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Medications

Medications used to lower blood cholesterol levels are broadly divided into five categories. For details of cholesterol-lowering medications, see Understanding Cholesterol-Lowering Medications.

• Statins: Commonly used agents include atorvastatin (Lipitor), fluvastatin (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 Statins and 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 levels.