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.
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
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 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.
If you experience any less common side effects of atorvastatin, healthcare professionals advise you to call a doctor or 911 immediately. These can include:
If you experience muscle issues as a side effect, 2018 research suggests that taking coenzyme Q10 can help.
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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:
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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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:
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:
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.
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