Cholesterol Medications

Updated:Nov 16,2017

your doctor will determine what's best for you


Control your levels with the right medicationsFor some people, lifestyle changes like a healthier diet and more exercise may prevent or treat unhealthy cholesterol levels. For others, medication may also be needed.

Your doctor can assess your risk for a heart attack or stroke based on your cholesterol levels and other risk factors. From there, you can work with your doctor to develop a treatment and prevention plan that's right for you.

If you have to take medication, you may feel disappointed. That’s OK – it’s normal. But don’t let your feelings stop you from taking your meds. Set up a routine, and stick to it. The minor inconvenience of medication vastly outweighs the devastation of a cardiovascular event.

Cholesterol-Lowering Drugs

pill bottlesVarious medications are used to lower blood cholesterol levels. Statins are recommended for most patients because they’re the only cholesterol-lowering drug class that’s been directly associated with reducing the risk of a heart attack or stroke. Your doctor may consider other medications too, especially if statins cause serious side effects or they don’t help you enough.

Guidelines recommend that people in any of these four groups talk to their doctor about the risks and benefits of statin therapy:

  • Adults 40-75 years of age with LDL (bad) cholesterol of 70-189 mg/dL and a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.
  • People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
  • People 21 and older who have a very high level of LDL (bad) cholesterol (190 mg/dL or higher).
  • People with diabetes and a LDL (bad) cholesterol level of 70-189 mg/dL who are 40 to 75 years old.

View a cholesterol animationSome patients who do not fall into these categories may also benefit from statin therapy.

View an animation to see how cholesterol drugs work.


*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. We’ve included generic names as well as major trade names to help you identify what you may be taking. Please understand that the American Heart Association is not recommending or endorsing any specific products. If your prescription medication isn't on this list, your healthcare provider and pharmacist are your best sources of information. It's important to discuss all the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication or change your dose or frequency without first consulting your doctor.

*Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice, pomegranate and pomegranate juice. Please talk to your health care provider about any potential risks.


Learn more about cholesterol drugs

Statins (also known as HMG CoA reductase inhibitors)

This class of drugs works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.
 
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. People who are pregnant or who have active or chronic liver disease should not take statins.

Statins now available in the U.S. include:

Atorvastatin (Lipitor®)**
Fluvastatin (Lescol®)**
Lovastatin (Mevacor®, Altoprev™)**
Pravastatin (Pravachol®)**
Rosuvastatin Calcium (Crestor®)**
Simvastatin (Zocor®)**
Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe).
 

This class of drugs works in the liver to prevent cholesterol from forming. This reduces the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol. They also help lower triglycerides (blood fats) and raise HDL (good) cholesterol.
 
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. People who are pregnant or who have active or chronic liver disease should not take statins.

Statins now available in the U.S. include:

Atorvastatin (Lipitor®)**
Fluvastatin (Lescol®)**
Lovastatin (Mevacor®, Altoprev™)**
Pravastatin (Pravachol®)**
Rosuvastatin Calcium (Crestor®)**
Simvastatin (Zocor®)**
Statins are also found in the combination medications Advicor®** (lovastatin + niacin), Caduet®** (atorvastatin + amlodipine), and Vytorin™** (simvastatin + ezetimibe).
 

This relatively new class of cholesterol-lowering medications works by preventing cholesterol from being absorbed in the intestine. Selective cholesterol absorption inhibitors are most effective at lowering LDL cholesterol. They may also have modest effects on lowering triglycerides (blood fats) and raising HDL cholesterol.

The first medication of this class, ezetimibe (Zetia®)**, was approved in 2002 for treating high cholesterol and certain inherited lipid abnormalities.

This class of LDL-lowering drugs works in the intestines by promoting increased disposal of cholesterol. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so they can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream.

Resins now available in the U.S. include:

Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®, Locholest® Light)**
Colestipol (Colestid®)**
Colesevelam Hcl (WelChol®)**

Fibrates (fibric acid derivatives):

Fibrates are best at lowering triglycerides and in some cases increasing HDL levels. These drugs aren't very effective in lowering LDL cholesterol.

