What medications can raise your cholesterol?

Certain essential prescription drugs can unexpectedly cause a spike in cholesterol levels [1.2.3]. This article answers the question, 'What medications can raise your cholesterol?' and explores how to work with your doctor to manage this potential side effect for your long-term health.

Quick Summary

A detailed look at prescription drugs known to elevate cholesterol, such as certain blood pressure pills, steroids, and antipsychotics, along with proactive management steps for patients.

Key Points

• Essential Medications: Many vital drugs for blood pressure, inflammation, and mental health can raise cholesterol levels as a side effect [1.2.3].

• Key Offenders: Thiazide diuretics, older beta-blockers, corticosteroids, retinoids, and some antipsychotics are common culprits [1.3.1].

• Monitoring is Crucial: Regular blood tests to check your lipid profile are essential when taking a medication known to affect cholesterol [1.4.4].

• Lifestyle Intervention: A heart-healthy diet and regular exercise can help counteract medication-induced increases in cholesterol [1.7.1].

• Consult Your Doctor: Never stop a prescribed medication. Instead, discuss your concerns and potential management strategies with your provider [1.3.3].

• Variable Effects: The impact on cholesterol can depend on the specific drug, its dosage, and individual patient factors [1.2.6].

• Triglycerides are a Concern: Several drug classes, particularly retinoids and some antipsychotics, can cause a significant spike in triglycerides [1.2.6].

The Unseen Side Effect: Drug-Induced Dyslipidemia

Many individuals diligently manage their diet and exercise to maintain healthy cholesterol levels, yet they might be unaware that a prescribed medication could be working against their efforts. This phenomenon, known as drug-induced dyslipidemia, occurs when a medication alters the body's lipid metabolism, leading to elevated levels of low-density lipoprotein (LDL or "bad") cholesterol, triglycerides, or a decrease in high-density lipoprotein (HDL or "good") cholesterol [1.3.1, 1.4.6]. While these medications are often crucial for treating specific health conditions, understanding their potential impact on your lipid profile is the first step toward proactive management and safeguarding your cardiovascular health [1.2.2].

Common Medications That Can Alter Cholesterol

Several classes of widely used drugs have been identified as potential culprits in raising cholesterol. It's important to note that the effect can vary based on the specific drug, the dosage, and individual patient factors [1.2.6].

Blood Pressure Medications

Certain medications prescribed for hypertension can influence lipid levels.

• Thiazide Diuretics: Often called "water pills," drugs like hydrochlorothiazide (HCTZ) and chlorthalidone are mainstays in blood pressure management [1.3.4]. However, particularly at higher doses (50 mg or more), they can cause a temporary increase in both LDL cholesterol and triglycerides [1.3.3, 1.3.1]. In many cases, the benefits of blood pressure control are considered to outweigh these mild lipid changes [1.3.3].
• Older Beta-Blockers: Medications such as propranolol, atenolol, and metoprolol can slightly raise triglyceride levels while lowering beneficial HDL cholesterol [1.3.5]. This effect may be more pronounced in individuals who smoke [1.3.4]. Newer beta-blockers, like carvedilol and nebivolol, are less likely to affect cholesterol levels [1.3.3].

Corticosteroids

Corticosteroids, such as prednisone, are powerful anti-inflammatory drugs used for a wide range of conditions, from arthritis to severe allergies [1.4.6, 1.4.4]. Chronic use of these medications, whether taken orally, inhaled, or injected, can lead to significant elevations in total cholesterol, LDL, and triglycerides [1.2.5, 1.4.5]. The exact mechanism is complex, but it's a critical side effect for patients on long-term steroid therapy to monitor with their healthcare provider [1.4.1].

Retinoids

Isotretinoin, a retinoid used to treat severe nodulocystic acne, is well-known for its impact on lipids [1.6.1]. A common side effect is a significant, dose-related elevation in serum triglyceride levels [1.6.3]. It can also increase total and LDL cholesterol while decreasing HDL [1.6.5]. These changes are typically reversible after treatment discontinuation, but they necessitate regular blood tests during the course of therapy [1.6.3, 1.6.5].

Antipsychotic Medications

Second-generation (atypical) antipsychotics are essential for treating conditions like schizophrenia and bipolar disorder. However, some are strongly associated with metabolic side effects, including weight gain and dyslipidemia [1.5.3]. Drugs like olanzapine and clozapine, in particular, have been shown to increase the risk of developing high cholesterol and high triglycerides [1.5.1, 1.5.4]. People taking these medications are nearly three times more likely to have high cholesterol [1.3.1].

