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, increase HDL levels between 5 and 20 percent, and lower triglycerides between 20 and 50 percent. Fibrates are often prescribed in conjunction with other cholesterol-lowering drugs, but they shouldn’t be taken with statins. They may be particularly helpful for people with insulin resistance syndrome, in which HDL tends to be low, LDL normal, and triglycerides high. Brands include Atromid-S (clofibrate), Lopid (gemfibrozil), and Tricor (fenofibrate).
Side effects: Fibrates have few side effects and most people can take them with no problem. The most common problems are gastrointestinal complaints, such as nausea and gas. The drug may also increase your likelihood of developing gallstones.
Warnings: Combining fibrates with statins could result in muscle damage. Fibrates are also not recommended if you have liver, kidney, or gallbladder disease.
Recommended dose: Fibrates are usually given in two daily doses totaling 1,200 milligrams, taken 30 minutes before morning and evening meals.
Bile Acid Sequestrants
This class of drug, in use for more than 40 years with no major problems, acts like super glue, binding with bile acids in the intestines so that the acids are removed with the stool. Bile acids (which help your body digest fatty foods) are made from cholesterol in the liver. Ordinarily, as they pass through the intestines they are reabsorbed into the bloodstream and carried back to the liver. This “recycles” the cholesterol component as well. But bile acid sequestrants interrupt this pathway, causing the bile acids to exit the body. This causes a loss of cholesterol as well. In response, the liver removes more LDL from the bloodstream. And — voilà — your blood cholesterol levels drop.
The most common drugs include cholestyramine, sold under the brand names Questran, Prevalite, and LoCholest, and colestipol (Colestid). These drugs generally lower LDL about 15 to 30 percent with relatively low doses while increasing HDL slightly (up to 5 percent). They may be prescribed with a statin if you already have heart disease. Together the two drugs can lower LDL more than 40 percent.
Side effects: These drugs may cause bloating, heartburn, constipation, and abdominal pain, and may increase triglycerides, particularly if levels are already high.
Warnings: Bile acid sequestrants may delay or reduce your ability to absorb oral medications and vitamins, so you shouldn’t take them along with other medications or supplements.
Recommended dose: Bile acid sequestrants generally come as tablets or as a powdered resin that you mix with liquids or foods. A typical dose is about 10 grams per day.