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There is a reason that medications like simvastatin and atorvastatin (Lipitor) are some of the most commonly prescribed medications in the United States: they have a proven track record of successfully lowering LDL (low-density lipoprotein, or “bad” cholesterol) and helping reduce the risk of cardiovascular-related deaths. Despite their efficacy, this class of drugs is also widely known to cause unpleasant side effects that some people simply cannot tolerate. Sometimes patients benefits from switching to a different statin (like from atorvastatin to simvastatin, etc. ). For those who find that these drugs are causing intolerable symptoms, though, what atorvastatin alternatives can they discuss with their doctor?

Potential Atorvastatin Alternatives

Bempedoic Acid (Nexletol)

Research published in the Journal of the American Heart Association concludes that this medication is a relatively safe and effective alternative for people who cannot tolerate statins. Fortunately, the U.S. Food and Drug Administration recently approved the use of bemedoic acid (Nexletol) (Nilemdo in the European Union) to treat LDL in certain groups of people. This drug is an adenosine triphosphate-citrate lyase (ACL) inhibitor, which means it inhibits ACL, an enzyme (specialized protein). Importantly, ACL is a liver enzyme that helps produce cholesterol. Therefore, by blocking ACL, this medication can help patients lower their cholesterol levels.

Ezetimibe (Zetia)

Ezetimibe (Zetia) is a cholesterol absorption inhibitor, which means it inhibits how much cholesterol from food the intestines absorb. Patients may use this drug alone or in combination with a statin to reduce LDL levels. Since statins are considered the cholesterol-lowering “gold standard,” ezetimibe is especially helpful as patients can take it with a statin, with the latter being in a lower dose to decrease the risk of negative side effects. According to Harvard Health, this medication paired with a statin may reduce LDL cholesterol by up to 25%.

Bempedoic Acid/Ezetimibe (Nexlizet)

Nexlizet is an FDA-approved drug that makes use of both bempedoic acid and ezetimibe to help patients manage lipid levels; patients use this medication to supplement treatment consisting of a proper diet and as much statin therapy as the patient can withstand. Patients may also use Nexlizet with a bile acid sequestrant, such as cholestyramine (Prevalite), another type of drug that people use to help manage their cholesterol levels.

Gemfibrozil (Lopid)

Another option for those who cannot tolerate statins is a fibrate (fibric acid derivatives) like gemfibrozil (Lopid). Many other drug classes cannot match statins when it comes to lowering triglyceride levels; fibrates, however, are superior to most statins, though, when it comes to lowering triglyceride levels. According to Harvard Health, only atorvastatin and rosuvastatin (Crestor) are as effective as fibrates in this area. Furthermore, fibrates are often quite successful in raising HDL levels (high-density lipoprotein, or “good” cholesterol). The downside to fibrates, however, is that they cannot match statins’ ability to lower LDL.

Natural Alternatives

For those looking for a more natural route, some research suggests that nutraceuticals—that is, natural remedies—like green tea and curcumin may help. Namely, such remedies may be useful in some cases for individuals still struggling with cholesterol after medication, diet, and exercise changes. It’s important to note, though, that more research is needed to confirm these remedies’ efficacy and safety (especially in the long run and at what dosage), as well as their effects on cardiovascular disease mortality and other outcomes.

In short, some research suggests that certain natural remedies (after clearing them with a licensed medical professional) may be an option for certain people when used as a complement—not a replacement or substitute— to statin therapy or other forms of cholesterol-lowering medication.

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