Other Notable Drug Classes

Other medications that can negatively affect your lipid profile include:

• Antivirals: Certain protease inhibitors used in HIV treatment can increase both LDL cholesterol and triglycerides significantly [1.2.6].
• Immunosuppressants: Drugs like cyclosporine, used to prevent organ transplant rejection, can raise both LDL and triglyceride levels [1.2.6].
• Anabolic Steroids: Used illicitly for muscle-building or prescribed for specific medical conditions, these can increase LDL and drastically decrease HDL cholesterol [1.2.6].

Comparison of Medications and Their Cholesterol Impact

Drug Class	Common Examples	Primary Cholesterol Effect [1.2.6]
Thiazide Diuretics	Hydrochlorothiazide, Chlorthalidone	Can increase LDL (5-10%) and Triglycerides (5-15%)
Older Beta-Blockers	Atenolol, Metoprolol, Propranolol	Can increase Triglycerides (10-40%) and decrease HDL (5-20%)
Corticosteroids	Prednisone, Cortisone	Variable increases in LDL and Triglycerides
Retinoids	Isotretinoin	Can significantly increase Triglycerides (35-100%) and LDL (15%)
Atypical Antipsychotics	Olanzapine, Clozapine	Can increase Triglycerides (20-50%)
Protease Inhibitors	(Various HIV medications)	Can increase LDL (15-30%) and Triglycerides (15-200%)

Proactive Management: What Patients Should Do

If you are taking a medication known to affect cholesterol, it's crucial to partner with your doctor. Never stop taking a prescribed medication on your own [1.3.3]. Instead, open a dialogue with your healthcare provider.

1. Ask for Monitoring: Before starting a new medication from one of these classes, ask for a baseline lipid panel. Follow up with regular blood tests as recommended by your doctor to track any changes [1.4.4].
2. Focus on Lifestyle: Adopting a heart-healthy diet and engaging in regular exercise can help offset medication-induced lipid changes [1.7.1]. Reducing intake of saturated fats and increasing fiber can be particularly effective [1.7.1].
3. Discuss Alternatives: Ask if there is an alternative medication for your condition that has less impact on cholesterol [1.2.3]. For instance, newer beta-blockers often have a more favorable lipid profile than older versions [1.3.5].
4. Consider Additional Treatment: If the medication is essential and its benefits outweigh the risks, your doctor may suggest adding a cholesterol-lowering medication, like a statin, to your regimen [1.7.2].

Learn more from the American Heart Association.

Conclusion: Balancing Treatment Benefits with Cholesterol Risks

Many of the medications that can raise cholesterol are vital for managing serious health issues. The goal is not to avoid these necessary treatments but to be aware of their potential side effects. Through regular monitoring, healthy lifestyle choices, and open communication with a healthcare provider, patients can successfully manage drug-induced dyslipidemia, ensuring they receive the full benefit of their primary treatment while protecting their long-term cardiovascular health.

Frequently Asked Questions

How quickly can a medication raise my cholesterol?

The effect can be relatively quick. For example, some diuretics can cause changes within hours of a dose, while other medications may show an impact on lipid panels after a few weeks or months of consistent use [1.2.6].

Will my cholesterol return to normal if I stop the medication?

In many cases, lipid levels return to baseline after the medication is discontinued, as is often seen with drugs like isotretinoin [1.6.5]. However, you should never stop a prescribed medication without consulting your doctor [1.3.3].

Are there any blood pressure medications that don't raise cholesterol?

Yes. ACE inhibitors and ARBs generally have little to no effect on cholesterol levels [1.3.2]. Additionally, newer beta-blockers like carvedilol and nebivolol are less likely to affect lipids than older versions [1.3.3].

Should I take a statin if my medication is raising my cholesterol?

This is a decision to make with your doctor. If the medication is essential and your cholesterol reaches a level that increases your cardiovascular risk, your doctor may recommend adding a cholesterol-lowering drug like a statin [1.7.4].

Does the dosage of a medication affect how much my cholesterol will rise?

Yes, the effect is often dose-dependent. For instance, higher doses of thiazide diuretics (above 25-50 mg) are more likely to raise cholesterol than lower doses [1.3.1, 1.3.3].

Do oral contraceptives (birth control pills) raise cholesterol?

Yes, some oral contraceptives can affect cholesterol levels due to their estrogen and progestin content. They may raise triglycerides and LDL while affecting HDL [1.2.3, 1.2.6]. This effect varies based on the specific formulation.

What are the symptoms of high cholesterol?

High cholesterol typically has no symptoms. The only way to know if your cholesterol is high is through a blood test called a lipid panel [1.2.2]. This is why regular monitoring is important when taking certain medications.