Cholesterol medications help by decreasing your low-density lipoprotein (LDL) aka the “bad” cholesterol that increases the risk of heart disease, decreasing your triglycerides which is the fat in the blood that also increases the risk of heart disease, or by increasing your high-density lipoprotein (HDL) aka the “good” cholesterol that protects from heart disease.

Depending on what your body needs most to lower your cholesterol, your doctor may prescribe one drug or a combination of several different drugs to help lower your cholesterol. Here is a quick overview of some of the drugs you may be prescribed, there benefits and some side effects to look out for.

Statins

Crestor, Lescol, Zocor, Mevacor, Pravachol, Lipitor, Altoprev all belong in the class of drugs called statins. Statins slightly increase HDL, and decrease triglycerides as well as LDL. Some possible side effects to look out for are constipation, nausea, diarrhea, stomach pain, cramps, and muscle soreness.

Bile acid binding resins

Colestid, Questran, and Welchol are all considered bile acid binding resins. These drugs only decrease LDL. Some possible side effects are constipation, nausea, and a possible increase triglycerides.

Cholesterol absorption inhibitors

Zetia is known as a cholesterol absorption inhibitor. Zetia decreases LDL, slightly decreases triglycerides, and also slightly increases HDL. Stomach pain and fatigue are the most common side effects associated with Zetia.

Combination cholesterol absorption inhibitor and statin

Vytorin is known as a combination cholesterol absorption inhibitor and statin and decreases both LDL and triglycerides, while increasing HDL. Some common side effects are stomach pain, fatigue, constipation, cramps, muscle soreness.

Fibrates

Fibrates such as Lofibra, Lopid, and TriCor decrease triglycerides and increase HDL. Common side effects include nausea, stomach pain, and gallstones.

Combination statin and niacin

Some drugs like Advicor are combination drugs which combine two or more other types of cholesterol fighting medications. The combination of statin and niacin decreases LDL and triglycerides while increasing HDL. Some common side effects are dizziness, heart palpitations, shortness of breath, sweating, and chills.

Niacin

Niaspan is classified under the drug class of Niacin and is known for decreasing both LDL and triglycerides, and increasing HDL. Some common side effects include nausea, vomiting, diarrhea, gout, high blood sugar, and peptic ulcers.

No matter what cholesterol medicine your doctor determines is right for you, be sure you know what side effects coincide with each drug and the warning signs you should be on the look out for. Be aware that if you are prescribed a statin or a combo drug that includes a statin, you should avoid consuming grapefruit juice.

If you would like to safely buy your cholesterol medication much cheaper than at your corner pharmacy, be sure to join eDrugSearch.com and start saving today.

The drug called Certriad, combines AstraZeneca’s blockbuster cholesterol pill Crestor with Abbott Laboratories TriLipix.

According to Rueters,

The manufacturers said on Tuesday they had received a so-called “complete response letter” from the U.S. Food and Drug Administration for Certriad, which combines Astra’s blockbuster cholesterol pill Crestor and Abbott’s TriLipix.

Both companies said they were evaluating the letter from the agency and would respond to the request for additional information. An AstraZeneca spokesman declined to give further details.

Combo pills are fairly common for heart drugs, and most thought that FDA approval was a given. Merck merged Zocor and Zetia to form Vytorin, and soon they plan to combine Zetia with Pfizer’s Lipitor.

Combo pills are also fairly common in diabetes drugs. For example Januvia, Avandia,and Actos are all available as combo product with generic versions Glucophage.

In typical big pharma fashion, Astra did not disclose what the FDA has a problem with, but many analysts have voiced concern that Certraid does not have enough backing to pass FDA approval after the results from a clinical study this month showed there was no real benefit from adding TriLipix to Crestor.

There are six statins on the market: atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. They differ in their ability to reduce cholesterol, and they also differ in their rates of reducing heart attacks. Their costs are also quite different — and since most people take statins for a long time, the costs add up over the years. With all of these variables, choosing the right statin for you can be complex.

