Drug Types

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Question

What's the difference between cholesterol drugs like fibric acids and statins?

Answer

The various types of cholesterol-lowering medications were created to target the different components that are measured in cholesterol level tests. If you have been diagnosed with high cholesterol, that means your blood tests show that you are not at the optimal level of one or more of the various components of cholesterol, including high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides.

Statin drugs (HMG-CoA reductase inhibitors) - including Zocor® (simvastatin), Lipitor® (atorvastatin), Crestor® (rosuvastatin), and Pravachol® (pravastatin) - are the most prescribed of the various cholesterol-lowering medications. They are very effective in lowering LDL and triglyceride levels, and raising HDL levels, and are safe for most people. However, because these drugs can cause liver abnormalities, you must have your blood tested periodically: initially at two to three months after starting or increasing your dosage, and then usually every six months.

Most statin drugs work best if you take them before bedtime or with your evening meal (since the body makes most of its own cholesterol at night). Lipitor® and Crestor® can be taken either in the morning or at night, and show the same efficacy.

Bile-acid sequestrants (also called bile-acid binding resins) - such as cholestyramine (Questran®) and colestipol (Colestid®) - also lower LDL. They can be used alone or along with statins.

The B vitamin niacin (also called nicotinic acid) is given to lower LDL and triglycerides. In addition, it raises HDL levels. The doses required are quite a bit more than what you can get with a daily multivitamin, so your doctor must prescribe the dose you need. Brand-name examples include Niacor® and Niaspan®.

Niacin can cause flushing, a side effect many people find to be very uncomfortable. Low-dose aspirin may help prevent flushing; however, always check with your doctor to make sure this is appropriate for you.

Fibric acid derivatives (also called fibrates) - such as gemfibrozil (Lopid®) - are prescribed to treat high triglyceride levels and low HDL levels. They also can lower LDL somewhat.

Selective cholesterol absorption inhibitors - such as Zetia® (ezemitibe), a 2-Azetidinone drug, which works by inhibiting absorption of cholesterol in the intestines. It often is used along with a statin drug to lower LDL.

While statins appear to be the most effective of these medications, they are not appropriate treatment for everyone needing cholesterol-lowering medications. All have their share of benefits and potential side effects alike.

Learn more about your medication.

Learn more about high cholesterol in the Health Encyclopedia.

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