Policosanol, an inexpensive dietary supplement of waxy alcohols from sugarcane, is promoted as a natural way to lower cholesterol. Trials from its Cuban developer and a licensed distributor report lower cholesterol and blood pressure; financially independent trials found no cholesterol effect. Side effects were no more common than with an inactive placebo. Used in place of proven cholesterol treatment, it leaves high cholesterol untreated; alongside it, a low-risk add-on. (Full Review)

Protocol

Standard dose (Cuban trials)

12 mg/day on average

Range 5–40 mg/day; up to 80 mg/day added no lipid effect

Time of day

Evening meal

With food; once daily in lipid and blood pressure trials

Claudication protocol

10 mg twice daily

For at least 6 months

Time to effect

Walking distance

After 6 months

Intermittent claudication; Cuban trials

Blood pressure

By 12 weeks

Cuban trials

LDL cholesterol

Within 30 days

Cuban trials; independent trials found no LDL-C reduction

Benefits

Medium: Lower blood pressure; longer walking distance in intermittent claudication; fewer serious vascular events; lower fasting glucose

Low: LDL cholesterol reduction

Speculative: Reduced platelet aggregation; higher HDL cholesterol and HDL function; lower liver enzymes; longer lifespan in worm models

Contraindications

Pregnancy and breastfeeding

Active bleeding, hemophilia or other bleeding disorders

Elective surgery or dental extraction within 7 days

Sole policosanol therapy for LDL-C ≥190 mg/dL, familial hypercholesterolemia or cardiovascular disease

Key Interactions

Aspirin: additive platelet inhibition

Clopidogrel with aspirin (P2Y12 inhibitor): additive platelet inhibition

Beta-blockers (atenolol, metoprolol): additive blood pressure lowering

Omega-3 fatty acids (fish oil supplement): additive platelet inhibition

Theoretical (inferred from mechanism)

Direct oral anticoagulants (apixaban) and heparins (enoxaparin): possible increased bleeding

NSAIDs, over-the-counter (ibuprofen, naproxen): possible gastrointestinal bleeding

Other blood pressure drugs (lisinopril, amlodipine): possible dizziness

Platelet-active supplements (Ginkgo biloba, garlic extract): possible bruising or bleeding

Blood pressure-lowering supplements (beetroot nitrate, magnesium): possible lightheadedness

Glucose-lowering drugs (metformin, insulin): possible additive glucose lowering

Risk & Side Effects

Medium: Forgone LDL-C lowering when used instead of proven therapy

Low: Minor adverse events; bleeding with anti-clotting drugs

Monitoring

Marker	Target	Why
LDL-C	<100 mg/dL	Expected to change; non-response guides stopping
HDL-C	≥60 mg/dL	Expected to change (reported rise)
Triglycerides	Not specified in the ER	Paired with LDL-C in the lipid panel
Blood pressure	<120/80 mmHg	Expected to change; safety check with blood pressure drugs
ALT	7–56 U/L	Safety check; small decrease reported
AST	Not specified in the ER	Paired with ALT; safety check
INR (warfarin users only)	No established target; change from own pre-policosanol INR	Safety check; a shift prompts prescriber review

Cadence: Baseline lipid panel, home blood pressure and liver enzymes (plus INR for warfarin users); lipids and blood pressure at 8–12 weeks, then every 6–12 months; liver enzymes at 12 weeks, then yearly; INR 1–2 weeks after starting; home blood pressure log during the first month.

Qualitative Assessment

Pain-free walking distance (for claudication), such as minutes walked before leg pain
Bruising, nosebleeds or gum bleeding, especially with anti-clotting drugs
Dizziness or lightheadedness on standing when combined with blood pressure drugs
Headache, sleep quality and gastrointestinal comfort

Policosanol for Health & Longevity

Protocol

Benefits

Risk & Side Effects

Monitoring

Qualitative Assessment