There are several other classes of medications that can help lower LDL cholesterol levels, and some of these medications may also have beneficial effects on triglycerides and HDL cholesterol levels, though the effects are usually small. Ezetimibe (brand name Zetia) blocks the absorption of cholesterol from the intestine. Used with statin drugs, this medication lowers LDL cholesterol impressively, and the drug Vytorin contains a combination of simvastatin along with ezetimibe. However, studies have yielded somewhat conflicting results in terms of whether ezetimibe reduces the risk of heart and vascular disease. Since there is strong evidence that the statins reduce the risk of heart disease, most experts in this field suggest that a person be treated first with a statin, and that the statin drug be increased as necessary until the cholesterol is controlled. Zetia should be added if the statin drug alone is not adequate to control the cholesterol, or if the person cannot tolerate high-dose statin therapy because of side effects.
Other drugs also lower LDL cholesterol. Niacin (also called nicotinic acid) is a B vitamin; at high doses it lowers LDL cholesterol and triglycerides, and it's more effective at raising HDL cholesterol than other cholesterol-lowering drugs. There are many brands, and the main side effect is an uncomfortable flushing. Niacin comes in immediate-release and slow-release forms, and the latter may reduce the flushing somewhat. Many niacin preparations are sold as supplements and are not subject to the same degree of oversight by the FDA as prescription drugs. Some over-the-counter forms of slow-release Niacin have been associated with liver damage, but the prescription form Niaspan has not. Niacin sometimes raises blood sugar levels, so it has to be used cautiously in people with diabetes.
The bile acid sequestrants, including the drugs cholestyramine (Questran, Questran Light, Prevalite, Locholest, and Locholest Light), colestipol (Colestid), and colesevelam (Welchol) lower LDL cholesterol, but the drugs cause severe constipation in many people and often raise triglyceride levels.
More Answers from Jack Merendino, MD