Non - Statin Cholesterol Lowering Drugs

You are at a point where your cholesterol level exceeds the standards set by your life or health insurance company (higher premiums or outright denial of coverage) or perhaps your potential employer refuses to hire you for the same reasons.

You have already tried statins with unacceptable side effects. You already know the entire country has been led astray by the misguided war on cholesterol but they don't hear you.

I can talk on this subject with complete confidence for I have twenty years of practice behind me. During this entire time I was a thoroughly trained cholesterol warrior, writing out prescriptions by the thousands for whatever of the cholesterol-busting drugs were then available to us. The statin drugs had not yet arrived and our weapons had their problems. Yet, when they are all you have, you do the best you can. Both doctors and patients accepted troublesome side effects from these drugs but at least they weren't permanent or lethal.

Bile Acid Sequestrants: Drugs like cholestyramine (Questran) or colestipol (Colestid) bind with bile acids in the intestines so that the acids are removed with the stool. Bile acids are made from cholesterol in the liver. Bile acid sequestrants interrupt this pathway, causing the bile acids to exit the body. This causes a loss of cholesterol as well, so your blood cholesterol comes down. Bile acid sequestrants generally come as tablets or as a powdered resin that you mix with liquids or foods. These drugs may cause bloating, heartburn, constipation, and abdominal pain, and may increase triglycerides, particularly if levels are already high. If you already have a high serum triglyceride level you might want to consider fibrates.

Fibrates: Fibric acid derivatives, or fibrates, affect the actions of key enzymes in the liver, enabling the liver to absorb more fatty acids, thus reducing production of triglycerides. These drugs also work well at increasing production of HDL. Although they can also lower LDL levels, they're not considered first-line treatments for high LDL or total cholesterol. Overall, they tend to lower LDL levels between 10 and 15 percent and tend to increase HDL levels. Atromid-S, Lopid, and Tricor are the major brand names. Side effects are relatively few.

 Trade Name Generic Name Spacedoc.net Site Links
 TriLipix Fenofibric acid TriLipix
 TriCor Fenofibrate 
 Fenocor-67 Fenofibrate 
 Fenogal  Fenofibrate 
 Lipidil Fenofibrate 
 Lipofen  Fenofibrate  
 Lofibra Fenofibrate  
 Lipanthyl  Fenofibrate 
 Antara  Fenofibrate 
                          Trade names in this table are Trademarks and are the property of their respective owners.

Cholesterol Absorption Inhibitors: Two organs primarily control cholesterol levels in your blood: the liver, which produces cholesterol and bile acids (used to digest fats), and the intestine, which absorbs cholesterol both from food and from the bile. While Statins primarily lower cholesterol by preventing its production in the liver, a new class of drug called cholesterol absorption inhibitors lowers cholesterol by preventing it from being absorbed in the intestine. The first approved drug in this class, Zetia (ezetimibe), hit American markets in 2002. By itself, Zetia reduced cholesterol about 18 percent in studies and although still able to cause muscle problems in a few, are generally well tolerated.

 Trade Name Generic Name Spacedoc.net Site Links
 Ezemibe Ezetimibe See Zetia
 Ezetrol Ezetimibe See Zetia
 Zetia Ezetimibe Zetia
                          Trade names in this table are Trademarks and are the property of their respective owners.

A prescription is required for these drugs and your physician likely will have additional advice especially as to drug interactions and dosing. If these measures succeed in lowering your cholesterol so you are now insured without penalty or employed, then it probably will have been worth the effort. But remember, cholesterol is almost certainly not the problem in CV risk, inflammation probably is.

Please note, if you have familial hypercholesterolemia and especially if you have fatty depositions in your eyes, eyelids, skin and tendons, you are a special case. If statin intolerant (at conventional dosing) please ask your doctor to consider low dose for its anti-inflammatory effects and work closely with your doctor to optimize your treatment plan with non-statin measures.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor


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