Harvard Heart Letter

Ask the doctor: What are the alternatives to a statin for lowering cholesterol?

Q. I have tried all of the statin drugs to lower my cholesterol, but each one has caused severe muscle pain. Are there any non-statin medications I could try using to lower my cholesterol?

A. Have you tried niacin yet? It is an excellent drug for reducing cardiac risk in almost every way — it lowers harmful LDL cholesterol, raises beneficial HDL, and reduces cardiac complications. One reason it plays second fiddle to statins is that it causes side effects like itching and flushing in many people. These side effects can often be minimized or even eliminated by taking an aspirin before niacin, by gradually building up the dose, or by taking the intermediate-release type called Niaspan, which is available by prescription only.

Two other drugs that may be used in place of a statin are ezetimibe (Zetia) and colesevelam (Welchol). Both of these medications work in the intestines, rather than the bloodstream, and so are less likely than statins to cause side effects. Ezetimibe blocks cholesterol in food from crossing the intestinal wall and getting into the bloodstream. Colesevelam grabs cholesterol-rich bile acids in the intestine and locks them into a watery goo that is excreted in the stool.

To continue reading this article, you must login.
  • Research health conditions
  • Check your symptoms
  • Prepare for a doctor's visit or test
  • Find the best treatments and procedures for you
  • Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online »