Some people have a genetic predisposition to high blood cholesterol levels. Others may have elevated cholesterol levels due to lifestyle, which may improve with a healthy diet and exercise. Drug therapy in addition to diet can help to bring cholesterol down to a safe level.

The text below presents a brief summary of some drugs of the representative classes of available cholesterol-lowering drugs.

Cholesterol-Lowering Drugs

Statin Medications

  • Generic Name: Atorvastatin
    Brand Name: Lipitor
  • Generic Name: Fluvastatin
    Brand Name: Lescol, Lescol XL
  • Generic Name: Lovastatin
    Brand Name: Mevacor
  • Generic Name: Pitavastatin
    Brand Name: Livalo
  • Generic Name: Pravastatin
    Brand Name: Pravachol
  • Generic Name: Rosuvastatin
    Brand Name: Crestor
  • Generic Name: Simvastatin
    Brand Name: Zocor

Fibric Acids

  • Generic Name: Fenofibrate
    Brand Name: Tricor, Antara, Fenoglide, Fibricor, Lipidil, Lipofen, Lofibra, Triglide, Trilipix
  • Generic Name: Gemfibrozil
    Brand Name: Lopid

Niacin (Nicotinic Acid)

  • Generic Name: Niacin Brand Name: Niaspan, Niacor, Slo - Niacin

Bile Acid Sequestrants

  • Generic Name: Cholestyramine
    Brand Name: Questran: Questran Light
  • Generic Name: Colesevelam
    Brand Name: Welchol
  • Generic Name: Colestipol
    Brand Name: Colestid

Cholesterol Absorption Inhibitor

  • Generic Name: Ezetimibe
    Brand Name: Zetia

Omega 3 Fatty Acids

  • Generic Name: Icosapent Ethyl
    Brand Name: Vescepa
  • Generic Name: Omega-3-Acid Ethyl Esters
    Brand Name: Lovaza

HMG-CoA Reductase Inhibitors (Statins)

Block production of cholesterol in the liver itself.

  • Atorvastatin
    • Brand Name: Lipitor
    • Dose: 10 – 80 mg daily
  • Fluvastatin
    • Brand Name: Lescol, Lescol XL
    • Dose: 20 – 80 mg daily (or split twice daily)
  • Lovastatin
    • Brand Name: Mevacor
    • Dose: 20 – 80 mg daily
  • Pitavastatin
    • Brand Name: Livalo
    • Dose: 2 – 4 mg daily
  • Pravastatin
    • Brand Name: Pravachol
    • Dose: 10 – 80 mg daily
  • Rosuvastatin
    • Brand Name: Crestor
    • Dose: 5 – 40 mg daily
  • Simvastatin
    • Brand Name: Zocor
    • Dose: 5 – 40 mg daily

Description: All tablets except fluvastatin, which is a capsule
Purpose: Lowers LDL (“bad” cholesterol) and triglycerides and increases HDL (“good” cholesterol)
Possible side effects: Possible side effects include muscle pain, constipation, weakness, abdominal pain and nausea. May cause rare but serious side effects involving the muscles, kidneys or liver.

  • Notify your physician promptly of unexplained muscle pain, tenderness, or weakness, particularly if accompanied by or feeling sick
  • Do NOT use with certain liver problems or while pregnant or breastfeeding

Fibric Acids

Primarily used for patients with elevated triglycerides.

  • Fenofibrate
    • Brand Name: Tricor, Antara, Fenoglide, Fibricor, Lipidil, Lipofen, Lofibra, Triglide, Trilipix
    • Dose: Dose varies based on formulation. Taken once daily
  • Gemfibrozil
    • Brand Name: Lopid
    • Dose: 600 mg twice daily

Description: Tablets or capsules
Purpose: Most effective at lowering elevated triglycerides (blood fats) and can also lower LDL (“bad” cholesterol) to a lesser amount than statins, and increase HDL (“good” cholesterol)
Possible side effects: Stomach upset, abdominal pain, muscle pain, nausea, diarrhea, vomiting and gas

  • Report unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever or feeling sick
  • Do NOT take with severe kidney or liver disease
  • Gemfibrozil should NOT be taken with statin medications

Nicotinic Acid

Niacin (nicotinic acid) is a B-complex vitamin. Some formulations are available over the counter (OTC).

  • Extended release
    • Brand Name: Niaspan
    • Dose: 1 – 2 g once daily
  • Immediate release
    • Brand Name: Niacor
    • Dose: 1.5 – 3 g/day (divide daily dose up to three times daily)
  • Sustained release
    • Brand Name: Slo – Niacin (OTC)
    • Dose: 1 – 2 g once daily

Description: Tablets or capsules
Purpose: Lowers LDL ("bad" cholesterol), increases HDL ("good" cholesterol) and is also useful to help lower triglycerides
Possible side effects: Flushing of the face and upper body, itching or tingling, headache and stomach upset. Can lead to increased blood sugars in patients who have diabetes. Can worsen gout attacks by increasing uric acid levels.

  • Take with meals to reduce stomach upset
  • Aspirin may help decrease flushing, if taken 1/2 hour before niacin
  • Caution in patients with diabetes, elevated uric acid and peptic ulcer disease
  • Do NOT use with chronic liver disease or severe gout

Bile-Acid Sequestrants

Work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulation. Bile is made largely from cholesterol, so these drugs deplete the body's supply of cholesterol.

  • Cholestyramine
    • Brand Name: Questran
    • Dose: 4 – 16 g/day (once or twice daily)
  • Colestipol
    • Brand Name: Colestid
    • Dose: 5 – 20 g/day (once or twice daily)
  • Colesevelam
    • Brand Name: Welchol
    • Dose: 2.8 – 3.8 g/day (once or twice daily)

Description: Powder or tablets
Purpose: Lowers LDL “bad” cholesterol and slightly increases HDL “good” cholesterol
Possible side effects: Constipation, weight loss, belching, bloating, diarrhea, nausea, vomiting and stomach pain. Rarely, black tarry stools.

  • The powder should never be taken in its dry form; it should always be mixed with at least three to four ounces of water, milk, flavored drink, juice or carbonated drink.
  • Other medications should be taken one hour before or four hours after taking a bile-acid sequestrant.

Cholesterol Absorption Inhibitor

Stops the body from absorbing cholesterol.

  • Ezetimibe
    • Brand Name: Zetia
    • Dose: 10 mg daily

Omega 3 Fatty Acids (Fish Oil)

Used for lowering triglycerides. Supplements are also available over the counter although the dose is different from prescription strength medications.

  • Icosapent Ethyl
    • Brand Name: Vescepa
    • Dose: 2 g twice daily
  • Omega-3-Acid Ethyl Esters
    • Brand Name: Lovaza
    • Dose: 2 g twice daily

Description: Capsules
Purpose: Lowers triglycerides, may lead to increase in LDL (“bad cholesterol”) levels
Possible side effects: Belching, fishy taste, gas, rash, itching

  • Can keep in refrigerator or freezer to prevent fishy aftertaste
  • Caution in patients with fish or shellfish allergy
  • May increase bleeding time, caution in patients who are on blood thinning medications or have bleeding disorders

All of these drugs will be more effective if you continue to follow a low cholesterol diet. Your doctor may be able to refer you to a dietitian for help in designing a diet especially for you and encouraging you to stay with it.

Last reviewed by a Cleveland Clinic medical professional on 07/16/2019.

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