High Cholesterol (cont.)
Medical Treatment: Other Medications
Bile acid sequestrants: These drugs bind with cholesterol-containing bile acids in the intestines and allow them to be eliminated in the stool. Bile acid sequestrants may lower LDL cholesterol by about 10%-20%. Bile acid sequestrants are sometimes prescribed with a statin to enhance cholesterol reduction.
- Cholestyramine (Questran, Questran Light), colestipol (Colestid), and colesevelam (WelChol) are the
three bile acid sequestrants currently available. These three drugs are available as powders or tablets and are are not absorbed from the gastrointestinal tract.
- Bile acid sequestrant powders must be mixed with water or fruit juice and are taken once or twice daily with meals. Tablets must be taken with large amounts of fluids to avoid stomach and intestinal complaints including constipation, bloating, nausea, and gas.
Cholesterol absorption inhibitors: These drugs inhibit cholesterol absorption in the gut and has few, if any, side effects. Cholesterol absorption inhibitors may be rarely associated with tongue swelling (angioedema).
Ezetimibe (Zetia) reduces LDL cholesterol by 18%-20%. It is probably most useful in people who cannot tolerate taking statins. When used in addition to a statin, ezetimibe is equivalent to doubling or tripling the statin dose.
Nicotinic acid or niacin: Nicotinic acid lowers total cholesterol, LDL cholesterol, and triglyceride levels, while raising HDL cholesterol levels.
- There are two types of nicotinic acid: immediate
release and extended release.
- The immediate-release form of crystalline
niacin is inexpensive and widely accessible without a prescription, but,
because of potential side effects, it should not be used for cholesterol
lowering without monitoring by a health care practitioner. (Nicotinamide, another form of
niacin, does not lower cholesterol levels and should not be used in place of
- Nicotinic acid reduces LDL cholesterol levels by
10%-20%, reduces triglycerides by 20%-50%, and raises HDL cholesterol by
- A common and troublesome side effect of nicotinic acid is flushing or
hot flashes, which are the result of blood vessels
dilating. Most people develop a tolerance to flushing, which can sometimes be decreased by taking the drug during or after meals or by the use of
aspirin or other
similar medications prescribed by your doctor 30 minutes prior to taking
niacin. The extended-release form may cause less flushing than the other
- The effect of high blood pressure medicines may
also be increased while taking niacin causing blood pressure to
potentially drop. A variety of
gastrointestinal symptoms, including
nausea, indigestion, gas,
and peptic ulcers, have been
experienced with the use of nicotinic acid.
Other major side effects include liver problems,
high blood sugar.
- Extended-release niacin is often better tolerated than crystalline niacin. However, its liver
damage) is probably greater. The dose of extended-release niacin
is usually limited to 2 grams per day.
Fibrates: These cholesterol-lowering drugs are effective in lowering
- gemfibrozil (Lopid),
fenofibrate (Tricor), which is more effective at
lowering triglycerides and LDL cholesterol.
Side effects of fibrates may include stomach or intestinal discomfort,
gallstones, and may
affect anticoagulation medication effects in thinning blood.
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