesterol and triglycerides. Low-density lipoprotein (LDL or "bad cholesterol") is the primary target of cholesterol-lowering medications.
Statins
Statins are often the chosen first line of treatment for elevated cholesterol. All of the generic names for these drugs end with "statin" as in atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. These medications are highly effective at lowering LDL cholesterol and also raise high-density lipoprotein (HDL or "good cholesterol") cholesterol, which is beneficial. Their mechanism is to inhibit an important enzyme in cholesterol metabolism. Each has the potential to cause liver damage, however, so routine blood tests are recommended. Side effects include muscle aches, and, rarely, muscle damage.
Bile Acid Sequestrants
There are three drugs in this category: colesevelam, cholestyramine and colestipol. They work by blocking absorption of bile acid in the intestine which works to deplete cholesterol in the liver. They are generally not as effective as the statins in lowering LDL. Gastrointestinal upset, especially constipation, is the most common side effect. As they work in the intestine, they may interfere with the absorption of other drugs.
Niacin
Niacin, or nicotinic acid, is a vitamin available in prescription form or over the counter. It lowers LDL and raises HDL. It is quite effective, but it is not commonly prescribed as it can cause flushing and skin irritation. Niacin is available as a combination drug with lovastatin or simvastatin. It also has the potential to be toxic to the liver and may worsen gout. Some long-acting agents carry a higher risk of liver injury.
Fibrates
Fenofibrate is available in several generic cholesterol-lowering drugs. It activates an enzyme which reduces cholesterol levels. Fibrates are not considered first-line therapy as they can cause stomach upset and kidney or liver damage.
Ezetimibe
This drug blocks cholesterol absorption in the intestine. It is often used in combination with a statin when a single drug is not successful at bringing cholesterol levels to goal. This drug also has the potential to cause liver or muscle toxicity and gastrointestinal upset.
