What medications make your cholesterol high? An in-depth guide to drug-induced dyslipidemia

October 10, 2025 •

4 min read

According to the National Institutes of Health, a wide variety of prescribed medications can cause or exacerbate hyperlipidemia, a condition known as drug-induced dyslipidemia. Understanding what medications make your cholesterol high is a vital step in managing your overall cardiovascular health, especially when starting a new treatment plan.

Quick Summary

Many medications, including certain blood pressure drugs, antipsychotics, and hormones, can cause an increase in cholesterol levels by impacting lipid metabolism. Key examples are corticosteroids, older beta-blockers, diuretics, and HIV protease inhibitors, and it's essential to monitor your lipid profile while on these therapies.

Key Points

Antihypertensives: Older beta-blockers and high-dose thiazide diuretics can increase triglycerides and LDL while lowering HDL.
Corticosteroids: These anti-inflammatory drugs, such as prednisone, can raise total cholesterol, LDL, and triglyceride levels.
Atypical Antipsychotics: Second-generation antipsychotics like clozapine and olanzapine are known to cause weight gain and significant dyslipidemia.
Antivirals: HIV protease inhibitors and certain hepatitis C antivirals can lead to elevated triglyceride and LDL levels.
Hormonal Medications: Some oral contraceptives and anabolic steroids can negatively alter lipid profiles, increasing cardiovascular risk.
Immunosuppressants: Drugs like cyclosporine, used after organ transplantation, commonly cause hyperlipidemia.
Retinoids: Acne medications such as isotretinoin are known to elevate triglycerides and LDL cholesterol.

Introduction to Drug-Induced Dyslipidemia

Drug-induced dyslipidemia refers to abnormal lipid levels caused by medication. While genetics, diet, and lifestyle are primary drivers of high cholesterol, various commonly prescribed drugs can have a significant impact on your lipid profile. This can include raising low-density lipoprotein (LDL) or "bad" cholesterol, increasing triglycerides, and in some cases, lowering high-density lipoprotein (HDL) or "good" cholesterol. For many conditions, the benefits of the medication far outweigh the risks, but monitoring is crucial. If you're concerned about your cholesterol while on a medication, never stop taking it without first consulting your healthcare provider.

Blood Pressure Medications

Certain drugs used to treat hypertension (high blood pressure) have been known to negatively impact lipid levels. The effect is often dose-dependent and can vary depending on the specific drug.

Older Beta-Blockers

Older, non-selective beta-blockers are a well-documented class of medications that can alter lipid profiles. These include:

Propranolol (Inderal)
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol-XL)

These drugs can cause an increase in triglycerides and a decrease in HDL cholesterol. Newer, cardioselective beta-blockers generally have a lesser impact on lipid levels.

Diuretics

Diuretics, or "water pills," help the body eliminate excess fluid. High doses of thiazide diuretics, such as hydrochlorothiazide, have been shown to increase total cholesterol, LDL cholesterol, and triglycerides, although these effects may diminish with long-term use. Examples include:

Hydrochlorothiazide
Chlorthalidone (Thalitone)
Indapamide

Hormonal Medications and Steroids

Corticosteroids

Corticosteroids like prednisone, used to treat inflammation and autoimmune diseases, are known to increase both cholesterol and triglyceride levels. The extent of this effect can depend on the dose and duration of use. Chronic use, especially at higher doses, is more likely to cause significant changes.

Hormonal Contraceptives and Anabolic Steroids

Oral contraceptives containing certain progestins have been associated with increased total cholesterol, LDL cholesterol, and triglycerides, along with decreased HDL cholesterol. The effect varies with the specific formulation. Additionally, anabolic steroids can cause a dramatic and negative shift in lipid profiles, including significantly lowering HDL cholesterol.

Mental Health and Anticonvulsant Medications

Antipsychotics

Atypical or second-generation antipsychotics, commonly used to treat conditions like schizophrenia and bipolar disorder, are associated with weight gain and dyslipidemia. High-risk drugs include:

Clozapine (Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)

The lipid-altering effects are often dose-dependent and may occur independently of weight gain.

Antidepressants

Some antidepressants, including SSRIs (like sertraline, fluoxetine) and tricyclic antidepressants (like amitriptyline), have been linked to higher cholesterol and triglyceride levels. However, the risk varies by medication and is not fully understood.

