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Sellers, BS Pharmacy, PharmD — By Jenna Fletcher on July 28, 2022People with high cholesterol can take several different medications and, in some cases, supplements to help lower their levels. However, a person should work closely with a doctor when taking these medications. Cholesterol comes in two forms: low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, and high-density lipoprotein (HDL) cholesterol, also known as “good” cholesterol. Medications that target cholesterol levels help reduce the amount of bad cholesterol, often by blocking its creation or absorption. There are several different cholesterol medications that doctors may prescribe. If a person does not find success with one medication, they can try another. This article comprises a list of several different types of cholesterol-lowering medications, their generic and brand names, and possible side effects. Statins Share on PinterestIuliia Bondar/Getty ImagesStatins are a class of medications that work by:reducing the amount of cholesterol the liver makeshelping the liver remove excess cholesterol from the blood Most people tolerate statins well. However, they can potentially cause side effects, including:issues with musclesincreased risk of developing type 2 diabetes Examples of statins include:simvastatin (Zocor, FloLipid)atorvastatin (Lipitor)lovastatin (Altoprev)fluvastatin (Lescol XL) pravastatin (Pravachol)pitavastatin (Livalo)rosuvastatin (Crestor, Ezallor) Learn more about statins here. Cholesterol absorption inhibitor As the name suggests, cholesterol absorption inhibitors work by blocking the absorption of cholesterol in the small intestine. The Food and Drug Administration (FDA) approved ezetimibe (Zetia) in 2002. It may help lower a person’s cholesterol by 18–25%. As with other medications, it works best in combination with weight management, diet, and exercise. A person should also inform a doctor if they experience any unusual symptoms, such as muscle fatigue or weakness, dark-colored urine, or fever. Combination cholesterol absorption inhibitor and statin In some cases, a doctor may prescribe a combination of ezetimibe and a statin to help better control cholesterol. The combination both blocks the absorption of cholesterol and the production of cholesterol. When someone takes both medications together, they will generally tolerate them well and experience few side effects. Combination calcium channel blocker and statin Combination calcium channel blockers and statins can help with both cardiovascular disease and cholesterol management. Some benefits include lowering cholesterol, controlling angina, and treating hypertension (high blood pressure) and coronary artery disease. The medications may be a combined pill or capsule or use of two different medications together. Examples include:amlodipine/atorvastatin (Caduet)amlodipine (Norvasc); atorvastatin (Lipitor) Older studies have shown that this combination can be effective in treating high cholesterol levels and reducing the risk of cardiovascular issues. Side effects can be similar to taking statins or calcium channel blockers, such as:fatiguenauseageneral stomach upset such as diarrhea or constipationrashesheadachesdizzinessflushingrapid heartbeat PCSK9 inhibitors Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a role in regulating cholesterol levels. Increased PCSK9 activity can lead to increased levels of LDL cholesterol and heart disease. Lower activity levels can help reduce cholesterol levels, particularly in people with familial hypercholesterolemia — significantly higher levels of bad cholesterol and cardiovascular risk. PCSK9 inhibitors work by blocking PCSK9 activity. In the United States, only three types of these inhibitors have FDA approval. They are:alirocumab (Praluent)evolocumab (Repatha)inclisiran (Leqvio) These medications can help reduce a person’s cholesterol levels and decrease their risk of developing cardiovascular disease. Some possible reactions include nasopharyngitis, which is inflammation of the pharynx and nasal passages, and injection site reactions. Adenosine triphosphate lyase ACL inhibitors Adenosine triphosphate lyase (ACL) inhibitors help block the production of cholesterol in the liver. A doctor may prescribe them alongside statins to help further reduce high levels of cholesterol. They will also likely recommend changes in diet and exercise. There are two kinds of ACL inhibitors, they include:bempedoic acid (Nexletol)bempedoic acid and ezetimibe (Nexlizet) Though most people tolerate these medications well, they can cause adverse reactions that may include:upper respiratory tract infectionmuscle spasmsinfluenzahyperuricemiaback painabdominal painfatiguepain in extremitiesanemiadiarrheasinusitiselevated liver enzymesarthralgiabronchitis Bile acid sequestrants Bile acid sequestrants are one of the older options for cholesterol reduction that doctors no longer frequently prescribe. Bile acid sequestrants do not provide as effective control of cholesterol