Hardening of the Arteries (cont.)
Medications used to lower blood cholesterol levels are broadly divided into
categories. For details of cholesterol-lowering medications, see
- Statins: Commonly used agents include atorvastatin
(Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), simvastatin
(Zocor), and rosuvastatin (Crestor). The statins inhibit an enzyme, which
controls the rate of cholesterol production in the body. See
Cholesterol. The pill is taken once a day and is usually started after a trial
of diet and exercise has failed.
- Bile acid sequestrants: Cholestyramine (Questran, Questran Light,
Prevalite, LoCholest), colestipol (Colestid), and colesevelam (Welchol) are
commonly prescribed bile acid
sequestrants. These drugs bind with cholesterol-containing bile acids in the intestines, which are then excreted in
the stool. Thus, they
reduce the absorption of ingested cholesterol from the intestine. They may cause diarrhea and many patients do not tolerate them.
- Cholesterol absorption inhibitors: Ezetimibe (Zetia) selectively reduces
the absorption of cholesterol. It is often combined with statins.
- Nicotinic acid or niacin: A water-soluble B vitamin that significantly
increases HDL cholesterol (good cholesterol) and reduces LDL cholesterol (bad
cholesterol). Flushing is the most common bothersome side effect.
- Fibrates: Commonly prescribed fibrates include gemfibrozil (Lopid) and
fenofibrate (Tricor). They are primarily effective in lowering triglyceride and
bad cholesterol levels and, to a lesser extent, in increasing good cholesterol
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