Anticonvulsants

Enzyme-inducing anticonvulsants, such as carbamazepine and phenytoin, can elevate total cholesterol and LDL levels. In contrast, valproic acid, which does not induce these enzymes, appears to have little effect on cholesterol.

Immunosuppressants and Other Medications

Immunosuppressants

Patients receiving immunosuppressive therapy, particularly post-organ transplant, are at a higher risk for hyperlipidemia. Key culprits include:

Cyclosporine: Causes significant increases in total and LDL cholesterol.
mTOR inhibitors (e.g., sirolimus): Known to cause marked increases in triglycerides and LDL.

Antivirals

Certain antiviral drugs, particularly HIV protease inhibitors like ritonavir, can lead to substantial increases in triglycerides and LDL cholesterol. Some antivirals for Hepatitis C can also impact lipid levels.

Retinoids

Retinoids like isotretinoin (Claravis), used for severe acne, are notorious for raising triglyceride and LDL levels. Regular monitoring of lipid profiles is standard practice for patients on these treatments.

Comparison of Medications and Their Effects on Lipids


Medication Class	Primary Lipid Effect	Common Examples	Management Considerations
Corticosteroids	↑ Total Cholesterol, ↑ LDL, ↑ Triglycerides	Prednisone	Dose-dependent effect; monitor closely.
Older Beta-Blockers	↓ HDL, ↑ Triglycerides	Propranolol, Atenolol	Newer options are often lipid-neutral; effects may be transient.
High-Dose Diuretics	↑ Total Cholesterol, ↑ LDL, ↑ Triglycerides	Hydrochlorothiazide	Effects can lessen over time; low doses may have minimal impact.
Atypical Antipsychotics	↑ Total Cholesterol, ↑ LDL, ↑ Triglycerides	Olanzapine, Clozapine	Monitor for weight gain; lipid-lowering drugs may be needed.
HIV Protease Inhibitors	↑ LDL, ↑ Triglycerides	Ritonavir-containing drugs	Adjustments to HIV therapy or addition of lipid-lowering drugs may be necessary.
Immunosuppressants	↑ Total Cholesterol, ↑ LDL, ↑ Triglycerides	Cyclosporine, Sirolimus	Effects are common; requires diligent monitoring post-transplant.

Conclusion: Navigating Medications and Cholesterol

It is clear that a number of necessary and effective medications across various therapeutic classes can influence cholesterol levels. For most patients, the therapeutic benefits of these drugs for conditions like hypertension or psychiatric illness outweigh the risk of moderate lipid changes. However, this is not a universal rule. If you are starting a medication known to cause dyslipidemia or have existing lipid issues, proactive management is key. This involves regular lipid panel testing and open communication with your healthcare team. Depending on the severity of the changes, your doctor may adjust your dosage, switch to an alternative medication with a more favorable lipid profile, or prescribe a separate lipid-lowering agent like a statin. For more information, you can consult sources like the National Institutes of Health [based on information from the National Institutes of Health (NIH)].

Disclaimer: This information is for educational purposes and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment.

Frequently Asked Questions

Common drug classes include older beta-blockers, high-dose thiazide diuretics, corticosteroids, atypical antipsychotics, HIV protease inhibitors, and some immunosuppressants and hormonal therapies.

No, not all beta-blockers have the same effect. Older, non-selective beta-blockers are more likely to raise triglycerides and lower HDL. Newer beta-blockers tend to have a lesser impact on lipid levels.

Yes, some formulations of hormonal birth control, particularly those containing specific progestins, can raise total and LDL cholesterol and increase triglycerides.

It depends on the magnitude of the change and your overall cardiovascular risk. For many patients, the benefits of a necessary medication outweigh mild lipid changes, but close monitoring is important, especially for those at higher risk.

Drug-induced dyslipidemia is an adverse effect where certain medications cause abnormal levels of lipids in the blood, such as high cholesterol or triglycerides.

You should not stop taking your medication. Instead, consult your healthcare provider to discuss your concerns. They may recommend monitoring, adjusting your dosage, or switching to an alternative medication.

The exact mechanism is not fully understood, but it is thought to involve metabolic changes independent of weight gain and may relate to the slowed breakdown of cholesterol.

The effects on lipid levels from high-dose diuretics can be temporary. Studies have shown that modest elevations may occur in the first year but often return to baseline with long-term treatment.

Yes, isotretinoin, a retinoid used for acne, can cause increased LDL and triglyceride levels. Regular lipid profile monitoring is a standard part of treatment with this medication.