Drug Therapy for High Cholesterol

Sometimes diet and exercise aren't enough to bring cholesterol back to normal, and drug therapy is also needed. ADA has guidelines for how doctors should treat lipid problems. The highest priority is usually to get LDL cholesterol levels below 100 mg/dL. The first drug to try is one of the "statins." These are:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor, Altocor)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Side effects of statins are usually mild. The most common side effects are muscle and stomach pain. Also, statins can raise the levels of some liver enzymes, so people need to have liver tests when they start taking statins.

Simvastatin lowers the risk of stroke and heart attack in people with diabetes even when they have normal LDL cholesterol levels. Some researchers suggest statins should be considered for such people at high risk for heart disease, even if their cholesterol is normal.

If statins can't be used or if they don't work, the second-choice drug is one of the bile-acid binding resins. These drugs are:

• Cholestyramine (Prevalite, Questran Light)
• Colesevelam (Welchol)
• Colestipol (Colestid)

Side effects include upset stomach and constipation. Also, bile-acid binding resins can interfere with your body's ability to absorb other drugs you may be taking.

People with type 2 diabetes often have too high triglyceride levels. Therefore, some people need a drug to lower triglycerides in addition to (or instead of) an LDL cholesterol-lowering drug. The first drug to try is one of the fibric acid derivatives, which are:

• Fenofibrate (TriCor)
• Gemfibrozil (Lopid)

The most common side effects are heartburn and stomach pain. Other side effects are diarrhea, skin rash, muscle pain and gallstones.

The second-choice drug for triglycerides is nicotinic acid. Because nicotinic acid can complicate blood glucose control, it is recommended for use at low doses (less than 2 grams per day). The three prescription brands are:

• Niacor (the immediate-release form, which is preferred for people with diabetes)
• Niaspan (the extended-release form, which may be tolerated better)
• Advicor (Niaspan combined with lovastatin)

In addition to its effects on blood glucose, nicotinic acid can cause skin flushing, gout, upset stomach, tiredness and diarrhea.

Ezetimibe (Zetia) is a new drug that reduces LDL cholesterol. It can be used alone or with a statin.

Some people may not be able to take certain cholesterol- or triglyceride-lowering drugs. A drug may not be suitable for someone because of other health problems, another drug he or she is already taking or personal habits (such as being a heavy drinker).