What is the best medicine for high triglycerides? Understanding Your Options

October 8, 2025 •

3 min read

Over one-third of American adults have borderline high or higher triglyceride levels, which increases the risk of heart disease. There is no single "best" medicine for high triglycerides; the most effective option depends on the severity of the condition, a patient's overall cardiovascular risk, and other health factors. The cornerstone of treatment for many people begins with therapeutic lifestyle changes, which are often followed by or combined with medication.

Quick Summary

This article explores the pharmacological treatments for high triglycerides, including fibrates, prescription omega-3 fatty acids, and statins. It compares their efficacy, use cases, and side effect profiles to help inform conversations with a healthcare provider, emphasizing that personalized medical advice is crucial for effective management.

Key Points

Start with lifestyle changes: Diet, exercise, and weight loss are the foundational treatments for managing high triglycerides.
Fibrates are potent triglyceride reducers: They are highly effective, especially for very high triglyceride levels, and are often prescribed to reduce the risk of pancreatitis.
Statins have a dual effect: Primarily known for lowering LDL cholesterol, statins also reduce triglycerides and are often a first-line therapy for patients with high cardiovascular risk.
Prescription omega-3s are effective at high doses: Unlike over-the-counter supplements, high-dose prescription omega-3 fatty acids can significantly lower triglyceride levels.
Niacin is less common today: Due to significant side effects and disappointing cardiovascular outcome trial results when combined with statins, niacin is no longer a preferred therapy.
Treatment is personalized: The best medication depends on the severity of triglyceride elevation, overall cardiovascular risk, and other health factors, requiring a thorough medical assessment.
Emerging therapies offer future hope: New drugs are in development to provide more potent triglyceride-lowering options for complex cases.

Understanding High Triglycerides

Triglycerides are a type of fat, or lipid, that circulates in the blood. Elevated triglyceride levels are associated with an increased risk of heart disease, stroke, and pancreatitis. Lifestyle changes are often the initial step in managing high triglycerides, especially for borderline-high levels.

Lifestyle Modifications: The First Step

Prior to considering medication, healthcare providers typically recommend lifestyle modifications, such as dietary changes, regular exercise, weight management, and limiting alcohol intake. These changes can significantly lower triglyceride levels.

Pharmacological Treatments for High Triglycerides

When lifestyle changes are insufficient or triglyceride levels are very high, medication may be prescribed. The selection of medication depends on the individual's lipid profile and overall health.

Fibrates

Fibrates are frequently used for significantly elevated triglycerides to reduce pancreatitis risk. They work by reducing the liver's production of VLDL, the main carrier of triglycerides, and can lower triglycerides substantially. Common examples include fenofibrate and gemfibrozil. When used with statins, fenofibrate is generally preferred due to a lower risk of muscle side effects compared to gemfibrozil.

Prescription Omega-3 Fatty Acids

High-dose prescription omega-3 fatty acids, derived from fish oil, are effective in lowering triglycerides. When used appropriately, they decrease the liver's secretion of triglycerides. Examples include icosapent ethyl (Vascepa), a pure EPA form shown to have cardiovascular benefits in high-risk patients, and omega-3-acid ethyl esters (Lovaza), containing both EPA and DHA. These require a prescription and differ from over-the-counter supplements. Side effects are usually mild, such as a fishy aftertaste.

Statins

Statins primarily lower LDL cholesterol but also reduce triglycerides to some extent. They work by inhibiting cholesterol synthesis and decreasing VLDL production in the liver. Atorvastatin and rosuvastatin are common examples. Higher doses generally have a greater effect on triglycerides. Statins are often the initial therapy for patients with or at high risk of cardiovascular disease, even with elevated triglycerides. Additional medication may be needed if triglycerides remain very high.

Niacin (Nicotinic Acid)

Niacin is a B-vitamin that can lower triglycerides and raise HDL cholesterol. Its use has decreased due to side effects and recent study results. Niacin limits the liver's ability to produce blood fats. Side effects can include flushing, and high doses have been linked to increased risk of strokes and liver damage. It is now mainly used for patients who cannot tolerate statins.

Comparison of Key Medications for High Triglycerides


Medication Class	Triglyceride Reduction Potential	Primary Purpose	Key Considerations
Fibrates	Significant	Reduce very high triglycerides, especially to prevent pancreatitis	Fenofibrate preferred over gemfibrozil for combination with statins
Prescription Omega-3 Fatty Acids	Significant	Lower triglycerides and potentially reduce cardiovascular risk (icosapent ethyl)	Prescription-strength required; mild gastrointestinal side effects
Statins	Moderate	Lower LDL cholesterol; also have a moderate triglyceride-lowering effect	Often first-line for cardiovascular risk; may not be enough for very high triglycerides
Niacin	Moderate to Significant	Lowers triglycerides and raises HDL (rarely used due to side effects)	High incidence of flushing; potential for liver issues; no proven cardiovascular benefit when added to statins

Conclusion

Determining the best medicine for high triglycerides requires a personalized approach based on the severity of the condition and individual cardiovascular risk. Lifestyle changes are foundational. When medication is needed, options like fibrates, prescription omega-3 fatty acids, or statins are chosen to create a tailored treatment plan. Discussing options with a doctor is essential for appropriate care. For additional cardiovascular health information, resources like the American Heart Association are available.

Emerging Therapies

Ongoing research is exploring new treatments for high triglycerides, including therapies targeting apolipoprotein C3. Investigational drugs are being studied for their potential to significantly reduce triglycerides, potentially offering new options for patients with challenging cases in the future.

Frequently Asked Questions

The primary goal depends on the severity. For very high triglycerides, the main goal is to prevent acute pancreatitis. For patients with high cardiovascular risk, the goal is to reduce heart disease and stroke risk by improving the overall lipid profile.

Yes, for many people with mildly or moderately elevated triglycerides, consistent lifestyle changes like a healthy diet, regular exercise, weight loss, and reduced alcohol intake can significantly lower triglyceride levels and may be sufficient.

No. Prescription omega-3 fatty acid products, like icosapent ethyl or omega-3-acid ethyl esters, contain more active fatty acids and are regulated by the FDA for specific health conditions. Over-the-counter supplements can have variable potency and are not a substitute for prescription medication.

Fibrates are more potent at lowering very high triglycerides, and are often used to prevent pancreatitis. Statins are primarily prescribed to lower LDL ("bad") cholesterol but also offer a more moderate triglyceride reduction.

Common side effects of fibrates may include gastrointestinal issues like diarrhea and abdominal pain, headaches, and dizziness. There is also a risk of muscle pain or breakdown (rhabdomyolysis), particularly when combined with certain statins, which requires monitoring.

Niacin's use has decreased due to significant side effects like skin flushing and potential liver toxicity. Recent clinical trials also showed that adding niacin to statin therapy did not provide additional cardiovascular benefits compared to statin therapy alone.

Combination therapy may be needed for patients who have both high LDL cholesterol and very high triglycerides that are not adequately controlled with a single medication, such as adding a fibrate or prescription omega-3 to a statin. This requires careful supervision by a doctor.