Lipid-Lowering Drugs
Type | Mechanism of Action | Indications | Some Potential Side Effects |
|---|---|---|---|
Adenosine triphosphate citrate lyase inhibitor | |||
Bempedoic acidBempedoic acid | Lowers LDL cholesterol | High LDL cholesterol in people with atherosclerotic cardiovascular disease or familial hypercholesterolemia in people with at least 1 abnormal gene (heterozygous) | Cold or flu-like illness Gout flare Pain in back, arms, or legs Stomach pain |
Angiopoietin-like protein 3 inhibitor | |||
EvinacumabEvinacumab | Lowers triglycerides, LDL and HDL cholesterol | Familial hypercholesteremia in people who have 2 abnormal genes (are homozygous) | Decreased energy Dizziness Influenza-like illness Nasopharyngitis Nausea Pain in legs or arms |
Bile acid binder | |||
CholestyramineCholestyramine ColestipolColestipol ColesevelamColesevelam | Bind bile acids in the intestine, causing the acids to be excreted rather than used to make bile and causing the liver to remove more LDL cholesterol from the bloodstream to make bile | High LDL cholesterol | Abdominal pain Binding of some other drugs (reducing their effectiveness) Bloating Constipation Nausea Increase in triglyceride level (especially in people with high triglyceride levels) |
Cholesterol absorption inhibitor | |||
EzetimibeEzetimibe | Decreases cholesterol absorption in the small intestine | High LDL cholesterol | Few serious side effects Face and lip swelling (very rare) Loose stools Muscle aches (very rare) |
Fibric acid derivatives | |||
Bezafibrate* Ciprofibrate* FenofibrateFenofibrate GemfibrozilGemfibrozil | Increase the breakdown of lipids and speed the removal of VLDL from the bloodstream May decrease VLDL production by the liver | High triglycerides Dysbetalipoproteinemia Possibly high VLDL cholesterol | Abdominal pain Bloating Diarrhea Gallstones High liver enzyme levels Muscle aches due to inflammation (myositis) Nausea Rash |
Microsomal triglyceride transfer protein inhibitor | |||
LomitapideLomitapide | Inhibits triglyceride secretion | Familial hypercholesteremia in people who have 2 abnormal genes (are homozygous) | Diarrhea Liver damage |
Niacin | |||
NiacinNiacin | Slows removal of HDL Lowers triglyceride levels At high doses, decreases production rate of VLDL, which is used to synthesize LDL | High triglycerides High LDL and VLDL cholesterol Dysbetalipoproteinemia | Digestive upset Flushing Gout High blood sugar level (hyperglycemia) High liver enzyme levels Itching Ulcers |
Omega-3 fatty acids | |||
Omega-3 fatty acids | Lower levels of triglycerides May decrease production of VLDL | High triglycerides | Belching Diarrhea |
PCSK9 inhibitors | |||
Alirocumab Alirocumab | Lowers level of LDL | Familial hypercholesterolemia and for other people at high risk of coronary artery disease | Flu-like symptoms Rarely, high liver enzyme levels Skin reactions at injection sites |
EvolocumabEvolocumab | Lowers level of LDL | Familial hypercholesterolemia and for other people at high risk of coronary artery disease | Flu-like symptoms Hives Skin reactions at injection sites |
SiRNA targeting PCSK9 | |||
InclisiranInclisiran | Lowers level of LDL | Familial hypercholesterolemia and for other people at high risk of coronary artery disease | Skin reactions at injection sites Joint pain or stiffness |
Statins (HMG-CoA reductase inhibitors) | |||
AtorvastatinAtorvastatin FluvastatinFluvastatin LovastatinLovastatin PitavastatinPitavastatin PravastatinPravastatin RosuvastatinRosuvastatin SimvastatinSimvastatin | Block the synthesis of cholesterol, increasing the removal of LDL from the bloodstream | High LDL cholesterol, triglycerides, or both | Bloating Constipation (mild) Fatigue Headache Loose stools Rarely, high liver enzyme levels Rarely, muscle aches due to inflammation (myositis) or degeneration (rhabdomyolysis) |
HDL = high density lipoprotein; HMG-CoA = 3-hydroxy-3-methylglutaryl coenzyme A; LDL = low density lipoprotein; PCSK9 = proprotein convertase subtilisin/kexin type 9; SiRNA = small interfering ribonucleic acid; VLDL = very low density lipoprotein. | |||
* Not available in the United States. | |||