From Jennifer Moll,
Your Guide to Cholesterol.
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About.com Health's Disease and Condition content is reviewed by Rich Fogoros, MD

Anytime your health care provider prescibes a new medication to you, be sure to ask questions. Although new drugs are supposed to help you on to the road to good health, they may have some undesirable side effects. For instance, there are some drugs on the market that may actually cause triglycerides and LDL cholesterol ("bad" cholesterol) to increase and/or HDL cholesterol ("good" cholesterol) to decrease. This may be bothersome to those of you who have never had high cholesterol before. Additionally, if you are currently on medication to lower your cholesterol, you might notice that your therapy may need to be adjusted.

If your health care provider places you on one of the following drugs, you may need to discuss with them what cholesterol lowering measures you need to take during your treatment.

Prednisone

Prednisone is a glucocorticoid that is used to reduce the swelling, warmth, and tenderness associated with many inflammatory conditions.

Beta blockers

Beta blockers are normally prescribed to treat high blood pressure. Despite the significant advantages they offer in treating several forms of heart disease, beta blockers also have been noted to decrease HDL levels and elevate triglyceride levels. In most cases, however, these lipid changes have been very small. It is important to note that not all beta blockers have this effect. The following beta blockers have been noted to slightly alter lipid profiles:

• Atenolol (Tenormin®)
  
• Betaxolol (Kerlone®)
  
• Bisoprolol (Zebeta®)
  
• Metoprolol (Toprol®, Lopressor®)
  
• Nadolol (Corgard ®)
  
• Propanolol (Inderal ®)
  

Beta blockers not only help lower blood pressure, they also are instrumental in prolonging the survival of individuals with active heart disease (such as congestive heart failure and previous heart attack). Therefore, even if slight alterations of your lipids are observed, it is very important that beta blockers are not discontinued.

Amiodarone

Amiodarone is drug used to treat a variety of heart arrhythmias and is associated with a wide range of side effects. One of the smaller side effects is related to high cholesterol. It mainly raises LDL cholesterol levels and has no effect on HDL cholesterol or triglyceride levels.

Estrogen

Estrogen is a female sex hormone found in female hormonal birth control and in other forms of hormone replacement therapy. For many years, estrogen had been considered "cardioprotective," thus promoting a healthy heart. This is mainly due its ability to raise HDL levels. This caused many post-menopausal women taking hormone replacement therapy to help their heart. However, recent studies have found that it does not protect against heart disease after menopause. The mechanism by which it causes heart attacks is unknown. Additionally, estrogens may also increase triglyceride levels.

Progestin

Progestin is a form of progesterone, another female sex hormone, which is used in oral contraceptives and hormone replacement therapy alone or in combination with estrogen. Higher levels of progestin have been associated with lower HDL levels. In combination with estrogen, progestin may cancel out the healthy effect estrogen has in raising HDL levels.

Anabolic Steroids

Anabolic steroids include testosterone, the male sex hormone that is used to treat delayed puberty in boys and some forms of impotence. It is also used illegally to build muscle mass. These drugs raise LDL levels and lower HDL levels. The detrimental effects this drug has towards cholesterol levels are more noticeable in the oral medications in comparison to the injectable medications.

Cyclosporine

Cyclosporine (Sandimmune ®, Neoral®, Gengraf®) is a drug used to suppress the immune system. It is commonly used after an organ transplant in order to prevent rejection. However, it may also be used to treat rheumatoid arthritis and psoriasis. Studies have shown that cyclosporine raises LDL cholesterol levels.

Protease Inhibitors

Protease inhibitors are used to treat human immunodeficiency virus (HIV). Although the mechanism by which these drugs raise cholesterol levels is not known, they appear to especially raise triglyceride levels and lower HDL cholesterol levels. Currently, fibrates and statins have shown promise in lowering triglycerides and raising HDL levels in these individuals.

Diuretics

Diuretics are used to treat high blood pressure and water retention. There are two types of diuretics that cause increased cholesterol levels:

• Thiazide diuretics (including hydrochlorothiazide, chlorothiazide, metolazone)
  
• Loop diuretics (including furosemide, torsemide, bumetanide)

Thiazide diuretics cause a temporary increase in total cholesterol levels, triglyceride levels, and LDL cholesterol levels. HDL cholesterol levels are not typically affected. This increase may range between 5 to 10 milligrams per deciliter. Currently, indipamide is the only thiazide diuretic that has not been shown to raise cholesterol levels. Loop diuretics share the same pattern as thiazide diuretics; however, some of these drugs have shown a slight decrease in HDL cholesterol. Since diuretics are very important in the treatment of lowering blood pressure, your health care provider may also place you on a low-fat diet while you are on this medication.

Sources:
Graham NM. Metabolic disorders among HIV-infected patients treated with protease inhibitors: a review. J Acquir Immune Defic Syndr 2000;25(suppl 1):S4-S11.

Hudig F et al. Amiodarone-induced hypercholesterolemia is associated with a decrease in liver LDL receptor mRNA. FEBS Lett 341(1):86-90.

Stone NJ. Secondary causes of hyperlipidemia. Med Clin North Am 1994 Jan;78(1):117-41

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (PDF), July 2004, The National Institutes of Heath: The National Heart, Lung, and Blood Institute.