as newer medications, such as statins, and may have unwanted side effects. They work by blocking bile acid in the intestines from absorbing food that may turn into cholesterol. There are three versions with FDA approval:cholestyramine (Questran)colesevelam (Welchol)colestipol (Colestid) Doctors observed that bile acid sequestrants can bind to medications, hormones, and vitamins, causing their effectiveness and absorption to decline. Fibrates Fibrates have a generally mild effect on lowering cholesterol levels. Their main effect is lowering a person’s amount of blood fat. Examples of fibrates include:fenofibrate (Tricor, Antara, Triglide, and Lofibra)gemfibrozil (Lopid)clofibrate (Atromid-S) Side effects tend to be mild and can include:nauseadiarrheastomach upset Niacin Niacin is a type of vitamin B. It has a mild effect on bad cholesterol and can help lower triglycerides. However, due to its potential to cause liver toxicity, a person should only take niacin when a doctor prescribes it. Some possible side effects include:upset stomachflushingitching The American Heart Association (AHA) warns that a person should never take niacin supplements due to the potential for serious side effects. The reason is that supplements can vary widely in how much is in each pill or batch, even within the same company. Omega-3 fatty acid ethyl esters Omega-3 fatty acid ethyl esters derive from fish oils. Companies use chemicals to change and purify them to help lower triglyceride levels. Some examples available in the United States include:icosapent ethyl (Vascepa)Lovaza Some common side effects include an odd taste in mouth, upset stomach, and excess gas. Marine-derived omega-3 polyunsaturated fatty acids PUFA People typically refer to these supplements as omega-3 fish oils or omega-3 fatty acids. Large amounts of omega-3 may help lower cholesterol levels. However, the amount is more than a person can typically get from their diet. To have a significant effect, a person would need to consume around 2–3 grams of omega-2 fatty acid, which is only achievable with supplements. A person should only take them under doctor supervision due to the potential for serious side effects at higher doses, such as:reduced blood sugar controlincreased bleeding interactions with other medicationshemorrhagic stroke What is the first-line medication In most cases, doctors consider statins the first-line medication when treating elevated or high cholesterol levels. They may prescribe other medications first if the person has familial hypercholesterolemia. Otherwise, they will likely prescribe other medications if statins do not work or do not work well enough for the person. Drug and food interactions People should use caution when taking cholesterol-lowering medication. Certain medications can interact with each other or, in some cases, the food a person eats. For example, when taking certain statins, grapefruit juice and fresh grapefruit may interact with them. It is important for a person to review all their current medications and supplements. They should also ask a doctor about any dietary restrictions they should be aware of when taking their medication to avoid potential complications. Summary Several different medications and combinations can help lower cholesterol in a person with high amounts of bad cholesterol. They work by blocking the absorption or creation of cholesterol in the body. A person taking any of these medications should work with a doctor and get regular screening to check the effectiveness of the medications. If they do not appear to help, a doctor can likely prescribe a different medication that may work better for the individual. Last medically reviewed on July 28, 2022CholesterolHeart DiseaseDrugs 8 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Bile acid resins or sequestrants. (2017).https://www.ncbi.nlm.nih.gov/books/NBK548342Cholesterol absorption inhibitor. (2012). https://thefhfoundation.org/fh-treatments/cholesterol-absorption-inhibitorCholesterol medications. (2020).https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medicationsControlling cholesterol with statins. (2017).https://www.fda.gov/consumers/consumer-updates/controlling-cholesterol-statinsGrigore, L., et al. (2008). Combination therapy in cholesterol reduction: Focus on ezetimibe and statins.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2496970Nexlizet (bempedoic acid and ezetimibe) tablets, for oral use. (2020).https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211617s000lbl.pdfPokhrel, B., et al. (2022). Pcsk9 inhibitors. https://www.ncbi.nlm.nih.gov/books/NBK448100Zhang, X, et al. (2014). Effects of combination of statin and calcium channel blocker in patients with cardiac syndrome x.https://journals.lww.com/coronary-artery/fulltext/2014/01000/effects_of_combination_of_statin_and_calcium.8.aspxFEEDBACK:Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — By Jenna Fletcher on July 28, 2022 Latest newsWhat sets 'SuperAgers' apart? 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