A B C D E F G H I J K L M N O P R S T U V W

CHOLESTEROL LOWERING DRUGS

What are the types of Cholesterol Lowering Drug?

Drugs which may be used to reduce the amount of cholesterol include ion exchange resins (colestipol, cholestyramine); fibrates (bezafibrate, ciprofibrate, clofibrate, fenofibrate and gemfibrozil) and statins (lovastatin, cerivastatin, atorvastatin, pravastatin, simvastatin and fluvastatin). Other agents such as ispaghula, nicotinic acid, acipimox, probucol and fish oils are also sometimes used.

What are Cholesterol Lowering Drugs for ?

Lipid (fat) lowering drugs reduce the levels of undesirable fats (such as certain types of cholesterol) in your blood if diet alone is not capable of achieving this aim. Some fat is necessary in your blood. If you have too much, it will build up on the walls of the arteries, forming a lumpy coating called "atheroma" or "atherosclerosis". This restricts the flow of blood and encourages clots to form which could block the artery completely. This could cause a stroke, heart attack or blood clots in your leg arteries. Lowering your fat levels can stop atheroma from developing and may remove it as well in some cases. Lipid-lowering drugs may also be used after you have had a heart attack to reduce the risk of having a further one. For more detail, read the leaflet on "hypercholesterolaemia".

How do Cholesterol Lowering Drugs work ?

The ion-exchange resins stop your body from absorbing chemicals called bile acids, which contain a lot of cholesterol. Fibrates, statins and probucol all act on the liver in one way or another, so that cholesterol and the other main lipid, triglyceride are not made in such large quantities. Fibrates have another useful effect. They increase the amount of a healthy type of cholesterol (called high density lipoprotein or HDL), which can actually reduce the risk of atherosclerosis. Nicotinic acid and acipimox mainly work by reducing the breakdown of fat into the chemicals which make the blood fats high. Fish oils have a particular lowering effect on the triglyceride level in the blood if that happens to be very raised. You should know that only part of the cholesterol and triglyceride in the blood comes from what you eat. The rest is made in the body (liver) itself. Even if you eat a totally "healthy" diet, your cholesterol level may still be high.

How should Cholesterol Lowering Drugs be used ?

First and foremost, being on a drug of this type does not mean that you can relax your diet: both are needed! The number and times of doses will be discussed by your doctor, and adjusted according to the levels of the different fats in your blood tests. These will be done regularly: there is no point in continuing these drugs if they are not having the desired effect. Your doctor may also advise other things that you can do to help yourself, such as stopping smoking and losing weight. As lipid lowering drugs do not cure the actual cause of your problem, it is likely that you will need to continue your drugs and diet for the rest of your life.

During Treatment 

Because there are usually no direct symptoms of high fat levels, you will not notice any improvement in your health. However, do remember that you are reducing your risk of long-term damage: a bit like paying premiums on an insurance policy! Most people feel well while taking these drugs. All of them can cause stomach or bowel upsets. This is likely to improve during the first few weeks. If it is severe or persistent, you should see your doctor. Let your doctor know if you have existing liver problems : if you are taking a statin, your doctor may do blood tests to check that your liver is functioning properly. Both the statins and the fibrates can cause a persistent headache, rash or muscle aches and pains. Any of these would be a reason to see your doctor as soon as possible.

They are also more likely to occur if you are taking these two drug types together: this is sometimes necessary when both the cholesterol and triglyceride levels are high. Cholestyramine and colestipol are particularly likely to cause constipation. They can also cause an unusual type of diarrhoea which can cause the bowel not to absorb certain vitamins. Your doctor will check for this possibility if you are on long-term treatment. Acipimox and nicotinic acid can cause unpleasant flushing and may also aggravate a peptic ulcer. The (omega-3) fish oils are rich in vitamin D: excessive dosage can cause a high calcium level in the blood which may need to be checked from time to time. They may also worsen control of diabetes.

Drug Interference

Certain lipid-lowering drugs may increase the effect of the anticoagulant warfarin. As mentioned above, muscle aches and pains are more likely to occur if you having both a statin and a fibrate together. This is not a reason to avoid combining these drugs: they may be necessary because of the particular type of fat problem which you have. Cholestyramine and colestipol can interfere with the bowel absorption of other medication. Such medication should be taken either one hour before, or 4 to 6 hours after these fat-lowering drugs.

What if Cholesterol Lowering Drugs are not taken ?

You would probably not notice any ill effects. Your blood fat levels would rise gradually. This would put you at increased risk of a heart attack or stroke. If you forget a dose, take it as soon as you remember. Do not take a double dose.

General advice on the use of Cholesterol Lowering Drugs

You should tell your doctor if you are or could be pregnant or breast-feeding: the fibrates and statins may interfere with your baby's development. If you have any questions not covered in this leaflet, please ask your pharmacist or doctor. Keep the leaflet handy in case you want to refer to it again.