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Cholesterol-Lowering Drugs

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

Cholesterol-Lowering Drugs
Generic Name Brand Name
Statin Medications
Atorvastatin Lipitor
Fluvastatin Lescol, Lescol XL
Lovastatin Mevacor
Pitavastatin Livalo
Pravastatin Pravachol
Rosuvastatin Crestor
Simvastatin Zocor
Fibric Acids
Fenofibrate Tricor, Antara, Fenoglide, Fibricor, Lipidil, Lipofen, Lofibra, Triglide, Trilipix
Gemfibrozil Lopid
Niacin (Nicotinic Acid)
Niacin Niaspan, Niacor, Slo - Niacin
Bile Acid Sequestrants
Cholestyramine Questran: Questran Light
Colesevelam Welchol
Colestipol Colestid
Cholesterol Absorption Inhibitor
Ezetimibe Zetia
Omega 3 Fatty Acids
Icosapent Ethyl Vescepa
Omega-3-Acid Ethyl Esters Lovaza
HMG-CoA Reductase Inhibitors (Statins)

Block production of cholesterol in the liver itself.

Medication Brand Name Dose
Atorvastatin Lipitor 10 – 80 mg daily
Fluvastatin Lescol, Lescol XL 20 – 80 mg daily (or split twice daily)
Lovastatin Mevacor 20 – 80 mg daily
Pitavastatin Livalo 2 – 4 mg daily
Pravastatin Pravachol 10 – 80 mg daily
Rosuvastatin Crestor 5 – 40 mg daily
Simvastatin Zocor 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.
  • Remarks:
    • Notify your physician promptly of unexplained muscle pain, tenderness, or weakness, particularly if accompanied by fever or feeling sick.
    • Do NOT use with certain liver problems or while pregnant or breastfeeding
Fibric Acids

Primarily used for patients with elevated triglycerides.

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

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

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

Medication Brand Name Dose
Ezetimibe Zetia 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.

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

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/15/2014...#8744.