Heart Health High Cholesterol Treatment Prescription Drugs for Cholesterol and Triglycerides By Richard N. Fogoros, MD facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Learn about our editorial process Richard N. Fogoros, MD Medically reviewed by Medically reviewed by Yasmine S. Ali, MD, MSCI on February 12, 2020 facebook twitter linkedin Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of Medicine at Vanderbilt University School of Medicine and an award-winning physician writer. Learn about our Medical Review Board Yasmine S. Ali, MD, MSCI Updated on February 13, 2020 Print Table of Contents View All Statins PCSK9 Inhibitors Ezetimibe Bile Acid Sequestrants Fibrates From statins like Lipitor (atorvastatin) to PCSK9 inhibitors like Repatha (evolocumab) to niacin and beyond, there are several kinds of medications that are regularly prescribed for treating high cholesterol and triglyceride levels. Which is most appropriate for you depends on several factors, but it's likely that your doctor will want you to begin taking prescription medication if diet and exercise are not enough to lower your levels, or your risk for cardiovascular disease is particularly elevated. Take A Pix Media / Blend Images / Getty Images Keeping your lipid (cholesterol and triglyceride) levels from getting too high is an important part of preventing atherosclerosis, coronary artery disease (CAD), stroke, and peripheral artery disease. It can help to learn about all of the possible prescription options your doctor might suggest so you can take an active role in your treatment discussions and decisions. Statins Statins are the mainstay of therapy for cholesterol. These oral drugs inhibit HMG-CoA reductase, reducing the liver’s ability to make cholesterol. Experts agree that some of the body's cholesterol is produced by the body rather than ingested, so inhibiting this enzyme lowers cholesterol through a different mechanism than dietary strategies. Statins also reduce vascular inflammation, decrease vascular thrombosis, and improve overall vascular function. Statins are usually well-tolerated, but you can experience side effects. The most notable one is muscle pain or weakness, which occurs in 0.3% to 33% of patients who take these drugs. Currently available statins include: Crestor (rosuvastatin)Lescol (fluvastatin)Lipitor (atorvastatin)Livalo (pitavastatin)Mevacor (lovastatin)Pravachol (pravastatin)Zocor (simvastatin) Who Should Take Statins and When PCSK9 Inhibitors PCSK9 inhibitors are a newer class of cholesterol-lowering drugs than statins. They work by inhibiting PCSK9, an enzyme that destroys the receptor proteins that help remove low-density lipoprotein (LDL or "bad cholesterol") from the circulation. The effect of these drugs is a therapeutic reduction of bad cholesterol. PCSK9 inhibitors, which are administered once or twice per month by injection and can be used in combination with other lipid-lowering medications, can drive LDL cholesterol to very low levels. They are often prescribed for those who have familial hypercholesterolemia or LDL cholesterol levels that remain very elevated despite treatment with statins. The two that are available, which were approved by the U.S. Food and Drug Administration (FDA) in late 2015, are: Praluent (alirocumab)Repatha (evolocumab) PCSK9 Inhibitors for Cholesterol Ezetimibe Ezetimibe reduces the absorption of cholesterol from the intestines, causing the liver to get more of the cholesterol it needs by removing it from the bloodstream. As a result, blood levels of LDL cholesterol levels are reduced. Clinical trials with ezetimibe have been fairly disappointing, and the drug is not used very often in clinical practice. It is used mainly prescribed for people who have continued high cholesterol levels despite statin therapy, or who are unable to take statins. Available versions of this drug include: Vytorin (ezetimibe)Zetia (ezetimibe/simvastatin) The Potential Risks of Cholesterol Drugs Zetia and Vytorin Bile Acid Sequestrants Bile acid sequestrants prevent the reabsorption of cholesterol-containing bile acids from the intestine. This causes the liver to remove more cholesterol from the circulation. Bile acid sequestrants include: Cholestid (colestipol)Questran (cholestyramine)Welchol (colesevelam) While these drugs also effectively reduce LDL cholesterol levels, they tend to cause gastrointestinal side effects that limit their usefulness. Clinical studies have failed to show that they improve outcomes. Cholestyramine Bile Acid Sequestrant Fibrates Fibrates inhibit the production of triglyceride-rich lipoproteins in the liver. They are most effective at reducing triglyceride blood levels (by up to 50%). They also increase HDL cholesterol levels and reduce LDL cholesterol levels to some extent. However, despite their favorable effect on blood lipids, several randomized trials have failed to show any improvement in clinical outcomes with the fibrates. Today, they are mainly used to treat severe hypertriglyceridemia. Fibrates include: Antara (gemfibrozil)Lopid (fenofibrate) The most prominent side effect of fibrates is that they can cause muscle toxicity, especially when used with statins. Using Fibrates to Lower Cholesterol A Word From Verywell Several classes of drugs have been shown to have a favorable effect on cholesterol and triglyceride levels. In 2018, the American College of Cardiology published a set of guidelines on treating cholesterol with recommendations regarding screening, a heart-healthy lifestyle, and statin and non-statin drugs. Speak to your doctor about your case and why they are recommending a particular course of treatment. Was this page helpful? Thanks for your feedback! Looking to start a diet to better manage your cholesterol? Changing lifelong eating habits can be scary at first, but our guide will make it easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hla D, Jones R, Blumenthal R, et. al. Assessing severity of statin side effects: fact versus fiction. American College of Cardiology. April 2018. American Heart Association. Familial hypercholesterolemia (FH). Updated April 2017. Zimmerman MP. How do PCSK9 inhibitors stack up to statins for low-density lipoprotein cholesterol control?. Am Health Drug Benefits. 2015;8(8):436-42. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387-97. doi:10.1056/NEJMoa1410489 American Heart Association. Cholesterol medication. Updated April 2017. Feingold KR, Grunfeld C. Triglyceride lowering drugs. 2018. In: Feingold KR, Anawalt B, Boyce A, et al. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Additional Reading Amaro-gahete FJ, De-la-o A, Jurado-fasoli L, Martinez-tellez B, Ruiz JR, Castillo MJ. Exercise training as a treatment for cardiometabolic risk in sedentary adults: Are physical activity guidelines the best way to improve cardiometabolic health? The FIT-AGEING randomized controlled trial. J Clin Med. 2019;8(12). doi:10.3390/jcm8122097 American College of Cardiology, 2018 Guideline on the management of blood cholesterol. Updated June 2019. Mani P, Rohatgi A. Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct?. Curr Atheroscler Rep. 2015;17(8):43. doi:10.1007/s11883-015-0521-x