6 best pills for cholesterol

*Editor’s Review of the Best. About the selection criteria. This material is subjective, not an advertisement and is not intended as a guide to purchase. Before buying it, it is necessary to consult with a specialist.

Many people think that cholesterol lowering with pills, diet or healthy lifestyle recommendations is a goal in itself: cholesterol should be within a given, normal range. Cholesterol does come in “good” and “bad,” and “bad” cholesterol is gradually deposited in the lumen of blood vessels, forming plaques that cause an increased risk of vascular accidents – heart attack and stroke.

But taking cholesterol-lowering drugs, or hypolipidemic agents, is primarily indicated not only to keep cholesterol normal, but for so-called secondary prevention in patients who have had a myocardial infarction. Above all, these drugs are needed to prevent a recurrent heart attack. There are many reliable clinical studies that have found on hundreds of thousands of volunteers that long-term use of statin drugs reduces the risk of overall mortality after a previous heart attack by at least 30%. Here we are talking about really long term use, for 3 or 5 years.

Of course, elevated blood cholesterol, or hypercholesterolemia, is not only a risk factor for heart attack or coronary heart disease. It contributes to obesity, high blood pressure, and increases the risk of diabetes and pancreatitis.

It is important that only a doctor should prescribe drugs to reduce cholesterol, and a standard tactic should be followed. First, the patient with an increased risk of heart attack and stroke should follow the recommendations on diet, change his lifestyle, give up bad habits, and only if all these measures are ineffective and prescribe drug therapy.

It is very important to achieve target values of total cholesterol. As an example, a healthy person should have a total cholesterol index below 6.2 mmol/L. In patients with coronary heart disease, the target level, that is, the plasma cholesterol concentration to be achieved by prescribing the drug, should be below 5 mmol / l.

It is well proven that long-term use of statins as indicated and achieving target values of total cholesterol and its fractions can reduce the risk of heart attacks, strokes, and sudden cardiac death. This rating includes the most modern, and effective tablets for cholesterol. These are hypolipidemic drugs from the group of statins, fibrates, and bile acid sequestrants.

Cholesterol tablets overview

Current statins for lowering cholesterol

Currently, there are several generations of statins. Although several classes of drugs lower cholesterol, it is the statins that lead in prescriptions worldwide. They all act by roughly the same mechanism, they inhibit a special enzyme called “HMG-CoA reductase”. It works in the liver, and is involved in the synthesis of cholesterol. Let’s first consider the most modern remedy for cholesterol – the latest, fourth generation statin.

Rosuvastatin – Crestor (Rosucard, Rosulip, Tevastor)

Popularity Rating*: 4.9

Crestor drug is indicated in all patients to achieve target cholesterol values, who have high risk of vascular accidents. Such patients include those with arterial hypertension, diabetes mellitus, coronary heart disease. There are certain conditions: Before taking the medication, the patient must prove that he or she can modify his or her diet and follow a diet aimed at lowering cholesterol. There is no point in taking the medication if the patient does not follow the diet, and consumes large amounts of cholesterol sources with food. Therefore, all cholesterol-lowering drugs require a diet.

The standard dosage of Crestor is 5 to 10 mg per day, with the initial dose depending on the initial cholesterol concentration. You can only increase the dose after one month. The maximum daily dose is 40 mg per day. The tablet should not be chewed and can be taken at any time of the day, in conjunction with meals.

Produces Crestor British company Astra Zeneca, and the package, with the minimum dosage (5 mg tablet) will cost 1835 rubles for 28 tablets. This is the minimum cost of a one-month course of the original product. Considering that quite often a gradual increase in dose is required, other figures can be cited. The same pack of four times the dosage of 0.02 g will cost 3,925 rubles for one month of treatment. There are cheaper versions. For example, a pack of the drug Rosart (Actavis) costs 535 rubles, the same 28 pills of 5 mg.

