Cholesterol Medications

Updated:Apr 27,2017

your doctor will determine what's best for you


For 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.

Control your levels with the right medicationsYour 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

Various 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:

  • View a cholesterol animationAdults 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.

Some 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 that you follow the recommendations made by your team of healthcare professionals. These recommendations 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 can give you the edge in the fight against heart disease and stroke. Follow your doctor's advice carefully, and if you don't understand something, ask questions. Let your doctor be your coach. It's your health. It's your heart.

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 that you follow the recommendations made by your team of healthcare professionals. These recommendations 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 can give you the edge in the fight against heart disease and stroke. Follow your doctor's advice carefully, and if you don't understand something, ask questions. Let your doctor be your coach. It's your health. It's your heart.

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.

Taking medicine may be new to you, and there may be a lot to remember. However, it's important to take medicine the right way — just as prescribed.

If you don't take medicine as directed, it may not work. It could also cause side effects that may be mild — or very harmful. Without knowing it, you could counteract one medicine by taking it with another. Medicine can also make you feel sick or dizzy.


How can I remember to take my medicine?

  • Take it at the same time every day.
  • Take it along with other daily events, like brushing your teeth.
  • Use special pill boxes that help you keep track, like the ones divided into sections for each day of the week (which can be found at a drugstore).
  • Ask people close to you to help 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. You can buy a small, magnetized white board with dry-erase markers and list your pills on the board. Each day, mark the board when you take your medication. It's an easy way to keep track, and at the end of the day, just erase the board and start over again in the morning.
Download a printable medicine tracker.

Quick Tips for Medication Use

  • Understand your medication. Know what it's for, and how and when you're supposed to take it.
  • Ask your doctor or pharmacist whether to take your medicine with food or on an empty stomach.
  • 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.
  • 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.
  • Ask your pharmacist to help you come up with a coding system for your medications that makes them easier to take.
  • Purchase timer caps for pill bottles to remind you when to take medication.

Additional tips:

  • You can buy many types of pill containers. Some even beep when it's time to take medication. Ask your pharmacist about these aids.
  • If your medication routine is too complicated, ask your physician or pharmacist to help you simplify the process, such as reducing the number of daily doses that you need.
  • If your medications are too expensive, ask your physician or pharmacist about finding financial assistance.
  • 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.
  • Some pharmacists will prepare blister packs for daily or weekly medications. Ask your pharmacist about this.
  • If you're using a commercial pill dispenser, set a regular time each week to refill it.
  • If you have trouble understanding your physician or pharmacist, ask a friend or loved one to go with you and help you.
  • If you don't feel like your medication is making a difference, talk to your physician and ask why.
  • Do not stop any medications without talking to your physician or healthcare provider.

  • Store your medicine the way your doctor or pharmacist tells you, and take all medications as prescribed.
  • ALWAYS keep it away from heat, light and moisture.
  • Keep track of what pills you can and can't take together, including over-the-counter medicines.
  • Tell your doctor if you have any side effects.
  • Ask your doctor or pharmacist before buying a new over-the-counter medicine, such as an antihistamine or cold tablets, to be sure they won't interfere with your prescribed medicine.
  • Always check with your doctor before you stop taking a medicine.
  • Make sure that ALL of your doctors know ALL of the prescriptions, OTC drugs, nutritional supplements or herbal preparations you're taking.
  • Don't share your medications with anyone else. What's right for you may be deadly for them.
  • Ask for your pharmacist's advice before crushing or splitting tablets. Some should only be swallowed whole.

Taking medications isn't as simple as swallowing a pill. Medicines can only help if you take them as prescribed. Take part in decisions regarding your treatment, follow the treatment plan you and your doctor agree on, watch for problems and become actively involved in solving them with your healthcare team. By following these guidelines, you can help reduce your risk of heart disease and stroke and achieve the fullest benefits from your treatment plan. Review the following questions with your healthcare team and take an active role in your health.


  • 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 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?

Prescription and over-the-counter medicines help many people live longer, more active lives. When you take the right medicines the right way, they're safe and effective tools for good health. But using them incorrectly can harm you. The more medicines you take, the greater your risk of problems. You can protect your health by getting a checkup on your medications. Take these simple steps as outlined by 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
  •  Take all of your medications in their original containers if possible.
     
  •  Take the bag to your doctor or pharmacist and get him or her to go over all of your medicines with you.
     
  •  Ask questions about anything you don't understand.

A checkup like this gives you the opportunity to ask your healthcare professional or pharmacist important questions about your medications. It can help you find dangerous medicine combinations you may be taking, medicines you may not need to take anymore, improper dosages of medicines, and mistakes that you may be making in taking them. Call your doctor or pharmacist today to schedule a medication checkup and take charge of your health.

Keeping Track / Developing a System

Keeping track of your prescribed medications can be challenging — especially if you're taking several different medicines. Writing things down will make managing your medications a lot easier. Use our printable medicine tracker to stay organized. Also available in Spanish.

Lowering High Blood Pressure
By treating high blood pressure, you can help prevent a stroke, heart attack, heart failure, kidney failure and peripheral artery disease. Our printable blood pressure tracker will help you monitor your blood pressure and record suggestions from your doctor. 

 

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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Know Your Medicines

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