Table: Lipid-Lowering Drugs - Merck Manuals Consumer Version

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Lipid-Lowering Drugs

Type	Mechanism of Action	Indications	Some Side Effects
Adenosine triphosphate citrate lyase inhibitor
Bempedoic 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
Evinacumab	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
Cholestyramine Colestipol Colesevelam	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
Ezetimibe	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* Fenofibrate Gemfibrozil	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
Lomitapide	Inhibits triglyceride secretion	Familial hypercholesteremia in people who have 2 abnormal genes (are homozygous)	Diarrhea Liver damage
Niacin
Niacin	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	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
Evolocumab	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
Statins (HMG-CoA reductase inhibitors)
Atorvastatin Fluvastatin Lovastatin Pitavastatin Pravastatin Rosuvastatin Simvastatin	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; VLDL = very low density lipoprotein.
* Not available in the United States.

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Lipid-Lowering Drugs