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What are the most effective cholesterol medications? Statins and alternatives

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StatinsStatin alternativesOther treatmentsSummary
Statins are the most common medications for high cholesterol, including atorvastatin and simvastatin. Doctors may prescribe other drugs, like ezetimibe or PCSK9 inhibitors, if statins are not helping.
Medically reviewed by Philip Ngo, PharmD
Written by Cathy Lovering
Updated on February 24, 2023

The goal of high cholesterol treatment is to reduce the amount of LDL (bad) cholesterol in your blood. Most cholesterol medications are statins, a group of drugs that removes LDL cholesterol from the blood and reduces how much cholesterol the liver makes. 

According to the American Heart Association, statins are most effective at lowering LDL cholesterol, and they can also raise HDL (good) cholesterol and reduce blood fats (triglycerides). If statins aren’t working, healthcare professionals often recommend ezetimibe as a second-line treatment.

Research, including a 2013 review, suggests simvastatin and pravastatin may be the most well-tolerated statins, with a lower chance of side effects.

Diet and lifestyle strategies, along with prescribed medications, can help reduce your cholesterol.

Statins

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Statins are the first-line medication for high cholesterol. Statins are categorized into high, moderate, and low intensity based on how much they can lower LDL cholesterol.

Atorvastatin

Atorvastatin (Lipitor) is a statin that lowers LDL (bad) cholesterol and increases HDL (good) cholesterol.

Atorvastatin 40 milligram (mg) and 80 mg are considered high intensity statins, while the 10-mg and 20-mg formulations are considered moderate intensity statins.

People take atorvastatin once per day in tablet form. You can take them with or without a meal.

Healthcare professionals generally recommended you keep taking atorvastatin even if you feel healthy. Your doctor can work with you if you want to stop the medication or reduce the dose.

Common side effects of atorvastatin include:

  • memory loss
  • confusion
  • joint pain
  • heartburn 
  • gas
  • diarrhea

If you experience any less common side effects of atorvastatin, healthcare professionals advise you to call a doctor or 911 immediately. These can include:

  • muscle pain or weakness
  • fatigue or lack of energy
  • itching, hives, or rash
  • problems breathing
  • pain in the upper right part of the belly
  • nausea 
  • flu-like symptoms
  • bleeding or bruising
  • swelling 
  • jaundice
  • dark-colored urine

If you experience muscle issues as a side effect, 2018 research suggests that taking coenzyme Q10 can help.

Need a refill for atorvastatin (Lipitor)? You may be able to get an online prescription through Optum Perks in as little as 15 minutes with no video or appointment needed. Learn more here.

Simvastatin

Simvastatin (Flolipid, Zocor) comes as a tablet or liquid to take once per day. Simvastatin is taken on an empty stomach. Shake the liquid for 20 seconds before taking it.

The 10-mg simvastatin formulation is considered a moderate intensity statin.

Simvastatin has some common side effects, including:

  • memory loss
  • confusion
  • constipation, nausea, or stomach pain
  • itchy skin
  • changes in skin color
  • headache

If you have any of these less common side effects, contact a doctor or 911:

  • muscle pain, weakness, or lack of energy
  • urinating less
  • dark urine or dark red urine
  • light sensitivity
  • joint pain
  • jaundice 
  • fever, chills, or loss of appetite
  • pain in the upper right side of the belly
  • hives, rash, itching, or blisters
  • swelling 
  • hoarse voice
  • difficulty breathing or swallowing

Pravastatin 

Pravastatin (Pravachol) is another type of statin. It comes in a once-a-day tablet. You can take pravastatin with or without food. As with other statin medications, keep taking pravastatin unless you consult with your doctor about stopping the medication.

Pravastatin 40 mg and 80 mg are considered moderate intensity statins, while the 10-mg and 20-mg formulations are considered low intensity statins.

