Cholesterol medications: Consider the options
By Mayo Clinic Staff
A healthy lifestyle is the best way to prevent and treat high cholesterol. But sometimes diet and exercise aren't enough. You also might need to take cholesterol medicines to help:
- Lower your level of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol that raises the risk of heart disease.
- Lower your level of triglycerides, a type of fat in the blood that also raises the risk of heart disease.
- Increase your level of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol that protects against heart disease.
Your healthcare professional might suggest a single medicine or a mix of cholesterol medicines. Here's a look at the pros and cons for common classes of cholesterol medicines.
If you're pregnant or breastfeeding, check with your healthcare professional before taking any of these medicines.
| Medicine class | How it helps | Common side effects | Less common or rare but more serious side effects |
|---|---|---|---|
| Statins Atorvastatin (Lipitor) Fluvastatin (Lescol XL) Lovastatin Pitavastatin (Livalo) Pravastatin Rosuvastatin (Crestor) Simvastatin (Zocor, Flolipid) | Lower LDL cholesterol and triglycerides; slightly raise HDL cholesterol | Muscle pain and weakness, trouble passing stool, upset stomach, loose stools, stomach pain, headache, raised liver enzymes | Muscle breakdown, liver damage, higher risk of diabetes |
| Cholesterol absorption inhibitor Ezetimibe (Zetia) | Lowers LDL cholesterol; slightly lowers triglycerides; slightly raises HDL cholesterol | Stomach pain, loose stools, gas, raised liver enzymes | Swelling of the face, lips, tongue, throat and genitals; life-threatening allergic reactions; low platelet count; pancreatitis |
| PCSK9 inhibitors Alirocumab (Praluent) Evolocumab (Repatha) Inclisiran (Leqvio) | Lower LDL cholesterol; mainly used for people who have a changed gene that causes very high LDL cholesterol or people with heart disease who can't take statins or other cholesterol-lowering medicines | Itching, swelling, pain or bruising at the site of the shot, flu-like symptoms, muscle pain, swelling and irritation of the nose and throat | Swelling of the face, lips, tongue, throat and genitals; life-threatening allergic reactions |
| Citrate lyase inhibitors Bempedoic acid (Nexletol) Bempedoic acid-ezetimibe (Nexlizet) | Lower LDL cholesterol | High uric acid levels, gout, swelling and irritation of the nose and throat, raised liver enzymes | With ezetimibe, tendon rupture, higher uric acid |
| Bile acid sequestrants Cholestyramine (Prevalite, Locholest) Colesevelam (Welchol) Colestipol (Colestid) | Lower LDL cholesterol; may slightly raise HDL cholesterol | Trouble passing stool, bloating, upset stomach, gas, heartburn, higher liver enzymes | Blockage in the intestines, higher triglycerides, not being able to take in vitamins that dissolve in fat, pancreatitis |
| Cholesterol absorption inhibitor and statin Ezetimibe-simvastatin (Vytorin) | Lowers LDL cholesterol and triglycerides; raises HDL cholesterol | Muscle pain, higher blood sugar, trouble passing stool, upset stomach, loose stools, stomach pain, cramps, tiredness, raised liver enzymes | Muscle breakdown, liver damage, higher risk of diabetes |
| Calcium channel blocker and statin Amlodipine-atorvastatin (Caduet) | The statin lowers LDL and triglycerides; the calcium channel blocker lowers blood pressure | Facial and neck flushing, leg swelling, dizziness, heart pounding, muscle soreness, higher blood sugar, trouble passing stool, upset stomach, loose stools, stomach pain, cramps, raised liver enzymes | Muscle breakdown, liver damage, higher risk of diabetes |
| Fibrates Fenofibrate (Antara, Lipofen, others) Gemfibrozil (Lopid) | Lower triglycerides; modestly lower LDL cholesterol; raise HDL cholesterol | Upset stomach, stomach pain, muscle pain and weakness, higher liver enzymes, headache | Muscle breakdown, gallstones; pancreatitis; damaging skin reactions |
| Niacin Prescription niacin (Niacor) | Lowers LDL cholesterol and triglycerides; raises HDL cholesterol | Facial and neck flushing, itching, stomach upset, headache | Liver damage, high uric acid, gout, high blood sugar, damaging skin reactions |
| Omega-3 fatty acids Prescription versions include Lovaza, Omacor and Vascepa | Lower triglycerides; may raise HDL cholesterol | Belching, fishy taste, stomach upset after eating; raised risk of bleeding |
There's a risk of muscle pain linked with statins that seems to vary by type of statin. But it isn't clear whether the medicine causes the muscle aches. Trials using substances that have no effect, called placebo, have shown that for most people who had muscle pain, the pain was not linked to the medicine.
People who are more likely to have muscle pain while taking statins include those with certain genes, people older than 80, people taking more than one medicine, and people with liver or kidney disease.
Most cholesterol medicines lower cholesterol with few side effects. But how well they work varies from person to person. Even if you take cholesterol medicine, you need to eat a healthy diet and get enough exercise. Cholesterol medicines and lifestyle choices can work together to help lower your risk of heart attack and stroke.
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