7 Statin Alternatives You Can Take to Help Lower Your Cholesterol

Statins have been first-choice treatments for high cholesterol for years. But for some people, a statin may not be the right medication. They can sometimes cause side effects that aren’t tolerable. In other cases, a statin alone may not lower your cholesterol enough.

When they’re needed, statin alternatives are available to treat high cholesterol so you can better meet your health goals.

Why aren’t statins always the best high cholesterol medication?

There are some cases where statins may not be the best or only option for cholesterol management.

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Prescription Savings Are Just the Beginning

See what other benefits you qualify for—from cashback cards to cheaper insurance.

Unlock Savings

If your cholesterol levels are still high while taking a statin such as atorvastatin (Lipitor), adding another cholesterol-lowering medication could be a good solution.

Safety is another factor. Statin intolerance may prevent some people from taking a statin. For instance, statins have been linked to muscle pain, including rare but serious muscle damage that can harm the kidneys. What’s more, women who are pregnant should avoid statins. They can affect how a growing fetus develops in the womb.

In cases like these, healthcare professionals may recommend a statin alternative. The best non-statin cholesterol medication for you will depend on many factors, such as your age, how high your LDL (or “bad”) cholesterol is, or if you’ve had a heart attack or stroke in the past. 

Many statin alternatives are available. The goal of each one is to help get your cholesterol levels down. Let’s discuss seven of the top options.

1. Ezetimibe

Ezetimibe (Zetia) is a medication that’s often prescribed in cases where a statin alone isn't enough. A healthcare professional might recommend it if you’re taking the maximum recommended dose of your statin but your cholesterol levels are still high. They might also recommend it in combination with atorvastatin or simvastatin (Zocor, FloLipid) if you have a genetic condition called homozygous familial hypercholesterolemia.

Ezetimibe works by preventing your small intestine from absorbing cholesterol. This causes your body to use up cholesterol in your blood. It’s one of the few non-statin cholesterol medications that can lower LDL cholesterol levels even more when combined with a statin. You can also combine it with other statin alternatives.

EXPERT PICKS: WHAT TO READ NEXT

• What you can do to feel better: Learn how to manage muscle pain from statins without stopping your prescription.

• Thinking of stopping your statin? Here’s what you need to know about the risks of stopping a statin and how to do so safely.

• PCSK9 inhibitors vs. statins: Both medication classes are effective treatment options for lowering LDL cholesterol. Here’s what sets them apart.

Ezetimibe comes as an oral tablet taken once daily. It’s also available in combination with a statin in a pill called Vytorin (ezetimibe / simvastatin) for convenience. If you can’t take a statin, it's also available in combination with a statin alternative called bempedoic acid (as Nexlizet). We’ll discuss this more later.

2. Fibrates like gemfibrozil

Fibrates, such as fenofibrate (Tricor) and gemfibrozil (Lopid), mildly lower LDL cholesterol levels. But their main benefit is treating high triglyceride levels. Triglycerides are a type of fat found in the blood. When triglyceride levels are too high, it can lead to conditions like heart disease and pancreatitis.

Fibrates can be prescribed with a statin, with ezetimibe, or taken alone as a statin alternative. But combining them with statins can mean more side effects, especially with gemfibrozil. Because of this, it’s best to avoid taking gemfibrozil with a statin.

3. Bile acid sequestrants like cholestyramine

Cholestyramine (Prevalite), colestipol (Colestid), and colesevelam (Welchol) belong to a class of medications called bile acid sequestrants. Bile acids are molecules made from cholesterol in the liver. Our intestines use them to help digest and absorb fats. 

Bile acid sequestrants attach to bile acids, which prevents them from being reabsorbed. As a result, the body removes them in the stool. The liver needs to use more cholesterol from the blood to make new bile acids, resulting in lower cholesterol levels. 

Bile acid sequestrants can lower LDL cholesterol, but they do have some disadvantages: 

• You may need to take several pills multiple times a day.

• They can interact with other medications and vitamins. This can make them less effective.

• They may cause triglyceride levels to increase.

• They may cause constipation and stomach upset.

4. Omega-3 fatty acids like Lovaza

There are two prescription omega-3 fatty acid medications available: Lovaza and Vascepa. Lovaza has two kinds of fatty acids, EPA and DHA. Vascepa (icosapent ethyl) is a newer medication that only contains EPA. They mainly help lower very high triglyceride levels.

