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eLearning Series: Cholesterol
My Cholesterol Level Is Too High -
What Can I Do?
( 8 pages )
Cholesterol
Medications & Prescription Drugs
We will review
the different types of medications available for the treatment
of high cholesterol as well as natural remedies.
Your doctor may decide that you need help in controlling your
cholesterol if you are not able to reduce it using natural
treatments.
Even if your doctor
prescribes any of these medications, you must still follow
through with a healthy lifestyle.
There are several
different types of medications used to lower cholesterol.
They are
called statins, bile acid sequestrants,
cholesterol absorption inhibitors, nicotinic acid agents
and
fibrates and we will review them one by one.
Statins
What are
they and how do they work? Statins repress the enzyme HMG-CoA
reductase. This enzyme controls the rate
that cholesterol
produces itself in the body. These drugs can lower
cholesterol from 20 to 60%. They slow the production while
they increase
the liver’s ability to withdraw LDL. Statins lower
the LDL levels better than any other type of drug.
They can
also produce a modest increase of HDL while decreasing
total cholesterol and triglycerides. Positive
results are
usually seen after just 4 to 6 weeks of beginning
the medication.
Overall statins
are proven for lowering heart attack risks, strokes and other
coronary diseases related
to high cholesterol
levels.
You should not
take statins if:
- You are allergic
to statins themselves or their ingredients
- You are pregnant
or breastfeeding
- You have liver
disease
- You consume
excessive amounts of alcohol
- Have a history
of myopathy
- Have renal
failure
Brand names
of statins that you might recognize are Lipitor, Lescol,
Mevacor,
Altocor, Pravahol, Zocor
and Crestor.
There
are some drug and/or food interactions that you
should
be aware of. More
than one quart of
grapefruit juice per
day can decrease the
ability of the liver to process
some statins.
More importantly, there
may be other medications that can
interact
and
cause serious side
effects. It’s
important
to let your
doctor know about any
other medications you are taking,
whether prescription
or non-prescription
including
vitamins, herbal
supplements, medication
for the immune
system, other cholesterols
drugs, medication for
infections, birth control pills, medication
for heart
failure, HIV or
AIDs,
or Coumadin.
Side
effects from statins are rare.
If you experience
muscle
soreness,
pain,
weakness,
vomiting, stomach
pain, discolored
urine, stop taking
the medication and contact
your doctor immediately.
Bile
Acid Sequestrants
Bile
acid sequestrants bind with bile acids
that contain
cholesterol
in the
intestines
and are
then eliminated
in the stool. They
are proven to reduce
LDL by 10 to 20%.
Small doses produce
decent
reductions
in LDL. They
are sometimes
prescribed
along with a statin
to enhance reduction.
When
combined, their
effects are counted
together and lower
LDL by more than
40%. They do not lower triglycerides.
People
who are allergic to bile acid sequestrants
should
not
take this
medication nor
should anyone who has
a medical history
of bile obstruction.
There
may be interactions
with other
drugs so make certain
your doctor
has a complete
list
of all
prescribed
and non-prescribed
medications
you are taking.
Bile
acid sequestrants do not become
absorbed
from the gastrointestinal
tract. It
has been
used for
30+ years
and is considered
safe for
long term use.
Cholesterol
Absorption
Inhibitors
A
newer drug class,
Zetia
is a
cholesterol absorption
inhibitor
that
was approved
in 2002
by the
FDA.
By
itself
it reduces
LDL by
18 to
20%. It does
this
by decreasing
absorption
of
cholesterol
and other
drugs
within this
class
also
mildly lower triglycerides.
Very
useful
for
prescribing to
people
who
cannot take
statins
or
as another
drug
that
can
be
taken if those
who
take statins
have
side
effects
if
the
statin dose
is
increased.
Adding
a
cholesterol
inhibitor
to
a statin
increased
the
lowering effect
by
a 2 to
3 fold
factor.
There
may
be
interactions
with
other
drugs
so
make
certain
your
doctor
has
a
complete
list
of
all
prescribed
and
non-prescribed
medications
you
are
taking.
Nicotinic
Acid Agents
Niacin,
Niacor and
Slo-Niacin are
common names
for nicotinic
acid agents.
Nicotinic
acid, which
is also
called niacin,
is a
water soluble
vitamin B.
It improves
levels of
all lipoproteins
when the
doses are
given far
above the
vitamin requirement.
Nicotinic
acid reduces
total cholesterol,
LDL and
triglycerides at
the same
time raising
HDL. It
reduces LDL
by 10
to 20%,
triglycerides by
20 to
50% and
raises HDL
by 15
to 35%.
Nicotinamide is
a niacin
by product
after the
body breaks
it down.
Nicotinamide has
no effect
in lowering
cholesterol and
should not
be used
in place
of nicotinic
acid.
Individuals
who are
allergic to
nicotinic acid,
and those
who have
liver disease,
active peptic
ulcer, or
arterial bleeding,
should not
use nicotinic
acid agents.
There
are two
types of
nicotinic acid.
One for
immediate release
and one
for extended
release. Immediate
release is
inexpensive and
widely available
without a
prescription. However,
because of
potential side
effects it
must not
be used
for lowering
cholesterol without
being monitored
by a
doctor.
Niacin
that is
extended release
is often
tolerated better
than crystalline
niacin. But
has a
greater chance
of causing
damage to
the liver.
If
you are
taking medication
for high
blood pressure,
the results
may be
increased while
taking niacin.
You should
have a
system available
to monitor
your blood
pressure when
beginning a
new niacin
regimen.
Again,
there may
be side
effects when
mixed with
other medications
or foods.
Discuss with
your doctor
and make
certain you
make him
aware of
all medications
prescribed
or
otherwise.
Fibrates
Primary
effectiveness
is
lowering
triglycerides.
There is
a lesser
effect in
increasing
HDL
levels.
Some
serious
side
effects
may
occur
so
be sure
and discuss
these
with
your doctor.
If you
are
allergic
to fibrates
or have
liver disease
or kidney
disease,
you
should
not
take
these
agents.
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