Cholesterol medication: what to know before you start

High cholesterol raises your risk of heart attacks and strokes, but you don’t have to guess about treatment. Medication choices depend on your LDL number, other health problems, and how well you tolerate drugs. This page lays out the main options, what they do, and the practical checks you’ll face while taking them.

Common drugs and how they work

Statins are the first-line choice. They lower LDL by blocking cholesterol production in the liver and reduce heart risk. Examples include atorvastatin, simvastatin, and rosuvastatin. Most people do well on statins; some notice muscle aches or tiredness. If that happens, your doctor can try a lower dose or a different statin.

Ezetimibe lowers cholesterol by cutting absorption in the gut. It’s often added when a statin alone doesn’t reach your LDL target. PCSK9 inhibitors are injectable drugs that dramatically cut LDL — used when risk is high or when statins and ezetimibe aren’t enough or aren’t tolerated. Bile acid sequestrants and fibrates are older options; they still help in certain situations, especially with high triglycerides.

Safety checks, side effects, and interactions

You’ll need blood tests. Doctors usually check a baseline liver panel and repeat it if symptoms or high doses occur. Muscle pain is the most common concern; if it’s severe or comes with dark urine or weakness, get medical help. Grapefruit and some antibiotics interact with specific statins — always tell your provider about every medicine and supplement you take.

For people with liver disease, active monitoring matters. If you have diabetes, certain statins can slightly raise blood sugar — but the heart protection usually outweighs that risk. For women who are pregnant or breastfeeding, most cholesterol drugs are avoided; plan treatment with your clinician.

Lifestyle changes still matter. Medication lowers risk faster, but diet, weight control, quitting smoking, and regular activity add real benefit. Think of drugs as a partner to healthy habits, not a replacement.

How long will you take medication? Often for life, especially if you have heart disease or very high LDL. If your risk changes, your doctor might adjust or stop a drug, but don’t change doses on your own. Regular follow-up tests check that your LDL is on target and that side effects aren’t developing.

Questions to ask your doctor: What is my LDL goal? What side effects should I watch for? If I get muscle pain, what should I do? Are there cheaper options or patient assistance programs to help with costs? Clear answers make treatment easier and safer.

If you want a closer look at specific drugs, interactions, or assistance programs, check our detailed guides and reviews. Good treatment starts with clear facts and a plan you can stick to.