Advantages and disadvantages

The advantage of the drug is its high activity and proven effectiveness. No dose adjustment is required in the elderly, and this is usually the fact to consider when prescribing many drugs for the elderly. It is also possible not to change the dosage with mild symptoms of renal insufficiency.

Although Krestor has proven by many studies to be highly effective, but it has contraindications. It is a concomitant treatment with cyclosporine, pregnancy and breastfeeding, the presence of various myopathies, and alcohol consumption. Crestor can be used with caution in patients with reduced thyroid function, as well as in other severe endocrine disorders and epilepsy. However, for all its shortcomings, Crestor is one of the most effective and modern drugs for reducing the risk of sudden death and vascular accidents.

Atorvastatin – Liprimar (Tulip, Torvacard, Atoris)

Popularity Rating*: 4.8

Liprimar is a highly effective cholesterol pill, but it belongs to the third, previous generation of statins rather than the fourth. Atorvastatin is the active ingredient. The main difference between the fourth and third generation statins is that the third generation drugs just work well and reduce the amount of “bad” cholesterol, and the fourth generation drugs, such as Crestor, described above, while still contributing to increase the blood concentration of “good” cholesterol. But Liprimar is a high-quality and original drug.

It comes in four dosages: 10, 20, 40, and 80 mg. It is indicated for use in high “bad” cholesterol levels – in hypercholesterolemia of different genesis, in complex prophylaxis of myocardial infarction and coronary heart disease in patients with high risk, both primary and secondary prevention are meant.

Liprimar, like Crestor, is used once a day, at any time and regardless of meals. The dosage can vary considerably: from 10 and up to 80 mg, with a maximum dosage of 80 mg per day. Generally they start with a minimum dose of 10 mg per day, but the dose can be increased gradually and only if a doctor prescribes it. Liprimar costs less than Crestor. A pack of 30 tablets, with a minimum dosage of 10 mg, designed for a month course, can be found in pharmacies from 350 rubles, and the average price is 717 rubles per pack. Liprimar is produced by the well-known pharmaceutical company Pfizer.

There are many much more affordable Liprimar analogues, including the domestic atorvastatin. So, exactly the same package, only produced by Irbit Chemical Pharmaceutical Plant, will cost, on average, 135 rubles. per package, but if you want it can be found in pharmacies and at a price even cheaper than 60 rubles.

Advantages and disadvantages

A big plus of Liprimar is its good research and international experience, high efficacy, convenient use once a day, and the flexibility to change the dosage. However, there are a large number of contraindications, side effects and special conditions, which include numerous interactions of atorvastatin with other drugs. Thus, Liprimar should not be prescribed when liver enzymes are high, pregnant and lactating women, persons under 18 years of age, as well as patients with severe renal dysfunction, reduced thyroid function and various muscular diseases.

Quite often there are such side effects as headache and sore throat, constipation and bloating, various pains in muscles and joints, increased liver enzymes, allergies, and even increased blood sugar. Liprimar interacts with a large number of different drugs, so it must always be prescribed by a doctor, as well as to control treatment. But this drug, when prescribed as indicated by a specialist, taking into account all contraindications, does a good job and reduces the risk of cardiac catastrophes.

Fluvastatin – Lescol Forte

Popularity Rating*: 4.8

Lescol forte is a highly effective drug for lowering cholesterol. It is indicated in patients with coronary heart disease, for primary and secondary prevention of myocardial infarction, with high levels of bad cholesterol, including those associated with familial cases of hypercholesterolemia. Lescol can be used as monotherapy, that is, no additional drugs are needed apart from it.

One tablet contains 80 mg of fluvastatin, and from this tablet the drug is released slowly, which creates a uniform concentration in the blood plasma without fluctuating overnight, this explains its high cost. The maximum effect of its appointment develops after a month, then you can review the prescribed dosage and change it upwards. Before treatment, the patient must be on a diet aimed at reducing cholesterol, and this diet must be followed for the entire course of treatment. Produces this drug by the pharmaceutical company Novartis, and the cost of one pack of 28 pills, designed for one month, is, on average, 2800 rubles.

