Cholesterol medications: Consider the options

A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may help:

• Decrease your low-density lipoprotein (LDL), the "bad" cholesterol that increases the risk of heart disease
• Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
• Increase your high-density lipoprotein (HDL), the "good" cholesterol that offers protection from heart disease

Your doctor may suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.

Brand and generic drug names	Drug class	Benefits	Cautions and possible side effects
Altoprev (lovastatin) Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor (lovastatin) Pravachol (pravastatin) Zocor (simvastatin)	Statins	Decrease LDL and triglycerides, slightly increase HDL	Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Colestid (colestipol) Questran (cholestyramine) Welchol (colesevelam)	Bile acid binding resins	Decrease LDL	Constipation, bloating, nausea, gas, may increase triglycerides
Zetia (ezetimibe)	Cholesterol absorption inhibitors	Decrease LDL, slightly decrease triglycerides, slightly increase HDL	Stomach pain, fatigue, muscle soreness
Vytorin (ezetimibe/simvastatin)	Combination cholesterol absorption inhibitor and statin	Decreases LDL and triglycerides, increases HDL	Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Lofibra (fenofibrate) Lopid (gemfibrozil) TriCor (fenofibrate)	Fibrates	Decrease triglycerides, increase HDL	Nausea, stomach pain, gallstones
Niaspan (prescription niacin) Slo-Niacin (nonprescription niacin)	Niacin (vitamin B-3, nicotinic acid)	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers
Advicor (niacin/lovastatin)	Combination statin and niacin	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills, possible interaction with grapefruit juice

Some cholesterol medications combine a statin and niacin, such as Advicor. No research studies have yet shown that taking these combination drugs lowers cholesterol any more than does taking niacin and a statin separately. However, the combination drug may be more convenient for you because it eliminates the need to take niacin and a statin separately. If you're interested in taking a combination medication, talk to your doctor.
You may have heard that the combination medication of ezetimibe and simvastatin (known collectively as Vytorin) is no more effective than is simvastatin (Zocor) by itself. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.
Most cholesterol medications are well tolerated, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.