No one really likes having to take medications, but millions of people in the United States (and around the world) take cholesterol-lowering drugs to get help preventing heart attacks and strokes.
Although statins (Lipitor, Zocor, and others) get all the attention, there are many other drug types that treat high cholesterol, such as niacin, bile-acid resins, fibrates, and Zetia, a cholesterol-absorption inhibitor.
If you are one of the millions taking or considering taking any of these drugs, read on to learn 10 things you should know about cholesterol drugs.
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They’re not for everyone
Statins and other cholesterol drugs work, but they are not for everyone. They can have side effects, and may cause birth defects if taken during pregnancy.
"We don't recommend statins or other cholesterol drugs for women of childbearing age," says Antonio M. Gotto Jr., MD, professor of medicine at Weill Medical College of Cornell University, in New York City.
They are also not for people at low risk for a heart attack or stroke," he says. Your risk becomes higher if you are over 60 (50 for men), or have high cholesterol, hypertension, or a family history of heart disease.
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You can’t ignore your diet
Your LDL may drop once you start taking the medication, but these aren't magic pills. You still may need to lose weight, eat a low-fat diet, and exercise.
"Medication doesn't take the place of a healthy lifestyle," Dr. Gotto says. "But if your cholesterol is still not in a range where it should be after you have made changes to your lifestyle or you have had heart attack, you need medication too." Changing your diet and exercising more can lower your cholesterol by 4% to 13%. Statins lower cholesterol by 20% to 45%, depending on the type of statin.
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Watch for side effects
All drugs have side effects, and cholesterol-lowering drugs are no exception. Although many side effects are more of a nuisance than anything else, some can be serious.
In general, cholesterol-drug side effects include problems such as nausea, stomach pain, constipation, or diarrhea; drowsiness; and muscle aches, weakness, or facial flushing. Talk with your doctor about switching to a different drug if you experience side effects.
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Not all are pricey
Cholesterol drug prices vary depending on the type, dosage, where you buy it, and your insurance.
Statins range from $11 per month to more than $250. Niacin, a B vitamin, can be bought over the counter or as a prescription drug for $15 a month. (If you buy over the counter, look for brands verified by the United States Pharmacopeia).
Many cholesterol-lowering drugsincluding Lipitor, one of the most widely prescribed drugs of all timeare now available as generics. If cost is an issue, talk to your doctor about less expensive alternatives or pill splitting. Prescription assistance programs could also help you afford name-brand drugs.
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Most people don’t take them correctly
The American Heart Association considers failure to take medication a major threat to patients. Some people simply forget, others skip or neglect medicines because they're worried about costs or side effects.
Research suggests that of people given a prescription, 12% don't fill it, 12% fill it but don't take it, and another 22% start taking it but then stop. "If you look at the people who are given statins after a cardiac event, only half are still taking their medications within five years," Dr. Gotto says.
A 2007 study found that failure to take medication was linked to a higher risk of heart attack and stroke.
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Grapefruit juice can be a problem
"Grapefruit juice can make statins more potent, so you may get side effects," Dr. Gotto says.
This is not true with other citrus fruits or with other cholesterol medications. But the compounds in grapefruit can affect how statins are absorbed in your GI tract, and this can increase the levels of the drug in your body to dangerous levels.
If you are taking statins, your best bet is to avoid grapefruits, any type of grapefruit juice, or juice blend that contains grapefruit juice.
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Tell your doctor about herbs, supplements
Many people pop multiple vitamins, minerals, or herbs to improve their health. Let your doctor know what you are taking. Some supplements may increase or decrease the effectiveness of cholesterol-lowering drugs.
For example, St. John's Wort could make some statins, including Zocor, Lipitor, and Mevacor, less effective.
And many supplements, including fish oil, garlic, ginseng, and red yeast rice, which actually is a statin in its own right, may affect cholesterol levels. So taking them could influence how well your medication works.
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They interact with other medication
It's not just food and supplements that can interfere with the effects of your cholesterol meds. Prescription pills such as antifungal or antibiotic drugs can increase your risk of statin side effects, says William O'Neill, MD, a cardiologist at the University of Miami School of Medicine, in Miami, Fla.
Statins may interact with drugs including warfarin; calcium channel blockers such as diltiazem; and immunosuppressants such as cyclosporine. Fibrates may also interact with warfarin, and niacin may interact with many drugs, including blood-pressure, seizure, and diabetes medicines.
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It may take trial and error to find the right drug and dose.
Zocor (simvastatin) can't exceed 20mg if it is prescribed with the blood-pressure drug amlodipine, ranolazine for chest pain, or amiodarone, an anti-arrhythmic drug. There is 10mg limit on Zocor when taken with the calcium channel blockers verapamil and diltiazem. You can't take Zocor at all with the cholesterol-lowering fibrate drug gemfibrozil or protease inhibitors for HIV.
"This does not mean that simvastatin is a bad drug; it just must be adjusted for potential drug interactions," says Robert S. Gold, the author of Are Your Meds Making You Sick?.
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Cholesterol remedies are for life
Once you start taking a statin or another cholesterol-lowering drug, you must continue taking them forever, or switch drugs if one isn't working or is causing side effects.
"Your cholesterol will rise to the levels that it was before you started [taking the medication]," Dr. O'Neill says. This means your risk of heart attack probably will rise too.
There may be valid reasons to take a holiday from your cholesterol medication, but you should discuss it with your doctor before you do.
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