MSD Manual

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Lipid-Lowering Drugs

Lipid-Lowering Drugs

Type

Mechanism of Action

Indications

Some Side Effects

Bile acid binders

Cholestyramine

Colesevelam

Colestipol

Bind bile acids in the intestine, causing the acids to be excreted rather than used to make bile and causing the liver to remove more LDL cholesterol from the bloodstream to make bile

High LDL cholesterol

Abdominal pain

Binding of some other drugs (reducing their effectiveness)

Bloating

Constipation

Nausea

Increase in triglyceride level (especially in people with high triglyceride levels)

Cholesterol absorption inhibitor

Ezetimibe

Decreases cholesterol absorption in the small intestine

High LDL cholesterol

Few serious side effects

Face and lip swelling (very rare)

Loose stools

Muscle aches (very rare)

Fibric acid derivatives

Bezafibrate*

Ciprofibrate*

Fenofibrate

Gemfibrozil

Increase the breakdown of lipids and speed the removal of VLDL from the bloodstream

May decrease VLDL production by the liver

High triglycerides

Dysbetalipoproteinemia

Possibly high VLDL cholesterol

Abdominal pain

Bloating

Diarrhea

Gallstones

High liver enzyme levels

Muscle aches due to inflammation (myositis)

Nausea

Rash

Microsomal triglyceride transfer protein inhibitor

Lomitapide

Inhibits triglyceride secretion

Familial hypercholesteremia in people who have 2 abnormal genes (are homozygous)

Diarrhea

Liver damage

Niacin

Niacin

Slows removal of HDL

Lowers triglyceride levels

At high doses, decreases production rate of VLDL, which is used to synthesize LDL

High triglycerides

High LDL and VLDL cholesterol

Dysbetalipoproteinemia

Digestive upset

Flushing

Gout

High blood sugar level (hyperglycemia)

High liver enzyme levels

Itching

Ulcers

Oligonucleotide inhibitor of apolipoprotein B

Mipomersen

Lowers level of LDL

Lowers level of apolipoprotein B

Familial hypercholesteremia (homozygous)

Flu-like symptoms

Liver damage

Skin reactions at injection sites

Omega-3 fatty acids

Omega-3 fatty acids

Lower levels of triglycerides

May decrease production of VLDL

High triglycerides

Belching

Diarrhea

PCSK9 inhibitors

Alirocumab

Lowers level of LDL

Familial hypercholesterolemia and for other people at high risk of coronary artery disease

Flu-like symptoms

Rarely, high liver enzyme levels

Skin reactions at injection sites

Evolocumab

Lowers level of LDL

Familial hypercholesterolemia and for other people at high risk of coronary artery disease

Flu-like symptoms

Hives

Skin reactions at injection sites

Statins (HMG-CoA reductase inhibitors)

Atorvastatin

Fluvastatin

Lovastatin

Pitavastatin

Pravastatin

Rosuvastatin

Simvastatin

Block the synthesis of cholesterol, increasing the removal of LDL from the bloodstream

High LDL cholesterol, triglycerides, or both

Bloating

Constipation (mild)

Fatigue

Headache

Loose stools

Rarely, high liver enzyme levels

Rarely, muscle aches due to inflammation (myositis) or degeneration (rhabdomyolysis)

HDL = high density lipoprotein; HMG-CoA = 3-hydroxy-3-methylglutaryl coenzyme A; LDL = low density lipoprotein; PCSK9 = proprotein convertase subtilisin/kexin type 9; VLDL = very low density lipoprotein.

* Not available in the United States.