Advantages and disadvantages

The advantages of Lescol are its high quality, proven efficacy, delayed release that does not allow for fluctuations in concentration, and long-lasting effects after discontinuation of the drug. But Lescol is contraindicated in pregnant and lactating women, in the presence of active pathological processes in the liver, which are accompanied by increased activity of liver enzymes. There are some side effects. Symptoms such as headache, abdominal discomfort, nausea are common. In spite of high efficiency, it is necessary to estimate the state of liver enzymes during the course of treatment every three months by means of biochemical blood test. This is done in order to monitor the liver function against the background of the prescribed drug.

Also, before starting treatment, make sure that the patient does not have hypothyroidism, inherited muscle diseases, and does not abuse alcohol. If everything is taken into account, and the treatment is supervised by a cardiologist, this drug will help the patient in many cases to get rid of “bad cholesterol”, heart attacks, strokes and the progression of coronary heart disease.

Review of drugs of other groups to reduce cholesterol

Statins have been singled out and reviewed separately because they are prescribed most often. But besides statins, there are other groups of drugs that reduce the amount of unwanted cholesterol in the blood plasma. These are nicotinic acid, ion exchange resins such as cholestyramine, fibroic acid derivatives, which include Clofibrate. Let’s look at some remedies that are often prescribed by doctors in the complex therapy of hypercholesterolemia in patients with high cardiac risk.

Ezetrol (ezetemibe)

Popularity Rating*: 4.9

Ezetrol is a drug that reduces “bad” plasma cholesterol by a different mechanism. It does not affect liver enzymes, but prevents absorption of cholesterol from food in the intestine. Thus, the liver gradually depletes cholesterol reserves after prescribing Ezetrol, and then its concentration also falls in the blood. This drug is indicated for the treatment of atherosclerosis, hypercholesterolemia, and can be used both alone and in conjunction with statins under medical supervision. But the main indication is severe hypercholesterolemia, which is inherited genetically and manifests itself in various family cases.

Ezetrol is prescribed at any time of the day, not in conjunction with meals. The starting dose of Ezetrol is 10 mg once a day. The cost of one pack of 28 pills for a month course is on average 2,000 rubles, and Ezetrol is produced by the well-known pharmaceutical company Schering-Plough. Numerous generics of this drug have not yet been identified.

Advantages and disadvantages

The advantage of Ezetrol will be a unique mechanism of action, good tolerability. The unwanted effects were mild, and often passed without dosage adjustment and without treatment withdrawal. The most common side effects reported were headache and abdominal discomfort. Ezetrol may be contraindicated in severe hepatic insufficiency, with hypersensitivity to components, and this drug should not be used simultaneously with a drug from the group of fibrates.

Ezetrol is not recommended for pregnant and breastfeeding women, but only because no studies have been done, but this is a very good reason to stop taking it if it becomes pregnant. But Ezetrol can be used together with statins, in which case the speed of achieving the target cholesterol values is significantly higher than when prescribing separate therapy. But even with Ezetrol, the patient still needs to eat a diet aimed at lowering dietary intake of cholesterol.

Omacor

Popularity Rating*: 4.8

Omacor reduces bad plasma cholesterol in a completely different way. These are no longer pills, but soft gelatin capsules, yet transparent, and they contain a light yellow oily liquid. The active ingredient of Omacor is Omega-3 unsaturated acids, namely the mixture of the ethyl esters of the two representatives of these acids.

Additionally, the capsules contain vitamin E, or alpha-tocopherol, which is fat-soluble. Omacor affects the concentration of very low density lipoproteins (VLDL), and reduces their amount. It reduces free fatty acid concentrations, and numerous studies have shown that those patients who took regularly one Omacor capsule daily for 3.5 years showed a reduction in overall mortality, and they were less likely to have myocardial infarctions and strokes.

