Drug Therapy: Cholesterol-Lowering Medicines

If cholesterol levels cannot be brought down to healthy levels by diet and exercise, cholesterol-lowering drugs may be helpful. They are also prescribed for people who have inherited a medical condition that causes high cholesterol.

The four types of cholesterol-lowering drugs are:

  • Fibrates (fibric acid derivatives), such as Atromid-S® or Tricor®. These drugs break down the particles that make triglycerides and use them in other ways in the body. Lower triglycerides can lead to increased levels of high-density lipoprotein (HDL).
  • Niocin or nicotinic acid, such as Niacor® or Slo-Niacin®. Niacin is a form of vitamin B. It slows the liver's production of certain chemicals that help make low-density lipoprotein (LDL) cholesterol. Niacin also helps lower triglycerides and raise HDL.
  • Resins (bile acid sequestrants), such as Colestid® or Questran®. Cholesterol helps in the production of bile, an acid used in digestion. This type of cholesterol-lowering drug binds to bile so it cannot be used during digestion, forcing the liver to make more bile. The more it makes, the more cholesterol it uses, leaving less cholesterol to circulate in the blood.
  • Statins (HMG-CoA reductase inhibitors), such as Lipitor®, Mevacor® or Zocor®. These drugs work by blocking an enzyme (HMG-CoA reductase) that helps the body make cholesterol. When the body produces less cholesterol, it signals the liver to make more LDL receptors. These receptors attract the LDL particles in the blood, reducing the amount of LDL cholesterol circulating in the blood. When the LDL level falls, the triglyceride levels fall and the HDL cholesterol increases.
If these medications are prescribed, the doctor should be made aware of any other drug, vitamin, mineral or herbal supplement the patient is taking, especially:
  • Warfarin, an anticoagulant, which can interact with cholesterol-lowering medications and may require that dosages of both be adjusted
  • Erythromycin
  • Certain antifungal medicines
Patients should avoid drinking and taking statins until they have talked about it with the doctor. The doctor should be told if the patient has:
  • Liver problems
  • Diabetes, gout or ulcers because nicotinic acid can make these worse
  • Kidney disease or gall bladder disease, particularly if prescribed a fibric acid derivative
  • Been thinking about becoming pregnant or already is pregnant
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