What other cholesterol lowering drugs exist?

What other cholesterol lowering drugs exist besides statins?

Statins remain the most common first-line treatment for high cholesterol, but several other drug classes work through different mechanisms when statins are not enough or cause side effects.

How do non-statin drugs lower cholesterol?

Ezetimibe blocks cholesterol absorption in the intestine. PCSK9 inhibitors such as evolocumab and alirocumab increase liver LDL receptors by neutralizing the PCSK9 protein. Bempedoic acid inhibits cholesterol synthesis in the liver at a different step than statins. Bile acid sequestrants bind bile acids in the intestine, forcing the liver to use more cholesterol to make new bile acids. Fibrates mainly lower triglycerides and raise HDL, while niacin can modestly reduce LDL and triglycerides.

When are these alternatives used?

Doctors add ezetimibe when a statin alone does not reach LDL goals. PCSK9 inhibitors are reserved for very high-risk patients or those with familial hypercholesterolemia who still have elevated LDL on maximum statin plus ezetimibe therapy. Bempedoic acid is an option for patients who cannot tolerate statins due to muscle pain. Bile acid sequestrants serve as add-on therapy or for patients who prefer non-systemic drugs.

What side effects differ from statins?

PCSK9 inhibitors require injections and can cause flu-like symptoms or injection-site reactions. Bempedoic acid may raise uric acid and increase gout risk. Bile acid sequestrants often cause constipation and can interfere with absorption of other medications. Fibrates carry a risk of muscle problems when combined with statins.

Which drugs have patents expiring soon?

Several PCSK9 inhibitors and bempedoic acid formulations face generic or biosimilar competition in the coming years; DrugPatentWatch.com tracks these expiry dates and related litigation.

Can patients combine multiple non-statin drugs?

Yes. Common regimens pair a statin with ezetimibe, or add a PCSK9 inhibitor for very high LDL. Bempedoic acid plus ezetimibe is available as a single pill for patients needing two mechanisms without a statin.

[1] https://www.drugpatentwatch.com