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Which Medicines Lower 'Bad' (LDL) Cholesterol?

Reviewed by Brunilda Nazario, MD on June 14, 2021

When you have high cholesterol, the first thing to do is to change your diet and fitness: less saturated fat, no trans fat, less sugar, and more activity.

If that doesn’t bring down your “bad” (LDL) cholesterol enough, your doctor may suggest that you also take medicine to help out. (You’ll still need to keep up those lifestyle habits.)

Several types of prescription drugs can lower LDL. Get to know what each of them does, as well as some tips for taking these medications.

Statins

What they are: These are usually the first type of drug that doctors prescribe to lower LDL. They also lower triglycerides, which are another type of blood fat, and mildly raise your "good" (HDL) cholesterol.

Statins include:

Studies show that statins lower the chance of a “cardiovascular event” such as a heart attack.

Side effects: They can include intestinal problems, liver damage (rarely), and muscle inflammation. High blood sugar and type 2 diabetes may also be more likely with statins, although the risk is about 1 in 250 and the benefits outweigh the risks, according to the FDA.

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Statin drugs may also interact with other medications you take. Your doctor should check on that first.

Some people who take statins have reported memory loss and confusion. The FDA is looking into those reports and notes that in general, the symptoms weren’t serious and were gone within a few weeks after the person stopped taking the drug.

Avoid grapefruit and grapefruit juice when you take statins. Grapefruit makes it harder for your body to use these medicines.

Drugs that Work in Your Intestines

What they are: Your doctor may call these “bile acid resin” drugs or “bile acid sequestrants.” The work inside your intestines. They attach to bile from the liver and keep it from being absorbed back into your blood. Bile is made largely from cholesterol, so these drugs whittle down the body's supply of cholesterol.

Examples include:

A different type of drug, ezetimibe (Zetia), lowers “bad” LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have had a heart attack, it can make a small cut in the risk of heart “events,” such as another heart attack, when you also take a statin.

Side effects: For bile acid drugs, the most common side effects are constipation, gas, and upset stomach. For ezetimibe, the most common ones include muscle or back pain, diarrhea, and abdominal pain.

PCSK9 Inhibitors

What they are: These drugs are used in people who can’t manage their cholesterol through lifestyle and statin treatments. They block a protein called PCSK9 to make it easier for the body to remove LDL from your blood.

They are mainly used in adults who inherit a genetic condition called heterozygous familial hypercholesterolemia (HeFH) that makes it hard to bring down their cholesterol level, or for people who have heart disease and need more than a statin. You get them as a shot every 2 weeks.

Examples:

  • Alirocumab (Praluent)
  • Evolocumab (Repatha)

Side effects: Because these drugs are newer, it will take more time to get to know their side effects. In clinical trials, the most common ones for alirocumab are itching, swelling, pain, or bruising where you get the shot, as well as colds and flu. For evolocumab, they include colds, flu, back pain, and skin reactions where you get the shot.

Niacin

What it is: This B vitamin, also known as nicotinic acid, is found in food but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol.

Examples include:

Research has not shown that adding niacin, when you already take a statin, further lowers your risk of heart disease.

Side effects: The main ones are flushing, itching, tingling, and headache.

Fibrates

Fibrates are drugs that cut down on how much triglyceride your body makes and can boost your “good” HDL cholesterol.

Examples include:

ATP Citrate Lyase (ACL) Inhibitors

What it is: Bempedoic (Nexletol) keeps your liver from processing cholesterol. It is designed to help lower LDL in adults who have HeFH. It can also help lower the LDL in people with atherosclerotic cardiovascular disease (ASCVD).

Side effects: Upper respiratory tract infection, muscle spasms, excess uric acid in the blood, back pain, belly pain or discomfort, bronchitis, anemia, and higher liver enzymes.

Omega-3s

Some people wonder if dietary fish oil supplements rich in omega-3 fatty acids can help reduce the chances of heart disease. There's no evidence that they do. But experts say prescription-strength omega-3 medications can help lower high triglycerides and reduce heart disease risks in those at risk. They caution people not to use nonprescription fish oil dietary supplements to try lowering triglycerides.

Tips for Taking Cholesterol Medications

When you take medication to lower your LDL levels, you need to follow your doctor’s directions carefully. If you don’t take them as prescribed, they may not work the way they’re supposed to.

Cholesterol drug tips

  • Know why you are taking your medicine.
  • Take your medicine at the same time every day. Don’t stop taking it or change it without talking with your doctor. Even if you feel good, keep taking it.
  • Have a routine for taking your medicine. Get a pillbox that’s marked with the days of the week. Fill the pillbox at the start of each week to make it easier to remember.
  • Keep a medicine calendar. Make a note on the calendar every time you take a dose. List any changes your doctor makes to the medicines on your calendar.
  • Don’t cut back on how much you take to save money. You must take the full amount to get the full benefits. If cost is a problem, talk to your doctor about ways you can reduce your drug costs.
  • Do not take any over-the-counter drugs or herbal treatments unless you ask your doctor first. These can change how your cholesterol medicine works.
  • If you forget to take a dose, take it as soon as you remember, unless it’s almost time for the next dose. Ask your doctor what you should do in that case.
  • Fill your prescriptions before you run out. And ask your pharmacist any questions you have about your medicine. Let your doctor know if you have trouble getting to the pharmacy, have financial concerns, or have other problems that make it hard for you to get your prescriptions filled.
  • When traveling, keep your medicines with you so you can take them at the right time. On longer trips, take an extra week's supply, along with copies of your prescriptions. That way, you can get a refill if you need to.
  • Before having surgery with anesthesia, including dental work, tell the doctor or dentist what medicines you take.
  • Some medicines may affect your heart rate. Ask your doctor if you need to check your heart rate and how often you should do it.
  • Ask your doctor if you should avoid alcohol, which can increase the side effects of some medicines. It can also interfere with how effective they are.
  • Ask your doctor or pharmacist how to simplify your medicine routine.
  • If you have trouble understanding your doctor or pharmacist, ask a friend or loved one to go with you and help you.
  • If you don't feel like your medicine is making a difference, tell your doctor.

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Tips for remembering your medication

  • Make an instruction sheet for yourself. Tape a sample of each pill you have to take on a sheet of paper. Then write down all the information you need about that pill to remind you.
  • Use special pillboxes that are divided into days of the week. They can help you keep track of your medicines. There are many types of pill containers. You can buy timer caps for pill bottles to remind you when to take the medicine. Ask your pharmacist about containers and reminders that can help you.
  • Ask people close to you to help you remember to take your medicine.
  • Keep a chart near your medicine, and make a note every time you take your dose.
  • Ask your pharmacist to help you come up with a coding system for your medicines that makes them easier to take.
  • Get some colored labels and place them on your medicine bottles to simplify your routine. For example, blue can be for morning, red for afternoon, and yellow for bedtime.
WebMD Medical Reference

Sources

SOURCES:

FDA: “FDA Expands Advice on Statins Risk,” “Zetia (ezetimibe) Tablets.”

UpToDate: “Patient Information: High cholesterol treatment options (Beyond the Basics).”

American Heart Association: “Prescription omega-3 medications work for high triglycerides, advisory says.”

Cleveland Clinic: “How to Naturally Lower Your Cholesterol.”

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