Non-Statin Lipid–Lowering Drugs*

Adenosine triphosphate citrate lyase inhibitor

Lowers LDL-C

Bempedoic acidBempedoic acid

Risk of hyperuricemia, tendon rupture

Especially useful in patients with statin-associated muscle adverse effects as the enzyme required to activate this drug is absent in the muscle

Bile acid sequestrants

Lower LDL-C (primary), slightly increase HDL-C (secondary), may increase TGs

CholestyramineCholestyramine

—

ColesevelamColesevelam

—

ColestipolColestipol

—

Cholesterol absorption inhibitor

Lowers LDL-C (primary), minimally increases HDL-C

EzetimibeEzetimibe

—

Medications for homozygous familial hypercholesteremia

Lower LDL-C

EvinacumabEvinacumab

Given as an intravenous infusion over 60 minutes

Adverse reactions in clinical trials include nasopharyngitis, influenza-like illness, and infusion reaction

LomitapideLomitapide

Risk of hepatotoxicity

Increase dose gradually (about every 2 weeks)

Measure transaminase levels before increasing dosage

Fibrates

Lower TGs and VLDL, increase HDL-C, may increase LDL-C (in patients with high TGs)

Bezafibrate

Decreased dose required in renal insufficiency

Not available in the United States

Ciprofibrate

Not available in the United States

FenofibrateFenofibrate

Decreased dose required in renal insufficiency

May be safest fibrate for use with statins

GemfibrozilGemfibrozil

Decreased dose required in renal insufficiency

Nicotinic acid (niacin)Nicotinic acid (niacin)

Increases HDL-C; lowers TGs (low doses), LDL-C (higher doses), and Lp(a) (secondary)

Frequent adverse effects: Flushing, impaired glucose tolerance, increased uric acid

Aspirin and administration with food minimize flushing

PCSK9 monoclonal antibodies

Lower LDL-C and TG, may lower Lp(a)

AlirocumabAlirocumab

For patients with familial hypercholesterolemia and for those with other high-risk concerns

EvolocumabEvolocumab

For patients with familial hypercholesterolemia and for those with other high-risk concern

Prescription omega-3 fatty acids

Eicosapentaenoic acid ethyl ester (EPA) + Docosahexaenoic acid (DHA)

Lowers TGs

Increases LDL-C

Eicosapentaenoic acid ethyl ester (EPA) only

Lowers TGs only

SiRNA targeting PCSK9

Lowers LDL-C and TG, may lower LP(a)

InclisiranInclisiran

For patients with familial hypercholesterolemia and for other high-risk patients