Non-Statin Lipid–Lowering Drugs*
Drugs | Comments |
|---|---|
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 | — |
Drugs for homozygous familial hypercholesteremia | |
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 US |
Ciprofibrate | Not available in US |
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 | |
AlirocumabAlirocumab | For patients with familial hypercholesterolemia and for other high-risk patients |
EvolocumabEvolocumab | For patients with familial hypercholesterolemia and for other high-risk patients |
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 | |
InclisiranInclisiran | For patients with familial hypercholesterolemia and for other high-risk patients |
* Many of these drugs are also available in combination with a statin. | |
HDL = high-density lipoprotein; HDL-C = HDL cholesterol; LDL = low-density lipoprotein; LDL-C = LDL cholesterol; Lp(a) = lipoprotein (a); PCSK9 = proprotein convertase subtilisin-like/kexin type 9; SiRNA = small interfering ribonucleic acid; TG = triglyceride; VLDL = very low-density lipoprotein. | |