Fibrates now available in the U.S. include:

Gemfibrozil (Lopid®)**
Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)**
Clofibrate (Atromid-S)**


Niacin (nicotinic acid):
 
This drug works in the liver by affecting the production of blood fats. 

Niacin side effects may include flushing, itching and stomach upset. 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.

Omega-3 Fatty Acid Ethyl Esters

These medications are derived from fish oils that are chemically changed and purified.  They’re meant to be used with dietary changes to help in people with very high triglyceride levels (over 500 mg/dL) lower their levels.

Omega-3 fatty acid ethyl esters may cause serious side effects. They may also interact negatively with other medications, herbal preparations and nutritional supplements. People with allergies/sensitivities to fish, shellfish or both and/or any other drug component(s) may have a severe adverse reaction to using these medications.

 

Omega-3 fatty acid ethyl esters available in the U.S. include:
Lovaza®
Vascepa™

Marine-Derived Omega-3 Polyunsaturated Fatty Acids (PUFA)

Marine derived omega-3 PUFAs, commonly referred to as omega-3 fish oils or omega-3 fatty acids, are used in large doses to lower high blood triglyceride levels. They help decrease triglyceride secretion and facilitate triglyceride clearance.  The amount of marine-derived omega-3 PUFAs needed to significantly lower triglyceride (2 to 4 g) is hard to get from a daily diet alone, so supplementation with capsules may be needed. 

Use these supplements only under a doctor’s direction and care, because large doses may cause serious side effects. These can include increased bleeding, hemorrhagic stroke and reduced blood sugar control in diabetics. Negative interactions with other medications, herbal preparations and nutritional supplements are also possible. People with allergies to fish, shellfish or both may have a severe adverse reaction to using these supplements.  
 



Medicine Management

What is compliance?

Compliance simply means following the recommendations of your team of healthcare professionals. These often include taking medications as well as making lifestyle changes such as quitting smoking, eating right, maintaining a healthy weight and getting the right kind of physical activity. Maintaining a healthy lifestyle is important in reducing the risk of heart disease and stroke.

Taking medications properly is another part of compliance. Medicines may not work unless taken as prescribed. Or they can leave you dizzy, sick or worse. Or, without knowing it, you could counteract one medicine by taking it with another.

Take part in treatment decisions and, if you don’t understand something, ask questions. Carefully follow the agreed upon treatment plan, and watch for and work with your healthcare team to solve any problems.

Are you a "Good Dog" or "Bad Dog" when it comes to your medication? Take our "Good Dog, Bad Dog Compliance Quiz" and find out how well you follow your healthcare professional's recommendations.

Compliance simply means following the recommendations of your team of healthcare professionals. These often include taking medications as well as making lifestyle changes such as quitting smoking, eating right, maintaining a healthy weight and getting the right kind of physical activity. Maintaining a healthy lifestyle is important in reducing the risk of heart disease and stroke.

Taking medications properly is another part of compliance. Medicines may not work unless taken as prescribed. Or they can leave you dizzy, sick or worse. Or, without knowing it, you could counteract one medicine by taking it with another.

Take part in treatment decisions and, if you don’t understand something, ask questions. Carefully follow the agreed upon treatment plan, and watch for and work with your healthcare team to solve any problems.

Are you a "Good Dog" or "Bad Dog" when it comes to your medication? Take our "Good Dog, Bad Dog Compliance Quiz" and find out how well you follow your healthcare professional's recommendations.

Review these questions with your healthcare team and be actively engaged in your health. If you think you might have trouble understanding your doctor or pharmacist, ask a friend or loved one to go with you to listen, help you and take notes.

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • How and when do I take it, and for how long?
  • What is one dose?
  • Should I take it with food or on an empty stomach?
  • What foods, drinks, other medicines or activities should I avoid while taking this medicine?
  • Is there any written information available about the medicine?
  • What happens if I miss a dose of my medicine?
  • How often will I have to get the medication refilled?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?
  • Are there less expensive medications for my condition? Can these questions be sent to a cell phone?

