Cholesterol Lowering Drugs
Cholesterol drugs called fibrates are primarily effective in lowering triglycerides and, to a lesser extent, in increasing HDL cholesterol levels.
Gemfibrozil (Lopid®) is the fibrate most widely used in the United States. This cholesterol lowering drug can be effective for patients with high triglyceride levels; however, it is not effective for lowering LDL cholesterol. It is used in some patients with heart disease for whom a goal of treatment is lowering triglycerides or raising HDL. One study found that patients with heart disease, somewhat elevated triglycerides, and low HDL who took fibrates had reduced risk for a heart attack.
These medications are usually administered in two daily doses 30 minutes before the morning and evening meals. The reductions in triglycerides generally are in the range of 20 percent to 50 percent, with increases in HDL cholesterol of 10 percent to 15 percent.
Fibrates are generally well tolerated by most patients. Gastrointestinal complaints are the most common side effect with fibrates. Fibrates appear to increase the likelihood of developing cholesterol gallstones. Also, fibrates can increase the effect of medications that thin the blood, and this should be monitored closely by your physician.
Bile acid sequestrants bind with cholesterol-containing bile acids in the intestines and are then eliminated in the stool. The usual effect of bile acid sequestrants is to lower LDL cholesterol levels by about 10 percent to 20 percent. Small doses of bile acid sequestrants can produce useful reductions in LDL numbers.
Bile acid sequestrants are sometimes prescribed with a statin for patients with heart disease to increase cholesterol reduction. When these two cholesterol medications are combined, their effects are added together to lower bad cholesterol levels by over 40 percent.
These medications are not absorbed from the gastrointestinal tract, and 30 years of experience with the sequestrants indicate that their long-term use is safe.
Examples of bile acid sequestrants used as drugs for lowering cholesterol include:
These medications come in either tablet or powder forms. Bile acid sequestrant powders must be mixed with water or fruit juice and taken once or twice (rarely three times) daily with meals. Tablets must be taken with large amounts of fluids to avoid gastrointestinal symptoms. Sequestrant therapy may produce a variety of symptoms, including:
The bile acid sequestrants are not prescribed as the sole medicine to reduce cholesterol if you have high triglycerides or a history of severe constipation.
Although sequestrants are not absorbed, they may interfere with the absorption of other medicines if taken at the same time. Therefore, other medications should be taken at least 1 hour before or 4 to 6 hours after the resin. Talk to your doctor about the best time to take these cholesterol medications, especially if you take other medications.