Common side effects of pravastatin include:

  • memory loss
  • confusion 
  • heartburn
  • headache 

Pravastatin also has less common side effects. If you experience any of these, call a doctor or 911.

  • muscle pain or weakness
  • extreme tiredness or lack of energy
  • jaundice 
  • bruising or bleeding
  • dark-colored urine
  • hives, itching, or rash
  • swelling
  • hoarse voice
  • difficulty swallowing or breathing
  • loss of appetite or nausea
  • fever
  • flu-like symptoms
  • pain in the upper right area of your stomach

Lovastatin 

Lovastatin (Altoprev) is another common statin. People take the extended-release tablet form of lovastatin once per day or the regular tablet once or twice per day. Talk with a doctor before stopping this medication.

Lovastatin 40 mg and 80 mg are considered moderate intensity statins, and the 20-mg formulation is considered a low intensity statin.

Common side effects of lovastatin include:

  • memory loss
  • confusion
  • constipation  

If you have any of these less common side effects of lovastatin, call a healthcare professional or 911:

  • muscle pain or weakness
  • rhabdomyolysis, a rare but potentially life threatening side effect where the muscle tissue breaks down
  • extreme fatigue or lack of energy
  • hoarse voice
  • difficulty breathing or swallowing
  • dark-colored urine
  • jaundice
  • bleeding or bruising
  • nausea or loss of appetite
  • itching, hives, or rash
  • swelling
  • flu-like symptoms
  • fever
  • pain in the upper right area of your belly

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Other types of statins

Along with the statins we discuss above, other FDA-approved statins include:

  • rosuvastatin
  • fluvastatin
  • pitavastatin

Statin alternatives

If statins aren’t having the desired effect, a healthcare professional might recommend different medications:

Ezetimibe

Ezetimibe (Zetia) is the most common non-statin for treating high cholesterol. This drug prevents the intestine from absorbing cholesterol.

PCSK9 inhibitors

PCSK9 inhibitors lower LDL cholesterol by inactivating a certain protein in the liver. This class of drugs includes:

  • evolocumab
  • alirocumab
  • inclisiran

ACL inhibitors

Adenosine triphosphate-citrate lyase (ACL) inhibitors are a more recent drug that gained FDA approval in 2020. They block the production of cholesterol in the liver. Types include:

Fibrates

These drugs lower blood triglyceride levels and have mild LDL cholesterol-lowering effects. Types include:

Niacin (nicotinic acid)

Niacin is a B vitamin that prevents the liver from producing triglycerides and has a mild LDL-lowering effect. It can have serious side effects, so avoid taking this medication without a doctor’s approval.

Omega-3 fatty acids

Along with dietary strategies, omega-3 supplements can help with your triglyceride levels. Brands include:

Other treatments

Lifestyle changes are often used along with medication to manage high cholesterol. Your doctor may recommend:

  • eating less saturated fat and trans fat
  • quitting smoking
  • exercise 

You can also work with your doctor to manage other conditions that can increase the risk for high cholesterol, such as:

You can also reduce cholesterol by eating more heart-healthy foods and avoiding foods that increase cholesterol risk. Foods to eat include:

  • foods high in healthy fats, like avocado, nuts, seeds, and fish
  • high fiber foods, like vegetables, legumes, fruits, and whole grains

Foods to avoid include:

  • foods high in saturated fats, like processed meat, deep-fried foods, coconut oil, palm oil, and butter
  • foods high in trans fats, like deep-fried foods, pastries, butter, or hydrogenated oils

Summary

The goal of high cholesterol treatment is to bring down high cholesterol levels in the body.

Statin medications help the liver remove LDL (bad) cholesterol from the body and reduce the amount of cholesterol the liver makes. You can also reduce your cholesterol levels by exercising, avoiding smoking, and eating a heart-healthy diet low in saturated and trans fats.

If you take prescription medication for high cholesterol — such as statins, fibrates, or PCSK9 inhibitors —the Optum Perks free Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication or search for a specific drug here.

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