These tips will help you remember your meds. Choose those that will work best for you.

  • Take your medicine at the same time every day.
  • Take it along with other daily events, like brushing your teeth.
  • Ask people close to you to help remind you.
  • Get some colored labels and stick them on your medicine bottles to simplify your routine. For example, blue can be for morning, red for afternoon and yellow for bedtime.
  • Many types of pill containers are available. You can find some available at a drugstore that are divided into sections for each day of the week. Timer caps for pills bottles even beep to remind you when to take medication. Ask your pharmacist about these aids.
  • Ask your pharmacist to help you come up with a coding system for your medications that makes them easier to take. Some pharmacists will prepare blister packs for daily or weekly medications.
  • Make an instruction sheet for yourself by taping a sample of each pill you take on a sheet of paper and writing down all the information about each pill to remind you.
  • Keep a "medicine calendar" near your medicine and make a note every time you take your dose.
  • Put a sticker or reminder note on your medicine cabinet or refrigerator. Or buy a small magnetized white board and use dry-erase markers to list your pills on it. Each day, mark the board when you take your medication. Then, and at the end of the day, erase the board and start over again in the morning. Download a printable medicine tracker.
  • If you're using a commercial pill dispenser, set a regular time each week to refill it. For example, you might fill it every Friday night after you eat.
  • If you're away from home a lot, make sure you carry enough of your medication with you to take the prescribed doses while you're out.

Follow these tips:

  • ALWAYS keep medications away from heat, light and moisture. Store your medicine the way your doctor or pharmacists tells you.
  • Tell your doctor if you have any side effects or if you don't think your medication is making a difference. NEVER stop any medications without first talking to your physician or healthcare provider.
  • Ask for your pharmacist's advice before crushing or splitting tablets. Some should only be swallowed whole.
  • Don't share your meds with anyone else. What's right for you could be deadly for them.
  • Before buying a new over-the-counter medicine, such as an antihistamine or cold tablets, ask your doctor or pharmacist about it. Be sure it won't interfere with your prescribed medicine.
  • If your medication routine is too complicated, ask your physician or pharmacist to help you simplify it. For example, there might be a way to reduce the number of daily doses that you need.
  • If your medications are too expensive, ask your physician or pharmacist about finding financial assistance.
  • Make sure that ALL of your doctors know ALL of the prescriptions, OTC drugs, nutritional supplements or herbal preparations you're taking. See the next section.

Prescription and over-the-counter medicines can work wonders when taken the right way. But using them incorrectly can harm you.

The more meds you take, the greater your risk of problems. That’s why a medication checkup is a good idea. One benefit is that it can help you find dangerous medicine combinations. It may also reveal medicines you don’t need to take anymore or improper dosages. You may even discover mistakes in how you’re taking your medicines.

To protect your health, follow these simple steps from the National Council on Patient Information and Education:

  • Make an appointment with your doctor or your pharmacist.
  • Put all your prescription and over-the-counter drugs in a bag, including:
      Prescriptions in vials, tubes, bottles and plastic bags
      Sleep and motion-sickness aids
      Headache remedies
      Cold remedies (liquid, capsules and tablets)
      Laxatives and upset stomach aids
      Other prescription or over-the-counter drugs you may be taking
      Vitamins and nutritional supplements
      Herbal remedies
  • Bring your medications in their original containers if you can.
  • Take the bag to your doctor or pharmacist so they can review all of your meds with you.
  • Ask questions about anything you don't understand.
If you take a lot of meds, call your doctor or pharmacist today to schedule a medication checkup.

Clinical Trials

Clinical trials are scientific studies that determine if a possible new medical advance can help people and whether it has harmful side effects. Find answers to common questions about clinical trials in our Guide to Understanding Clinical Trials.




This content was last reviewed April 2017.

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