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Types of Cholesterol Medication
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We will review the different types of medications available for the
treatment of high cholesterol as well as natural remedies. Your
doctor may decide that yo u need help in controlling your cholesterol
if you are not able to reduce it using natural treatments. Even if your doctor prescribes any of these medications, you must
still follow through with healthy lifestyle treatments that we will
discuss further on.
There are several different types of medications used to lower
cholesterol. They are called statins, bile acid sequestrants,
cholesterol absorption inhibitors, nicotinic acid agents and
fibrates and we will review them one by one.
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Statins
What are they and how do they work? Statins repress the enzyme
HMG-CoA reductase. This enzyme controls the rate that cholesterol
produces itself in the body. These drugs can lower cholesterol from
20 to 60%. They slow the production while they increase the liver’s
ability to withdraw LDL. Statins lower the LDL levels better than
any other type of drug.
They can also produce a modest increase of HDL while decreasing
total cholesterol and triglycerides. Positive results are usually
seen after just 4 to 6 weeks of beginning the medication.
Overall statins are proven for lowering heart attack risks,
strokes and other coronary diseases related to high cholesterol
levels. You should not take statins if:
- You are allergic to statins themselves or their ingredients
- You are pregnant or breastfeeding
- You have liver disease
- You consume excessive amounts of alcohol
- Have a history of myopathy
- Have renal failure
Brand names of statins that you might recognize are Lipitor, Lescol,
Mevacor, Altocor, Pravahol, Zocor and Crestor.
There are some drug and/or food interactions that you should be
aware of. More than one quart of grapefruit juice per day can
decrease the ability of the liver to process some statins. More
importantly there may be other medications that can interact and
cause serious side effects. It’s important to let your doctor know
about any other medication you are taking, whether prescription or
non-prescription including vitamins, herbal supplements, medication
for the immune system, other cholesterols drugs, medication for
infections, birth control pills, medication for heart failure, HIV
or AIDs, or Coumadin.
Side effects from statins are rare. If you experience muscle
soreness, pain, weakness, vomiting, stomach pain, discolored urine,
stop taking the medication and contact your doctor immediately.
Bile Acid Sequestrants
Bile acid sequestrants bind with bile acids that contain cholesterol
in the intestines and are then eliminated in the stool. They are
proven to reduce LDL by 10 to 20%. Small doses produce decent
reductions in LDL. They are sometimes prescribed along with a statin
to enhance reduction. When combined, their effects are counted
together and lower LDL by more than 40%. They do not lower
triglycerides.
People who are allergic to bile acid sequestrants should not take
this medication nor should anyone who has a medical history of bile
obstruction.
There may be interactions with other drugs so make certain your
doctor has a complete list of all prescribed and non-prescribed
medications you are taking.
Bile acid sequestrants do not become absorbed from the
gastrointestinal tract. It has been used for 30+ years and is
considered safe for long term use.
Cholesterol Absorption Inhibitors
A newer drug class, Zetia is a cholesterol absorption inhibitor that
was approved in 2002 by the FDA. By itself it reduces LDL by 18 to
20%/ It does this by decreasing absorption of cholesterol and other
drugs within this class also mildly lower triglycerides.
Very useful for prescribing to people who cannot take statins or
as another drug that can be taken if those who take statins have
side effects if the statin dose is increased. Adding a cholesterol
inhibitor to a statin increased the lowering effect by a 2 to 3 fold
factor.
There may be interactions with other drugs so make certain your
doctor has a complete list of all prescribed and non-prescribed
medications you are taking.
Nicotinic Acid Agents
Niacin, Niacor and Slo-Niacin are common names for nicotinic acid
agents.
Nicotinic acid, which is also called niacin, is a water soluble
vitamin B. It improves levels of all lipoproteins when the doses are
given far above the vitamin requirement.
Nicotinic acid reduces total cholesterol, LDL and triglycerides
at the same time raising HDL. It reduces LDL by 10 to 20%,
triglycerides by 20 to 50% and raises HDL by 15 to 35%. Nicotinamide
is a niacin by product after the body breaks it down. Nicotinamide
has no effect in lowering cholesterol and should not be used in
place of nicotinic acid.
Individuals who are allergic to nicotinic acid, and those who have
liver disease, active peptic ulcer, or arterial bleeding, should not
use nicotinic acid agents.
There are two types of nicotinic acid. One for immediate release
and one for extended release. Immediate release is inexpensive and
widely available without a prescription. However, because of
potential side effects it must not be used for lowering cholesterol
without being monitored by a doctor.
Niacin that is extended release is often tolerated better than
crystalline niacin. But has a greater chance of causing damage to
the liver.
If you are taking medication for high blood pressure, the results
may be increased while taking niacin. You should have a system
available to monitor your blood pressure when beginning a new niacin
regimen.
Again, there may be side effects when mixed with other medications
or foods. Discuss with your doctor and make certain you make him
aware of all medications prescribed or otherwise.
Fibrates
Primary effectiveness is lowering triglycerides. There is a lesser
effect in increasing HDL levels.
Some serious side effects may occur so be sure and discuss these
with your doctor. If you are allergic to fibrates or have liver
disease or kidney disease, you should not take these agents.
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