All statins are capable of lowering LDL (“bad”) cholesterol and triglycerides, and raising HDL (“good”) cholesterol. The statins do differ in how effectively they can do this, and it is highly dose-dependent. Says Drug Digest:

If the needed LDL-C reduction is up to 35-36%, any of the statins should be acceptable choices for therapy. For a desired reduction of LDL-C greater than 42%, simvastatin (Zocor), atorvastatin (Lipitor), or rosuvastatin (Crestor) would be needed.

Indeed, the best-known statins are Crestor, Lipitor, and Zocor (quite probably because they have the greatest effect on cholesterol levels). The latter two are also endorsed by Consumer Reports. Taking evidence for effectiveness, safety, and cost into account, the publication rated both of these statins as “Consumer Reports Best Buy Drugs.” They recommend:

• Generic simvastatin (20mg or 40 mg) — if you need 30% or greater LDL reduction and/or have heart disease or diabetes, or if you have had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
• Atorvastatin (Lipitor) (40mg or 80mg) — if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated; use for two years and then reconfirm need or switch to generic simvastatin.

Charts on Drug Digest have some great comparisons. For instance, they show that Lipitor (10-80 mg.) can reduce total cholesterol by 25-45%, while Zocor (5-80 mg.) can reduce the same numbers by 19-36%, and Crestor (5-40 mg.) can reduce it by 33-46%. As for lowering HDL, Lipitor can offer reduction of 5-9%, Zocor lessens HDL by 8-16%, and Crestor lowers these numbers by 8-14%. As you can see, choosing the proper statin has a lot to do with which numbers (Total Cholesterol, HDL, LDL, or triglycerides) you are trying to effect.

A final consideration is that last year there was reporting on an observational study done by Pfizer that suggested that there were certain benefits to using Lipitor over Crestor. However, one must keep in mind that Pfizer conducted the study, and they are the manufacturer of Lipitor, and they are defending this drug against Merck’s Zocor product, which is now available in a generic formula. Here is the information as presented by The Wall Street Journal:

An analysis, published in the latest Clinical Therapeutics Journal, mined a large database of health-care records and found that patients taking Lipitor had a 12% lower risk of a cardiovascular event than those on simvastatin, the generic name for Zocor. The patients on Lipitor had a 15% lower risk of having a heart attack.

So-called observational studies like this one that look at data after the fact aren’t as powerful as prospective clinical trials. Jack Tu, a cardiologist who specializes in outcomes research at Canada’s Institute for Clinical Evaluative Sciences, says the latest Pfizer study didn’t take into account factors that could predispose a patient to heart problems, such as smoking and cholesterol levels. “Just on this alone, you wouldn’t recommend that everyone should switch onto Lipitor,” he says.

Still, Pfizer hopes that doctors will take notice. “We’ve done two rather large observational studies and patients have a lower risk of cardiovascular events on Lipitor [compared with] simvastatin,” says Susan Shiff, Pfizer’s team leader for cardiovascular outcomes. “Doctors need to factor this into discussions with patients.”

You should definitely discuss with your physician which statin is right for you. In general, the best plan is to take the LOWEST dose of a statin that gets you to your target level for cholesterol. Overly large doses can be harmful to your liver and to your muscles. If you experience muscle aches and pains when taking a statin, contact your doctor immediately.

As you might expect, we’ve had a fair amount of discussion in the eDrugSearch.com Community about statin drugs, which are used for the treatment of high cholesterol. People are most interested in understanding and comparing the benefits of Lipitor, Zocor and Crestor. Zocor is currently available in generic form in the U.S., but the other two drugs are not.

Vytorin, of course, is on the outs these days after research showed in January that this combination drug (essentially a combination of Zocor and Zetia) is no more effective than generic Zocor alone (simvastin).

One juicy morsel in John McCain’s recently released medical records is that he switched from Vytorin to simvastin after the study came out.

So, of the statins, should you go with Lipitor, Zocor or Crestor? As always, the reaction of individuals to different treatments varies widely, so what often happens is a doctor starts you on one, and if it’s ineffective or you experience side effects, he switches you to another.

Dr. Nicholas Browning provides a nice overview of the benefits of statins in this column in The Union newspaper of Grass Valley, Calif. A recent Houston Chronicle column, however, focuses more on the side effects of these drugs — principally muscle pain and weakness — and says that doctors too often downplay these negatives.

