Cholesterol is a waxy lipid (fat) that has many important functions in your body, such as:
- supporting digestion
- building cells
- making certain hormones
- ensuring normal organ function
Your liver produces all of the cholesterol your body needs. But there are some factors that can cause you to have too much cholesterol in your blood. The most common causes of high cholesterol include:
- eating a diet that’s
too high in saturated fat
- having overweight or obesity
- not getting enough physical activity
- genetic (inherited) factors
If you’ve received a diagnosis of high cholesterol, your doctor will likely recommend certain lifestyle changes, like eating a healthier diet, getting more exercise, and quitting smoking. Depending on your cholesterol levels and other risk factors, they may also prescribe certain medications to help lower your cholesterol.
This article will take a closer look at these medications, who should take them and when, and what types of side effects they may have.
If your cholesterol is higher than it should be, it’s known as a lipid disorder, hyperlipidemia, or hypercholesterolemia. Having high cholesterol increases your risk of heart-related issues such as a heart attack and stroke.
Statins are usually the first choice of medications for high cholesterol. Doctors often prescribe these drugs because of their high efficacy. Research shows that statins can decrease low-density lipoprotein (LDL), or “bad,” cholesterol by
But statins can cause side effects in some people. Depending on the side effects and the severity, some people may have to switch to other types of cholesterol drugs. These include:
- bile acid sequestrants
- cholesterol absorption inhibitors
- proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors
- adenosine triphosphate-citrate lyase (ACL) inhibitors
- medications to treat familial hypercholesterolemia
Statins are prescription medications that lower your blood cholesterol by blocking an enzyme in your body that creates cholesterol. This helps lower your LDL levels while increasing your high-density lipoprotein (HDL), or “good,” cholesterol levels.
These drugs are taken by mouth, usually as tablets.
Statins are very effective.
The following statins are currently available in the United States:
Statins are generally safe. According to the American College of Cardiology, 85% to 90% of people who take statins don’t experience any side effects. But, as with any medication, some people may experience adverse reactions to statins.
Minor side effects of statins may include:
More serious side effects may include:
Some people are at a higher risk of developing side effects with statins. This includes people who:
- are taking several medications to lower cholesterol
- are older adults
- have a smaller body frame
- have kidney or liver disease
- consume too much alcohol
In addition, pregnant people should avoid taking statins.
Some types of statins can interact with other drugs or organic compounds.
For example, lovastatin (Altoprev), atorvastatin (Lipitor), and simvastatin (Zocor) can interact with grapefruit juice. This interaction can be very dangerous. Mixing these statins with grapefruit or grapefruit juice can increase the amount of medication in the bloodstream and cause serious side effects.
Not all statins cause the same side effects. The safest statin for you is dependent on your individual situation and risk factors.
If statins aren’t an appropriate medication for you or you begin having bothersome side effects, a doctor may recommend other drugs to lower your cholesterol. Let’s take a closer look at what these are.
Bile acid sequestrants
These drugs are also called bile acid-binding agents. They bind to the bile in your intestines, which prevents it from being absorbed into your bloodstream. Your liver then needs to make more bile acid, which it does by absorbing the cholesterol from your blood. This lowers your blood cholesterol level.
Bile acid sequestrants aren’t as effective as other cholesterol-lowering drugs. They’re often prescribed for people who have only slightly increased levels of cholesterol. Or they may be prescribed in combination with other medications.
Bile acid sequestrants can cause some side effects, mostly of a gastrointestinal nature, such as:
You may be able to relieve some of these side effects by drinking more water, taking a stool softener medication, or consuming more fiber.
Currently, three bile acid sequestrant drugs are available in the United States:
Cholesterol absorption inhibitors
Cholesterol absorption inhibitors prevent the absorption of LDL cholesterol in the intestines.
Ezetimibe (Zetia) is the only available treatment from this class of medications. According to the
Side effects of ezetimibe may include:
- abdominal pain
Niacin (nicotinic acid)
Niacin is also known as vitamin B3. According to research it can decrease your level of LDL cholesterol by
Although you can purchase it over the counter, only prescription-strength niacin is effective with lowering cholesterol. Because of a number of side effects, niacin is usually reserved for people who can’t tolerate statin therapy.
Side effects of niacin can include:
Examples of prescription-strength niacin include:
PSCK9 inhibitors are monoclonal antibodies. They work by inactivating a protein that normally prevents your body from clearing cholesterol from your blood.
Two PCSK9 inhibitors are available in the United States:
Unlike other cholesterol medications, these drugs are injected directly into your blood. This may cause pain or bruising at the injection site.
PCSK9 inhibitors are expensive. That’s why this type of medication is usually only used when other medications don’t sufficiently lower your cholesterol.
ACL inhibitors block a cholesterol-producing enzyme in your liver.
Bempedoic acid (Nexletol) is the only available medication in this class. Nexletol is usually taken together with other cholesterol-lowering medications to help them work more effectively.
The side effects can include:
- increased uric acid levels, which may increase your risk of gout
- decreased kidney function
Medications to treat familial hypercholesterolemia
Familial hypercholesterolemia is a genetic condition that causes high cholesterol in the blood.
In addition to statins and other cholesterol-lowering medications, people with this condition may be prescribed the following:
- evinacumab (Evkeeza)
- inclisiran (Leqvio)
- lomitapide (Juxtapid)
Many medications can help lower your cholesterol levels. Statins are the most effective and the most commonly prescribed option. But, for some people, statins can cause side effects. Or statins may not lower their cholesterol levels enough.
If statins don’t work effectively or cause unpleasant or serious side effects, a doctor may prescribe other cholesterol medications, which include both oral and injection options. Not all medications are appropriate for everyone, so make sure you talk with a doctor about which option is best for you.