You can take omega-3 fatty acid medications in combination with statins. They usually aren’t taken alone for cholesterol support.

Good to know: In some cases, a healthcare professional may recommend taking Vascepa to lower the risk of heart-related health problems. This is especially true if you take the highest dose of a statin and still have high triglyceride levels.

5. PCSK9 inhibitors like Praluent and Repatha

Praluent (alirocumab) and Repatha (evolocumab) are in a newer group of medications called PCSK9 inhibitors. These cholesterol-lowering medications are injected under the skin once to twice monthly. They work by blocking an enzyme (protein) in the liver called PCSK9. PCSK9 is a protein that indirectly lessens LDL cholesterol removal from the blood. Blocking PCSK9 helps the liver clear more LDL cholesterol, leading to lower levels.

PCSK9 inhibitors are typically considered after trying statins and ezetimibe. They might be considered if a maximum statin dose, lifestyle changes, and ezetimibe aren’t enough. Sometimes, they might even be used instead of ezetimibe.

These statin alternatives are often very effective. But they can cause cold and flu-like symptoms, and we’re still learning about their possible long-term effects. What’s more, not every pharmacy has these medications, so it may be helpful to check with your pharmacy to make sure they can fill your prescription. You may need to use a specialty pharmacy.

6. Leqvio

In late 2021, the FDA approved Leqvio (inclisiran) to help lower LDL cholesterol. It’s in another newer class of medications called small interfering RNAs (siRNAs). Leqvio blocks the PCSK9 enzyme, but it works differently than Praluent and Repatha. It stops the gene that makes the PCSK9 enzyme from working.

Leqvio is usually combined with a statin for high cholesterol due to different causes, including heterozygous familial hypercholesterolemia. This condition is present at birth and results in very high cholesterol levels. When combined with a statin, Leqvio can lower cholesterol levels by up to 40% to 50%.

After your first two starter doses, Leqvio is injected under the skin every 6 months by a healthcare professional. Common side effects include pain and swelling at the injection site. It’s usually available through a specialty pharmacy, too.

7. ACL inhibitors like Nexletol and Nexlizet

Bempedoic acid (Nexletol) and bempedoic acid / ezetimibe (Nexlizet) are the two ATP citrate lyase (ACL) inhibitors that are available. These are newer medications approved to lower LDL cholesterol in a different way than other cholesterol medications. They prevent your liver from making cholesterol by blocking the ACL enzyme from working. This also results in more LDL cholesterol being removed from the blood.

ACL inhibitors currently have a few approved uses in adults:

• If you have high cholesterol, your prescriber may recommend taking Nexletol or Nexlizet in combination with a statin. Or, if a statin isn’t a good option for you, you may take Nexletol or Nexlizet by itself. They’re both meant to be paired with a low-cholesterol diet.

• If you have heart disease or heart disease risk factors and a statin isn’t a good option for you, a healthcare professional may prescribe Nexletol or Nexlizet to lower the risk of having a heart attack and other heart-related events.

Are there natural alternatives to statins that can help lower cholesterol?

Yes. Prescription medications aren’t the only way to tackle high cholesterol. Some natural and over-the-counter (OTC) products can play an important role, too. For instance, adding more soluble fiber to your diet is one easy way to lower cholesterol. Other options are also available.

Common foods that help lower cholesterol include:

• Plant sterols (found in nuts, grains, and more)

• Soy products

• Fatty fish, such as salmon

• Avocados

• Fruits, especially berries and bergamot

• Vegetables

• Legumes

Dietary supplements that may help lower cholesterol include:

• Omega-3 fatty acids from fish oil

• Red yeast rice

• Vitamin C

• Vitamin D

• Niacin

• Psyllium

• Berberine

• Probiotics

Non-prescription products like these can come with their own risks. Before you make any purchases, talk to a healthcare professional. They can help you determine what’s safe to try.

Frequently asked questions

Why trust our experts?

Written by:

Arnisha Carter, PharmD, BCPS

Arnisha Carter, PharmD, BCPS, is a licensed pharmacist in Florida. She’s worked in the pharmacy industry for more than 10 years and began writing for GoodRx in 2024.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Our editorial standards

Meet our experts