Some people do not tolerate statins well and must use another medication to help control their cholesterol. In other situations, people may wish to control their cholesterol levels with natural remedies.

Along with all statin alternatives, doctors recommend people work to reduce their cholesterol and intake of saturated and trans fats, and that they exercise.

Statins are a class of medications used to reduce total cholesterol, low-density lipoprotein (LDL) or bad cholesterol, and triglycerides. They also increase high-density lipoprotein (HDL), or good cholesterol. Alternatives to statins must have similar effects on cholesterol.

Keep reading to learn more about 6 statin alternatives, including natural remedies and other cholesterol-lowering medications.

The Food and Drug Administration (FDA) have approved fibric acids to help lower cholesterol. In adults they reduce:

  • low-density lipoprotein (LDL) cholesterol or “bad cholesterol”
  • total cholesterol
  • triglycerides
  • apolipoprotein B

Fibric acids also increase high-density lipoprotein (HDL) cholesterol. Doctors mostly use fibric acid drugs to help people reduce their triglyceride levels. Fibric acid is less beneficial than statin medications for reducing the risk of cardiovascular issues.

Doctors will check on people taking fibric acid after two or three months to make sure the drug is working. If it is not working, the doctor will stop the treatment and consider other options.

In this class of cholesterol-lowering drugs, doctors may choose among three different prescription medications:

  • fenofibric acid
  • fenofibrate
  • gemfibrozil

The most common side effects of fibric acid include:

Bile acid sequestrants are a class of prescription medications that help the body get rid of bile acids. When the body breaks down cholesterol, it produces bile acids. With bile acid sequestrants, the body more easily excretes bile acids.

When there is a lower amount of bile acids in the body when people take bile acid sequestrants, the conversion of cholesterol to bile acid increases. This process reduces the amount of cholesterol in the body.

When lowering the amount of LDL cholesterol in the liver, the body produces more LDL receptors. More LDL receptors increase the removal of LDL cholesterol out of the blood.

The following drugs are bile acid sequestrants:

  • cholestyramine
  • colestipol
  • colesevelam

Doctors may prescribe bile acid sequestrants to help lower LDL cholesterol. After about two or three weeks of taking cholestyramine, people will achieve the peak effect of the medication.

The most common side effects of bile acid sequestrants include:

  • nausea
  • bloating
  • cramping
  • increase liver enzymes
  • constipation

Ezetimibe is another cholesterol-lowering medication available by prescription. It reduces LDL cholesterol by reducing cholesterol absorption from the intestine. The FDA have approved its use for reducing total cholesterol, LDL cholesterol, apolipoprotein B, and non-HDL cholesterol, when used in combination with a diet.

The most common side effects of ezetimibe include:

  • headache
  • runny nose
  • sore throat
  • body aches
  • back pain
  • chest pain
  • diarrhea
  • joint pain
  • fatigue
  • weakness
  • muscle pain

Omega-3 fatty acids are unsaturated fats that people can find in:

  • fish
  • fish products
  • seeds
  • nuts
  • green leafy vegetables
  • beans

Researchers consider the following three omega-3 fatty acids to be the most clinically relevant:

  • alpha-linolenic acid (ALA)
  • eicosapentaenoic acid (EPA)
  • docasahexaenoic acid (DHA)

The FDA have approved the use of three prescription omega-3 fatty acids:

  • icosapent ethyl
  • omega-3-acid ethyl esters
  • omega-3-carboxylic acids

Icosapent ethyl is the only prescription omega-3 fatty acid that contains only EPA. All other prescription omega-3 products contain both DHA and EPA. Doctors can prescribe these three omega-3 fatty acids for adults 18 years old and older with very high triglycerides.

The EPA/DHA-containing products may increase LDL cholesterol, so these prescription omega-3 products are not alternatives to statins.

Some people use fish oils to help improve their cholesterol. These supplements do not go through the same regulatory evaluations for efficacy, safety, and purity as prescription drugs.

People who take fish oil for cholesterol management should use these supplements with caution. They may have impurities not identified on the product label. The amounts of EPA and DHA on the label may also be inaccurate.

Prescription omega-3 fatty acids and fish oils may cause the following side effects:

  • fishy taste
  • belching
  • upset stomach
  • diarrhea or constipation
  • gas
  • nausea
  • vomiting
  • joint pain
  • mouth and throat pain
  • itchy skin or rash
  • increased liver enzymes
  • fatigue
  • change in taste
  • upper respiratory infection

Learn more about omega-3 fatty acids here.

Niacin is another prescription medication used to improve cholesterol. It is vitamin B3, so people can also find this product over the counter. However, its effect is limited to raising HDL cholesterol. Compared with statin medication, niacin may not improve clinical outcomes.

Doctors usually prescribe niacin with statin medications. In people living with diabetes or those with mixed high cholesterol, niacin may help balance cardiovascular risks. This effect is more pronounced when people take niacin and a statin medication together.

Taking niacin can be bothersome for some people. Flushing is a common side effect. People may experience rash, itchiness, and a burning sensation of the skin of the face and chest. Flushing typically lasts about 20 to 30 minutes. Over time, this side effect disappears.

Studies demonstrate that people taking niacin who are not diabetic have a 34% increased risk of developing diabetes after an average of five years. People with diabetes may notice an increase in fasting blood sugar levels.

Before taking over-the-counter vitamin B3 for cholesterol control, people should speak with a doctor.

Learn more about niacin here.

Red yeast rice extract is a traditional Chinese cholesterol-lowering agent. Experts suggest that red yeast rice extract lowers LDL cholesterol.

Red yeast rice extract contains monacolins, like monacolin K. This substance inhibits the same enzymes that statins target, the hydroxymethylglutaryl-coenzyme A (HMG CoA) reductase. It may, therefore, have the same effect as the statin medication lovastatin (Mevacor).

In the United States, the FDA restrict the sale of red yeast rice extract products that contain more than small amounts of monacolin K. Red yeast rice extract products do not go through the same regulatory evaluations as prescription medications.

Some products may have more or less monacolin K and consumers have no way of knowing how much is present. Products may also contain a contaminant called citrinin, which can cause kidney failure. For these reasons, people should speak with a doctor before taking red yeast rice extract.

In a review article published in Atherosclerosis, researchers evaluated 20 different studies on red yeast rice extract. The researchers could not assess the safety of red yeast rice extract because of the low quality of the evaluations in the individual trials.

People with high cholesterol may need to take statin medications. Some people do not tolerate statins or may want to try natural remedies to treat their high cholesterol. Statin alternatives include some prescription medications like ezetimibe and fibric acids.

Natural remedies that some people use to help treat high cholesterol include omega-3 fatty acids and red yeast rice extract. Before stopping a statin medication and trying an alternative, speak to a doctor or pharmacist.