Prescription Pad

How they work:

The name of these medications comes from an enzyme known as HMG CoA Reductase. This enzyme regulates an early step in the process of making cholesterol in the liver. Statins block this step, leading to a decrease in the LDL cholesterol and triglycerides. Statins also increase the HDL cholesterol by about five to 10 percent.

This class of medications is the most widely studied of all cholesterol modifying medications, both in patients with and without cardiovascular disease. Statin use can reduce heart attacks and strokes. Because statins work in the liver, your healthcare provider may routinely monitor liver function studies while you are on these medications.

Possible side effects:

Side effects are usually mild. Some people may experience:

• Rash or flushing, which is redness or warmth of the face
• Sleep problems
• Bloating
• Gas
• Heartburn
• Nausea
• Headache, or
• Dizziness

A rare-but-serious side effect is liver damage. Symptoms of liver damage include:

• Yellow skin or eyes
• Dark urine
• Nausea and vomiting, and
• Loss of appetite

It’s possible your blood sugar level may increase when you take a statin, which may lead to developing type 2 diabetes. The risk is small, but talk to your healthcare provider if you have concerns.

Some people develop memory loss or confusion while taking statins. These side effects reverse once you stop taking the medication. Contact your provider if you experience memory loss or confusion.

Skeletal muscle problems have been reported with this class of medications, though they occur rarely. Generally, statins are well-tolerated.

If you have any problems that you feel are related to your medication, please consult your healthcare provider.

Special notes:

• Tell your provider if you are pregnant, breastfeeding, or have liver disease.
• Statins can cause harm to an unborn baby. Use an effective form of birth control and if you become pregnant while using this medication, tell your provider right away.
• Avoid alcohol consumption.
• Statins may make you dizzy.
• Avoid driving or using dangerous machinery.
• Tell your dentist that you are on this medication.

Generic names of commonly prescribed diuretics:

• Lovastatin
• Pravastatin
• Simvastatin
• Fluvastatin
• Atorvastatin

How they work:

Fibric acid derivatives, or fibrates, are effective at lowering triglyceride levels. Fibrates also lower LDL cholesterol, though generally to a lesser extent than statins. They work by both decreasing cholesterol made in the liver and by increasing its removal through bile. Fibrates also mildly increase HDL cholesterol levels.

Studies have shown a reduction in cardiovascular complications when the use of fibrates was compared to placebo, or a non-active medication or “sugar pill.”

Possible side effects:

Side effects are usually mild. Some people may experience:

• Rash or flushing, which is redness or warmth of the face
• Sleep problems
• Gall stones
• Bloating
• Gas
• Heartburn
• Nausea
• Headache, or
• Dizziness

A rare, but serious, side effect is liver damage. Symptoms of liver damage include:

• Yellow skin or eyes
• Dark urine
• Nausea and vomiting, and
• Loss of appetite

Skeletal muscle problems have been reported with this class of medications, though they occur rarely. Generally, fibrates are well-tolerated.

If you have any problems that you feel are related to your medication, please consult your healthcare provider.

Special notes:

• Tell your provider if you are pregnant, breastfeeding, or have liver disease.
• Fibrates can cause harm to an unborn baby. Use an effective form of birth control and if you become pregnant while using this medication, tell your provider right away.
• Avoid alcohol consumption.
• Fibrates may make you dizzy.
• Avoid driving or using dangerous machinery.
• Tell your dentist that you are on this medication.

Generic names of commonly prescribed diuretics:

• Gemfibrozil
• Fenofibrate, and
• Clofibrate

How they work:

These medications bind to cholesterol in the intestines, prevent its absorption, and lead to its removal in the stool. Cholesterol continuously moves between the blood, bile, and gastrointestinal tract. Resins take advantage of this system to help reduce cholesterol levels.

These medications have the advantage of remaining in the intestine and not being absorbed into the bloodstream. As a result, liver and muscle problems do not occur with these medications. Bile resins typically lead to a drop in LDL cholesterol, but also an increase in triglycerides. HDL cholesterol is usually increased by a small amount.

