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Lipid-lowering Drugs

Drugs used to reduce the level of lipids (fats and related substances) in the blood

Common drugs

    Statins

  • Atorvastatin

  • Fluvastatin

  • Pravastatin

  • Simvastatin

    Fibrates

  • Bezafibrate

  • Ciprofibrate

  • Fenofibrate

  • Gemfibrozil

    Nicotinic acid and derivatives

  • Acipimox

  • Nicotinic acid

    Drugs that bind to bile salts

  • Colestipol

  • Colestyramine

    Other lipid-lowering drugs

  • Ezetimibe

  • Omega-3 compounds

Lipid-lowering drugs reduce excessive levels of lipids, particularly cholesterol and triglycerides, in the blood. They are used to treat, or provide protection against, hyperlipidaemia. They also help to prevent or slow the progression of atherosclerosis, which in turn reduces the risk for cardiovascular disorders such as coronary artery disease, myocardial infarction, and stroke.

For maximum cardiovascular risk reduction, lipid-lowering drugs should be used together with other measures, such as stopping smoking, a lipid-lowering diet (see Diet and health), regular exercise, and control of raised blood pressure.

What are the types?

The main types of lipid-lowering drug are statins, fibrates, nicotinic acid and its derivatives, and drugs that bind to bile salts. Other lipid-lowering drugs include ezetimibe and omega-3 compounds.

Your doctor’s choice of drug treatment will depend on which type of lipid is causing your condition. In some instances, your doctor may prescribe a combination of drugs. Lipid-lowering drugs are taken orally on a daily basis, and most need to be taken long term.

Statins

These drugs reduce the formation of cholesterol and triglycerides in the body. Side effects may include nausea, headaches, abdominal pain, and diarrhoea or constipation. Statins may also cause muscle inflammation; you should inform your doctor if you develop any unexplained muscle pain, tenderness, or weakness. Long-term use of statins may affect liver function, so you may need regular liver function tests. You should also tell your doctor if you are planning a pregnancy, are pregnant, or are breast-feeding because statins can harm a fetus or baby.

Fibrates

These drugs are effective in lowering levels of both cholesterol and triglycerides in the blood. Fibrates are unsuitable if you have a disorder of the kidneys, liver, or gallbladder. The drugs occasionally cause side effects, including muscle pain, nausea, headache, and erectile dysfunction. Muscle pain may be more common if you have a disorder of the kidneys or are also receiving a statin. Fibrates can harm a fetus or baby, and it is important to tell your doctor if you are planning a pregnancy, are pregnant, or are breast-feeding.

Nicotinic acid and derivatives

Excessively high levels of cholesterol or triglycerides in the blood may be reduced by treatment with nicotinic acid or its derivative. However, these drugs often cause side effects and are generally used only when other drugs have proved ineffective. The side effects may include facial flushing, unsteadiness, headache, nausea and vomiting, and itching. Muscle pain may develop if these drugs are used together with a statin. Women who are planning a pregnancy or who are pregnant or breast-feeding should avoid these drugs because they may harm a fetus or baby.

Drugs that bind to bile salts

These drugs lower blood cholesterol levels by reducing fat absorption from the intestines. They may be used in combination with other lipid-lowering drugs, such as fibrates and statins. You should take any other lipid-lowering drugs at least 1 hour before or 4–6 hours after taking a drug that binds to bile salts because they can interfere with the absorption of the other lipid-lowering drugs.

Drugs that bind to bile salts have few side effects, although they sometimes cause nausea, abdominal discomfort, and constipation. Supplements of vitamin K may be necessary in long-term treatment with drugs that bind to bile salts because the drugs reduce the body’s absorption of these vitamins.

Other lipid-lowering products

Ezetimibe and omega-3 compounds are used to reduce blood levels of triglycerides. Each is usually used in combination with a statin and/or dietary measures. Possible side effects of ezetimibe include gastrointestinal disturbances, headache, tiredness, and muscle pain. Omega-3 compounds may cause gastrointestinal disturbances; other side effects are rare.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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