The Complete Cholesterol Medication List A-Z

Key Takeaways

Statins are the most commonly prescribed group of drugs used to treat high cholesterol. Statins available in the United States include atorvastatin, fluvastatin, lovastatin, pravastatin, pitavastatin, rosuvastatin, and simvastatin.
Other classes of cholesterol medications include cholesterol absorption inhibitors, bile acid sequestrants, PCSK9 inhibitors, ACL inhibitors, fibrates, nicotinic acid, and omega-3 fatty acids.
Your doctor may prescribe ezetimibe (Zetia) in addition to or instead of a statin due to ezetimibe’s better side effects profile or if statins alone do not adequately control your high cholesterol levels.

According to the American Heart Association (AHA), having high cholesterol is one of the major risk factors for heart disease and stroke, which are the leading causes of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 86 million U.S. adults age 20 or older have total cholesterol levels above 200 mg/dL (milligrams per deciliter).

Statins are commonly prescribed to lower cholesterol levels and reduce a person’s risk of heart attack and stroke. Statins and other cholesterol-lowering medications help to control high cholesterol when lifestyle changes such as a healthier diet and increased physical activity are not enough.

There are people who cannot tolerate statins and who are prescribed alternative medications. These statin alternatives can be used instead of or in addition to statin. According to the CDC, slightly more than half of American adults (47 million people) who could benefit from a cholesterol-lowering medicine are currently taking it.

Please continue reading to learn about all the FDA-approved medications available in the United States that are used for lowering cholesterol, including their potential benefits and potential risks.

What are the top 10 cholesterol medications?

HMG-CoA reductase inhibitors (statins)

Statins belong to a drug class called HMG-CoA (hydroxymethylglutaryl-CoA) reductase inhibitors. Statins are the most commonly prescribed group of drugs used to treat high cholesterol. They work by decreasing the production of cholesterol in the liver, which leads to lower levels of blood cholesterol. Specifically, statin therapy helps in lowering LDL cholesterol (bad cholesterol). It can also help to decrease triglycerides (another type of fat in the blood) and slightly increase HDL cholesterol (good cholesterol).

The statins available in the United States include the following (generic names with brand names in parentheses):

Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Lovastatin (Mevacor, Altoprev)
Pravastatin (Pravachol)
Pitavastatin (Livalo, Zypitamag)
Rosuvastatin (Crestor, Ezallor Sprinkles)
Simvastatin (Zocor, Flolipid oral suspension)

Some combinations include a cholesterol medicine plus other drugs for high blood pressure, for example, Caduet (generic name: atorvastatin and amlodipine). Amlodipine belongs to a drug class called calcium channel blockers, which are used to treat high blood pressure and chest pain.

Common side effects of statins include muscle soreness or tiredness, weakness, headache, nausea, diarrhea, and constipation. Rarely, statins can cause more serious side effects such as liver abnormalities and muscle problems. This group of drugs may not be safe for people with pre-existing liver disease.

If you cannot take statins, you develop severe side effects, or your cholesterol numbers don’t respond to statins, your doctor may recommend other cholesterol medications to be used instead of a statin or in combination with a statin at lower doses.

Cholesterol absorption inhibitors

These cholesterol medicines work by preventing the absorption of cholesterol from the intestines. An example is ezetimibe (Zetia). Common side effects include joint pain, tiredness, and diarrhea.

Bile acid sequestrants

These drugs are also referred to as bile acid-binding agents. They work by helping the intestines eliminate more cholesterol. Examples include colestipol (Colestid), cholestyramine (Prevalite, Questran, Locholest), and colesevelam Hcl (WelChol). Possible side effects include heartburn, burping, gas, indigestion, nausea, and diarrhea.

Proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors)

These new drugs are used to lower LDL levels and improve heart health. They inactivate a protein found in liver cells that prevents the clearance of cholesterol from the blood. PCSK9 inhibitors are administered through a subcutaneous (under the skin) injection every 2 or 4 weeks. Your doctor will teach you how to properly administer this shot so you can comfortably give yourself this injection at home. Examples include evolocumab (Repatha) and alirocumab (Praluent). Side effects include redness, swelling, and pain at the injection site, back pain, and flu-like symptoms (sore throat, runny nose).

Adenosine triphosphate-citrate lyase (ACL) inhibitors

ACL inhibitors block cholesterol formation in the liver. They are used, along with natural remedies (diet and exercise) and statins, in adults with familial hypercholesterolemia and heart disease who need further reduction in their LDL. Examples of ACL inhibitors include bempedoic acid (Nexletol) and a combination of bempedoic acid and ezetimibe (Nexlizet). Side effects of ACL inhibitors include flu-like symptoms, back pain, stomach pain, muscle spasms, and elevated liver enzymes.

Talk to your doctor if you have kidney problems or high levels of uric acid, as ACL inhibitors can impact kidney function and increase the risk of developing gout.

Fibrates or fenofibric acid derivatives

Fibrates help to lower triglycerides and also LDL cholesterol. Examples include fenofibrate (Tricor, Antara, Lofibra, Triglide), gemfibrozil (Lopid), and clofibrate (Atromid-S). Side effects may include stomach pain, nausea, constipation, headache, back pain, runny nose, and abnormal liver function.

Nicotinic acid

Niacin belongs to a drug class called nicotinic acid. Interestingly, niacin is also known as a B vitamin (vitamin B3). It helps to reduce the production of triglycerides and LDL cholesterol in the liver and increase HDL cholesterol. Brand names for this cholesterol-lowering medication include Niaspan and Niacor. Side effects may include flushing (redness of the face), nausea, vomiting, diarrhea, cough, skin rash, and itching. Learn how much niacin you can take safely.

Omega-3 fatty acids

Omega-3 fatty acids are made from purified fish oils. They are used, along with dietary modifications and more exercise, to treat high triglyceride levels. Examples of omega-3 fatty acids include Lovaza, Vascepa, Epanova, and Omtryg. Omega 3s are also available as a dietary supplement. Possible side effects include burping, joint pain, muscle pain, upset stomach, changes in taste, and constipation.

Why take Zetia instead of a statin?

Your healthcare provider may prescribe Zetia instead of a statin for the treatment of high cholesterol if you cannot take statins due to a pre-existing health condition or if you have severe side effects on statins. If statins alone are unable to control your high cholesterol levels, Zetia can be used in combination with a statin.

Zetia is the brand name for ezetimibe, a cholesterol-lowering medication that belongs to a group called cholesterol absorption inhibitors. It works by decreasing cholesterol absorption from the digestive tract. A statin helps to lower blood cholesterol by reducing cholesterol formation in the liver. Therefore, these two drugs work differently to manage high cholesterol.

A combination of Zetia and statin (for example, Vytorin, which contains simvastatin and ezetimibe, or Roszet, which contains rosuvastatin and ezetimibe) may have better cholesterol-lowering effects than either medication alone. Combination therapy is generally used in people who can’t achieve the goal levels of cholesterol by statin alone.

What is the safest cholesterol medicine on the market?

Statins are the most widely prescribed cholesterol-lowering medications on the market. They are generally safe and well-tolerated. According to an assessment by the American College of Cardiology, 85% to 90% of people take statins without any side effects. However, some people may not be able to take statins due to underlying health conditions, inability to tolerate side effects, allergic reactions, or drug interactions with other medications.

Other medications for high cholesterol are available besides statins, such as fibrates, bile acid sequestrants, PCSK9 inhibitors, and ACL inhibitors. Your doctor will choose the best cholesterol-lowering drug for you based on your cholesterol numbers, medical history, side effects, personal preferences, and insurance coverage.

Older drug classes like statins are available as more affordable generic drugs, while newer drugs like Repatha (evolocumab) and Praluent (alirocumab) can be very expensive and may not be covered by your insurance.

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