Medications 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 medication 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 for cholesterol are usually given 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.
This type of cholesterol drug lowers LDL and can be used alone or in combination with statin drugs. This medication acts within the intestine to block cholesterol absorption.
One example of cholesterol absorption inhibitors used for lowering cholesterol is ezetimibe (Zetia®).
Microsomal Triglyceride Transfer Protein Inhibitors
Approved in December 2012, lomitapide (Juxtapid™) is the first and only medication in this class. It is approved for a specific genetic high cholesterol disorder known as homozygous familial hypercholesterolemia (HoFH).
This medication may be prescribed and dispensed only by healthcare providers and pharmacies that have been specially certified to do so, due to the potentially serious risks associated with its use. In particular, lomitapide can cause serious liver problems. It also has several significant drug interactions, and dosing is not particularly straightforward (people must start with a low dosage and gradually increase to a higher one).