The Problems with Cholesterol Medication
If you or someone close to you has been diagnosed with high cholesterol you know that one of the most effective ways to treatment is lifestyle changes. Following a healthier diet and including exercise as a part of a daily routine is the first defense and a strong offense against bad cholesterol. You most likely already knew this – it seems like “healthy diet and exercise” is the top prescribed treatment for just about every ailment, doesn’t it?
What you may not already know is that in some cases, where bad cholesterol has been allowed to grow and good cholesterol production has been squelched, diet and exercise alone may not be sufficient and cholesterol medication will need to be prescribed.
At Warner Family Practice we recommend our patients have quarterly lab work done in order to monitor cholesterol and avoid ever having to prescribe medication. Why? Cholesterol medication is often one of the trickiest prescriptions to dial in on a proper combination of drug and dosage.
There are many options for cholesterol medications, each with it’s own benefits and side effects. When you visit with one of our providers you will be well educated about your options and will be in good position to determine which medication is best suited for you and your body.
In this article we discuss some of the most common cholesterol medications and provide some of the pros and cons of each. Knowing this information will help you make a better decision with your doctor when choosing how to treat your cholesterol with medication.
For a greater understanding of good and bad cholesterol and how cholesterol impacts your body, please see our article, The Basics of Cholesterol: What You Need to Know.
Treating High Cholesterol with Statins
Statins are a class of drugs used to treat cholesterol issues. A statin will most likely be the first type of medication that your provider will prescribe to help lower your low-density lipoprotein (LDL), also knows as your “bad” cholesterol. The main benefit of this type of drug is that it works in the liver to prevent cholesterol from forming. In addition to lowering your LDL cholesterol, it also helps raise your high-density lipoprotein (HDL) or “good” cholesterol. It’s a win-win.
Studies have also shown that statins lower the chance of having a “cardiovascular event” such as a heart attack.
Some of the most common statins include:
- Altoprev (lovastatin)
- Crestor (rosuvastatin)
- Lescol (fluvastatin)
- Lipitor (atorvastatin)
- Livalo (pitavastatin)
- Pravachol (pravastatin)
- Zocor (simvastatin)
Although this is the most common type of medication for cholesterol, there are possible side effects with statins. According to Mayo Clinic, side effects can include: constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness and possible interaction with grapefruit juice. If you are taking statins you should avoid grapefruit and grapefruit juice. Grapefruit makes it harder for your body to use these medicines.
Most side effects are mild and go away as your body adjusts, but like any medication, always talk to your doctor about any possible side effects before starting statins.
Treating High Cholesterol with Bile Acid Binding Resins
Next to statins, your doctor may prescribe a bile acid binding resin. This type of drug works inside your intestine by blocking cholesterol absorption. This is accomplished through the drug attaching to the bile.
Bile is what your your body uses to produce cholesterol. When the drug attaches to the bile, the bile can no longer be used during digestion – so your liver will make more bile. The more bile your liver makes, the more cholesterol it uses. Through this process, the bile acid binding resin drug is aiding in whittling down the body’s supply of cholesterol.
Some of the most common bile acid binding resins include:
- Colestid (colestipol)
- Prevalite (cholestyramine)
- Welchol (colesevelam
Just like statins, bile acid binding resins also have side effects. The most common side effects include constipation, gas, and upset stomach. This may vary by person, but it is important to note that these are some side effects you may encounter with this type of medication.
Treating High Cholesterol with Niacin
Niacin, also known as nicotinic acid, is a B-vitamin found in food but also available by prescription. In the case of this medication, this drug works in the liver by affecting the production of blood fats. This in turn lowers your LDL cholesterol and raises your HDL cholesterol.
See The Basics of Cholesterol for understanding of LDL and blood fats.
While niacin is an effective drug for many patients, it should be noted that research has not shown that adding niacin, when you already take a statin, further lowers your risk of heart disease. Talk to your doctor before taking niacin if you have a high risk of heart disease.
The most common statins include:
- Niacor (prescription niacin)
In regards to side effects of niacin, you may encounter facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers, and itching. In addition, your liver functions may be closely monitored because niacin can cause toxicity.
When our practice Founder and Medical Director, Dr. Merle Turner would prescribe niacin to a patient he would often suggest taking it in the evening to minimize the side-effects.
Treating High Cholesterol with Absorption Inhibitors
A more recent type of medication available to lower cholesterol is the cholesterol absorption inhibitor. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. This medication prevents the cholesterol from ever being absorbed in the first place.
The most common cholesterol absorption inhibitors include: Zetia (ezetimibe).
Reported side effects include: stomach pain, fatigue, and muscle soreness. As mentioned above, this is a newer form of medication to control cholesterol and while it has been effective for many, you will want to discuss with your doctor if there is any risk for your situation.
Treating High Cholesterol with Injectable Medications
Every person is unique and while some patients will be able to achieve cholesterol control through diet and exercise, some through drugs mentioned above, there will still be some who require a more regimented treatment plan.
Injectable medications are typically the next level of treatment when standard prescription drugs and lifestyle changes are not sufficient.
Injectable medications are for adults who inherit a genetic condition called “heterozygous familial hypercholesterolemia” which makes it difficult to bring down their LDL, or ‘bad’ cholesterol level. This condition is typically caused by a protein called PCSK9 being blocked. This protein makes it easier for the body to remove LDL from your blood. This method of treatment can also be for people who have heart disease and need more than a statin.
Injectible medications include:
- Praluent (alirocumab)
- Repatha ( evolocumab)
This medication is given as a shot every 2 weeks. These types of medication are also newer so not all side effects are known. As of now, some reported side effects include: itching, swelling, pain or bruising at injection site, back pain, rash, hives, swelling of nasal passages and flu.
Which Cholesterol Medication is Right for You?
There are many options you and your provider have to choose from when treating high cholesterol with medication. Side effects will always vary from patient to patient and it is most likely that, with the help of your provider, you will try several combinations of drugs and doses before finding the right balance which helps your cholesterol levels with minimal or acceptable side effects.
The reality is that no cholesterol medication is perfect. What works for you and your lifestyle might not work for someone else. Controlling your cholesterol may be enduring some of these mild side effects. You have to take into account your health and what will be the most beneficial.
At Warner Family Practice we emphasize the prescription of preventative care. We encourage all our patients, of all ages, to routinely participate in lab work so we can begin creating a baseline for disease and illness, including cholesterol levels. Cholesterol medication is always a final option when preventative care through over-the-counter drugs and lifestyle changes have not worked. Learn more about our approach to care by reading through our About Our Practice page here.
An ongoing relationship with your provider is your best asset as you create a plan to control your cholesterol, whether to prevent issues or reign your cholesterol back into healthy levels. By making healthy lifestyle choices and with the right medications you can keep your cholesterol under control. In addition, if you are seeking additional methods of treatment options, naturopathic care opens up a host of additional choices. Visit our Live Well Wellness Center page to discover additional naturopathic treatments.
If you are in the Chandler, Tempe, Mesa, Phoenix or Gilbert area of Arizona, we encourage you to schedule a visit with one of our providers. You can call 480.831.8457 to speak with our scheduling department.
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