What is the Best Drug to Reduce Triglycerides? A Guide to Medication Options

October 12, 2025 •

3 min read

According to the Mayo Clinic, high triglycerides, a type of fat in the blood, can increase the risk of heart disease and require management through lifestyle changes and, if necessary, medication. The answer to what is the best drug to reduce triglycerides is not one-size-fits-all, as the optimal treatment depends on a patient’s individual health profile, risk factors, and the severity of their condition.

Quick Summary

The most effective medication for high triglycerides depends on the level of elevation and the patient's overall cardiovascular risk. Key drug classes include fibrates, prescription omega-3 fatty acids, and statins, each offering different mechanisms and levels of triglyceride reduction. A healthcare provider tailors the therapy to the individual based on their specific lipid goals and health status.

Key Points

No Single 'Best' Drug: The ideal medication for reducing triglycerides is highly individualized and depends on the patient's specific lipid profile and cardiovascular risk factors.
Fibrates for Severe Cases: Fibrates like fenofibrate are most potent for very high triglyceride levels (≥500 mg/dL) to reduce the risk of pancreatitis.
Prescription Omega-3s are Effective: Prescription omega-3 fatty acids, especially icosapent ethyl, can significantly lower triglycerides and reduce cardiovascular events in high-risk patients.
Statins are Foundational: Statins primarily lower LDL cholesterol but also contribute to triglyceride reduction, making them a cornerstone for patients with combined lipid issues and cardiovascular risk.
Lifestyle is the Starting Point: Lifestyle modifications, including diet, exercise, and alcohol restriction, form the essential foundation of any treatment plan for high triglycerides.
Emerging Therapies Offer Promise: Novel drugs like olezarsen are being developed with new mechanisms to significantly lower triglycerides for specific, severe genetic conditions.

Treating high triglycerides, also known as hypertriglyceridemia, typically begins with significant lifestyle modifications such as dietary changes, increased exercise, and limiting alcohol. If these measures are insufficient, medication may be necessary. The selection of the most suitable medication involves a healthcare provider assessing the severity of hypertriglyceridemia, the patient's cardiovascular risk, and other individual health factors.

The Primary Classes of Triglyceride-Lowering Medications

A range of drug classes is used to manage high triglycerides, each with different mechanisms, effectiveness, and side effects. For a detailed breakdown of these medications including how they work, key drugs, effectiveness, and considerations, refer to Dr.Oracle.

Fibrates

Fibrates are frequently used, especially for very high triglyceride levels (≥500 mg/dL) to reduce the risk of acute pancreatitis. Fibrates work by activating PPAR-alpha receptors, decreasing liver production of VLDL, and increasing triglyceride breakdown. Common fibrates include fenofibrate and gemfibrozil, which can lower triglycerides significantly. Fenofibrate is often preferred with statins due to a lower risk of muscle problems. These medications are not recommended for those with severe kidney or liver problems.

Prescription Omega-3 Fatty Acids

Prescription-strength omega-3 fatty acids are an option for patients with very high triglycerides or those with moderate levels and high cardiovascular risk. They are believed to reduce triglyceride production and enhance their breakdown. Prescription options like icosapent ethyl (Vascepa) and omega-3-acid ethyl esters (Lovaza) can significantly lower triglycerides, with icosapent ethyl showing reduced cardiovascular events in high-risk patients on statins. Prescription omega-3s differ from less regulated over-the-counter supplements.

Statins

Primarily for cholesterol and cardiovascular risk, statins also lower triglycerides. They block an enzyme in the liver needed for cholesterol synthesis. Examples include atorvastatin and rosuvastatin. High-intensity statins can reduce triglycerides. Statins are key when high triglycerides accompany high LDL cholesterol. The choice of statin and therapy depends on overall cardiovascular risk.

Niacin (Vitamin B3)

Niacin's role is limited due to side effects and trial findings. It decreases liver production of VLDL, lowering triglycerides and LDL, and increasing HDL. Prescription extended-release niacin is available and can significantly lower triglycerides. Common side effects include flushing and itching; it can also affect liver and blood sugar.

Comparison of Major Triglyceride-Lowering Medications


Medication Class	Primary Use Case	Effectiveness at Lowering TG	Key Considerations
Fibrates	Very high triglycerides (≥500 mg/dL) to prevent pancreatitis.	Significant reduction	Fenofibrate preferred with statins; risk of myopathy and liver issues.
Prescription Omega-3s	Very high triglycerides or high-risk patients with moderate levels.	Significant reduction	Different from OTC supplements; potential cardiovascular benefit.
Statins	Moderate hypertriglyceridemia, especially with high LDL and ASCVD risk.	Moderate reduction	Primarily for LDL; higher potency statins reduce triglycerides more.
Niacin	Limited use due to side effects, but effective at lowering TGs.	Significant reduction	Significant flushing and potential liver toxicity; can impact blood sugar.

The Emergence of Newer Therapies

Newer treatments are being developed for specific patient groups. For instance, olezarsen (Tryngolza) was recently approved for adults with familial chylomicronemia syndrome (FCS), a rare genetic condition. This drug works by blocking apolipoprotein C3, a protein that hinders triglyceride breakdown, and can significantly lower triglycerides in this population. While promising for severe cases, its use for more common forms of hypertriglyceridemia is still being studied in larger trials.

Lifestyle Modifications: The Foundation of Care

Lifestyle changes are crucial before or alongside medication for managing triglyceride levels:

Dietary Adjustments: Limit saturated and trans fats, sugars, and refined carbohydrates.
Weight Management: Losing weight, particularly if overweight or obese, can significantly reduce triglycerides.
Physical Activity: Regular exercise helps lower triglyceride levels.
Alcohol Restriction: Reducing or avoiding alcohol is important as it can increase triglycerides.

Conclusion: Personalized Treatment is Key

The most effective medication to reduce triglycerides varies from person to person. A healthcare provider must conduct a thorough evaluation, considering lab results, cardiovascular risk, and medical history. Fibrates or prescription omega-3s are often chosen for severe cases, while statins are common when high LDL is also present. The decision is a collaborative process to find the optimal treatment plan. Always consult a healthcare professional before starting or changing any medication.

For more information on cholesterol and triglyceride medications, refer to resources from organizations like the American Heart Association.

Frequently Asked Questions

For very high triglyceride levels (typically over 500 mg/dL), the primary goal of treatment is to lower the levels to prevent acute pancreatitis, a painful inflammation of the pancreas.

Over-the-counter fish oil supplements are not as effective as prescription versions for significantly lowering triglycerides. Prescription omega-3 preparations contain higher concentrations of purified fatty acids and are regulated for quality.

Yes, statins can help lower triglycerides in addition to their primary function of lowering LDL cholesterol. They are often a first-line therapy for patients with moderate hypertriglyceridemia and high cardiovascular risk.

Niacin is associated with common side effects, including flushing and itching. It can also cause elevated liver enzyme levels and worsen glycemic control in people with diabetes, which has limited its use compared to other therapies.

Fenofibrate and gemfibrozil are both fibrates used to lower triglycerides. However, fenofibrate is generally considered safer to use in combination with statins than gemfibrozil, which can increase the risk of muscle problems.

Lifestyle changes are the cornerstone of managing high triglycerides. A diet low in saturated fat, sugar, and alcohol, along with regular exercise and weight management, can significantly reduce triglyceride levels and improve overall heart health.

If triglycerides remain elevated after a patient has reached their LDL-C goal on statin therapy, a doctor may consider adding another medication, such as a fibrate or prescription omega-3 fatty acid, to the treatment plan.