Miscellanous Cholesterol Agents – Test Prep and Practice Pearls
Real Life Pharmacology - Pharmacology Education for Health Care Professionals
Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist
4.9 • 773 Ratings
🗓️ 19 February 2026
⏱️ 16 minutes
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Summary
In this episode, we explore several important non-statin cholesterol-lowering therapies, focusing on their mechanisms, clinical uses, and practical considerations for patient care.
We start with bile acid sequestrants, also known as resins, including cholestyramine, colestipol, and colesevelam. These medications lower LDL cholesterol by binding bile acids in the gut, prompting the liver to use more cholesterol to make new bile acids. They are effective for LDL reduction but may cause gastrointestinal side effects and have drug interaction considerations.
Next, we cover niacin (vitamin B3), which can lower LDL and triglycerides while raising HDL cholesterol. While niacin was historically widely used, its role has declined due to flushing, gastrointestinal symptoms, and potential liver toxicity.
Omega-3 fatty acids, including icosapent ethyl (EPA), primarily lower triglycerides and are used in patients with severe hypertriglyceridemia to reduce the risk of pancreatitis. Icosapent ethyl is a purified EPA formulation with evidence of cardiovascular benefit in select high-risk patients.
Finally, we discuss bempedoic acid, a newer oral agent that inhibits ATP-citrate lyase in the liver. Because it is activated only in the liver, bempedoic acid may be useful for patients with statin-associated muscle symptoms. Common adverse effects include elevated uric acid and mild increases in liver enzymes.
This episode highlights how these non-statin agents can be strategically used alone or in combination with other therapies to help patients reach their lipid goals and reduce cardiovascular risk.
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Transcript
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| 0:00.0 | Hey, all, welcome back to the Real Life Pharmacology podcast. I'm your host pharmacist, Eric Christensen. |
| 0:05.3 | Thank you so much for listening today. Go check out real life pharmacology.com. We've got a free 31-page |
| 0:13.0 | PDF. It's on the top 200 drugs. I throw out some of the most important practice pearls, as well as some of the |
| 0:19.8 | most important things that are going to |
| 0:21.1 | show up on pharmacology exams in your career as well. So definitely a no-brainer to have, |
| 0:27.6 | whether you're in practice or whether your student going through pharmacology classes, |
| 0:33.4 | it'll definitely help you prepare and become a better healthcare professional |
| 0:38.3 | with a much better understanding of pharmacology. |
| 0:41.6 | So again, simply an email. |
| 0:42.8 | We'll get you access to that at real life pharmacology.com. |
| 0:47.7 | All right. |
| 0:48.1 | So today's episode, I am wrapping up kind of our series on cholesterol lowering medications. |
| 0:56.3 | I'm going to finish up with kind of some of the miscellaneous agents that are hanging out there that I haven't covered. |
| 1:03.5 | Go check out, you know, previous podcast on statins. |
| 1:07.2 | Also done PCSK-9 inhibitors and Zetamib as well and fibrates as well. |
| 1:15.1 | So again, I'm going to kind of cover a hodgepodge of medications here |
| 1:20.7 | that lower cholesterol or are classified as cholesterol lowering agents. |
| 1:25.4 | And let's get into them now. |
| 1:27.8 | So first one, bile acid sequestrants. |
| 1:32.3 | Examples include colostyramine, brand name questrine. |
| 1:37.8 | Colostopoles, another example in this class. |
| 1:42.3 | These medications work in a unique way. They bind bile acid in the gut. |
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