Possible side effects:

Some possible side effects include:

• Belching
• Bloating
• Constipation
• Gas
• Stomach discomfort, or
• Larger stools

If you have any problems that you feel are related to your medication, please consult your healthcare provider.

Special notes:

Other medications should be taken one hour before or at least two hours after taking bile acid sequestrants.

If you do have constipation, increase the amount of fluids that you drink and add fiber to your diet.

Generic names of commonly prescribed diuretics:

• Cholestyramine
• Colestipol
• Colesevelam

How they work:

Niacin, or nicotinic acid, is a water-soluble vitamin that in large doses has favorable effects on the lipid profile. Niacin reduces levels of LDL cholesterol and triglycerides. Its main effect, however, is increasing the level of HDL cholesterol. Niacin has also been shown to reduce cardiovascular disease. It has a good safety profile, but affects the liver and, therefore, requires close monitoring of liver function.

Possible side effects:

Common side effects of niacin include:

• Flushing, which is redness or warmth of the face
• Itching
• Upset stomach
• Mild dizziness, or
• Headache

These side effects often decrease over time as niacin therapy continues.

Niacin may worsen gout, diabetes, and stomach ulcers. A rare side effect of niacin is liver damage. This occurs more often with doses greater than 3000 mg daily or when using slow-release niacin products.

Symptoms of liver damage include:

• Yellow skin or eyes
• Dark urine
• Nausea and vomiting, and
• Loss of appetite

If you have any problems that you feel are related to your medication, please consult your healthcare provider.

Special notes:

• Tell your provider if you are pregnant, breastfeeding, or have liver disease.
• Niacin can cause harm to an unborn baby. Use an effective form of birth control and if you become pregnant while using this medication, tell your provider right away.
• Avoid alcohol consumption.
• Niacin may make you dizzy.
• Avoid driving or using dangerous machinery.
• Tell your dentist that you are on this medication.

Use of earlier forms of this medication was limited due to flushing and itching side effects. Newer formulations include slow-release medications that are better tolerated. Some other ways to reduce the risk of flushing include:

• Taking niacin with food, and
• Taking aspirin about 30 minutes before your niacin dose

Generic names of commonly prescribed diuretics:

• Crystalline nicotinic acid
• Sustained-release nicotinic acid
• Extended-release nicotinic acid

How they work:

Cholesterol absorption inhibitors are a class of medications that block absorption of cholesterol in the small intestine. This medication tends to localize itself where cholesterol is normally taken up and prevents it from doing so.

This class of medications reduces LDL cholesterol and triglycerides, and also mildly increases HDL cholesterol. They are well-tolerated and are often prescribed in conjunction with statins.

Possible side effects:

• Unexplained muscle pain, tenderness, or weakness
• Sinusitis
• Stomach pain
• Diarrhea, or
• Feeling tired

If you have any problems that you feel are related to your medication, please consult your healthcare provider.

Special notes:

• Tell your provider if you are pregnant, breastfeeding, or have liver disease.
• Cholesterol absorption inhibitors can cause harm to an unborn baby. Use an effective form of birth control and if you become pregnant while using this medication, tell your provider right away.
• Avoid alcohol consumption.
• Tell your dentist that you are on this medication.

How they work:

Fish oil is rich in omega-3 fatty acids, which are effective in lowering triglyceride levels. They may also prevent blood clot formation and reduce the risk of rhythm disturbances in your heart.

Fish oil can be obtained from eating fish or by taking supplements. Fish that are especially rich in omega-3 fatty acids include mackerel, tuna, salmon, sturgeon, mullet, bluefish, anchovy, sardines, herring, trout, and menhaden. They provide about one gram of omega-3 fatty acids in about three and a half ounces of fish.

A weaker type of omega-3 fatty acid is also found in some plant sources, such as tofu, soybeans, and canola and flaxseed oils.

Possible side effects:

Side effects are usually mild. Some people may experience:

• Belching
• Bad breath
• Heartburn
• Nausea
• Loose stools
• Rash or itching, or
• Nosebleeds

Special notes:

Because some types of fish may contain other substances, which may offset some of the benefits, please check with your provider before consuming larger quantities of fish oil on a regular basis.