Although your doctor should help you decide which statin to try first, Crestor has been shown to be the most effective statin for lowering LDL cholesterol, followed by Lipitor and then Zocor. However, the side effects for Crestor may be more pronounced in some patients.

Unfortunately, even though your doctor may wish to put you on Crestor or Lipitor, insurance companies often push doctors hard to prescribe generics. We encourage you to use the best drug for you.

In pill splitting, patients cut larger-dose tablets in half to double the amount of smaller-dose pills they receive in a single prescription — for example, dividing 40-milligram tablets to create twice as many 20-milligram doses for the same price. And since drug companies and pharmacies don’t usually double the price of medications as the dose doubles, that can mean lower overall per-pill drug costs and fewer drug store co-pays for consumers…

[Cholesterol-reducing] statins tend to be good candidates for splitting, the researchers noted, because they linger in the body for a long time, and any impact splitting might have on their action wouldn’t greatly alter their effects. The authors cautioned, however, that not all pills can be safely split. For example, those that pass through the body rather quickly, or have special time-release coatings, are not good candidates for splitting.

After the six-month randomized trial, 89 percent said they’d be willing to continue splitting their cholesterol medications in exchange for a 50 percent reduction in their prescription co-pays, the study found. A survey returned by 109 health plan members found that 59 percent would be willing to split medications for as little as $5 to $10 in savings per prescription.

Full article here.

is now recommended for use in patients at high risk for cardiovascular conditions because of prior MI, heart surgery, or chest pain with evidence of atherosclerosis and to reduce the risk of non-fatal heart attacks and strokes.

The expanded label for the world’s top-selling prescription drug will also now include its approval for use in reducing the risks of hospitalization for heart failure. Lipitor is the first cholesterol-lowering drug to win approval for reducing such risks.

The approval comes as a result of a five-year study, ‘”Treating to New Targets (TNT),” involving 10,000 patients with heart disease and elevated LDL levels which compared Lipitor at its lowest and highest doses. It was found that patients taking 80 mg of Lipitor had a significant 22% reduction in the risk of major cardiovascular events compared with patients taking 10 mg. It was also found that the patients on the higher dose of Lipitor had a significant 26% reduction in the risk of hospitalization for heart failure.

This should provide Pfizer an advantage in Lipitor’s competition with Zocor, Pravachol, Zetia, Vytorin and Crestor.

According to the news release from Thomson Medstat:

Researchers analyzed the healthcare use, costs, and behaviors of more than 100,000 people who were prescribed statins, a common treatment for high cholesterol, from 2000 to 2003. They found that higher co-payments for statin medications made it less likely that patients would adhere to prescribed drug regimens – while lower adherence rates were associated with more hospitalizations and emergency room visits. In the two scenarios there was virtually no net effect on total direct medical costs.

Patients who adhered to their drug regimens had higher prescription drug expenditures, but – because they had fewer emergency-oriented episodes- their total healthcare costs were not significantly different from non-adherent patients. A $10 increase in co-payment was associated with an 8.9 percent decrease in the probability of adherence for new users of statin drugs and an 11.9 percent decrease in the probability of adherence for long-term statin users.

It’s predictable, but still sad, that people not taking their medications because of the cost are having more medical emergencies. It’s also significant that total healthcare costs remain the same because of the high cost of emergency care.

Analysts expect prices to drop as much as 70 percent with the new competition. According to the New York Times:

As the first companies to file for approval of generic versions of Zocor — known as simvastatin — Teva and Ranbaxy won six months of exclusivity under an American law aimed at offering an incentive to generic drug makers. That enabled them to keep prices close to what Merck charges.

The QDIS Blog adds:

This could have an impact on other brand name statin drugs particularly Lipitor from Pfizer, the best selling of all the statin class of drugs. Many health insurance companies are certainly going to recommend that their patients ask their doctor about switching to simvastatin as a means for not only controlling cholesterol but also controlling cost. It will be interesting to see how much of an impact it does have on the sales of LIpitor

As the QDIS Blog points out, I hope that this has an impact on the price of other statins on the market — but I doubt we will see that happen. This is where all that money that Pfizer has poured into direct-to-consumer marketing comes into play.