Omacor is used as a means for heart attack prevention, with elevated cholesterol levels as an adjunct to drug therapy. Omacor can also be used alone, without prescribing drugs from the group of statins. But again, the patient must first start a hypocholesterolemic diet. Produces Omakor pharmaceutical company Banner Pharma, located in Germany and the Netherlands, and one pack of 28 capsules, designed for a month of use, will cost in the pharmacy in 1657 rubles.

Advantages and disadvantages

A big plus of Omacor is the flexibility of prescription: in patients with low cholesterol, it can be prescribed alone, and in the case of severe hypercholesterolemia, it is used in conjunction with statins. Omacor has proven efficacy and is well tolerated. It will be contraindicated only in pregnancy, lactation and sensitivity to the drug components. Omacor is contraindicated if there is a significant intake of triglycerides with food.

Nevertheless, it should be prescribed with caution in persons under 18 years of age, in the elderly, and in patients with severe hepatic and renal impairment. Also requires special medical supervision if used concomitantly with fibrates. The most common side effects were dyspeptic complaints, such as abdominal discomfort and bloating. Omacor is a good, reliable, adjuvant for the treatment of all stages of hypercholesterolemia: from severe familial form as part of complex therapy, to mild.

Lipantil (fenofibrate)

Popularity Rating*: 4.7

Fenofibrate refers to fibric acid derivatives, and reduces blood concentrations of triglycerides, and very low density lipoproteins, which are eventually transformed into “bad” cholesterol. This drug is available in capsules, with 200 mg of fenofibrate in each capsule. It is a means of affecting triglyceride metabolism. As a result of its use the synthesis of fatty acids is disturbed and the concentration of cholesterol is reduced. Lipantil also improves blood flow, and slightly lowers plasma sugar concentrations, so it can be prescribed in patients with diabetes.

Studies show that Lipantil lowers total cholesterol by 25%, and it is shown in the treatment of hypercholesterolemia, which can not be corrected by diet. Lipantil is prescribed with food, one capsule a day. The duration of the course is determined by the doctor. Lipantil is produced by the French company Riefarm, and a pack of 30 capsules for a month course costs on average 1000 rubles.

Advantages and disadvantages

Lipantil is contraindicated in muscle tissue pathology, including hereditary, severe liver and kidney damage, as well as intolerance to fibrates. It is not used in children under 18 years of age, in pregnant or nursing women, or in patients with lactase deficiency. The drug is well tolerated, but it should be prescribed by a doctor, because if it is combined with statins, in the form of self-treatment, there may be complications on the muscle tissue. If a patient uses Warfarin after a heart attack or stroke, or other anticoagulants, there may be a risk of bleeding. Lipantil cannot be prescribed with monoamine oxidase inhibitors (MAO). All of these precautions, if taken in time, and including monitoring the levels of liver enzymes in the blood serum during treatment, can achieve a pronounced reduction in cholesterol.

Conclusion

In conclusion, an important, but very simple thing needs to be said. The modern pharmaceutical industry produces a large number of expensive and cheap drugs to reduce cholesterol levels, and their use, according to numerous studies, significantly increases life expectancy and reduces the risk of vascular accidents. But in each case, the drug must be prepared, and the preparation of the patient comes down to changing lifestyles, giving up bad habits, and most importantly – adhering to a diet low in cholesterol.

Anyone who thinks that taking Lipantil can replace diet by taking pills should remember that. Diet cannot be substituted by pills, and a reduction in mortality risk and an increase in life expectancy have reliably appeared only when the patient has not only taken the medication, but also consciously worked on his or her own diet.

This is something to keep in mind, and it’s not worth wasting money on. Only if the patient has been on the diet for at least three weeks or a month, and he has no change in his cholesterol tests, should the medication be connected. If, however, the diet is fruitful, you need to continue it until the cholesterol stops dropping. And if it does not reach the target values on the diet, only then it is necessary to connect the drugs included in the rating.

*Popularity rankings are based on an analysis of demand data fromwordstat..