Relatively recent on the non-prescription cholesterol lowering radar is policosanol. Policosanol, which originally became popular in Cuba, consists of a mixture of fatty alcohols derived from waxes of sugar cane (the main source of marketed policosanol,) yams, and beeswax. The main ingredient of policosanol is octanosol, which is also sold as a separate product. Because of the interest in this product in South America, clinical studies have been conducted with policosanol (or octanosol) in recent years, and based on these studies policosanol appears quite promising.
It is thought that the alcohols in policosanol act on cholesterol metabolism in the liver, but at a different part of the metabolic pathway than statins. Many animal studies with policosanol demonstrate a cholesterol lowering effect, and more recently human studies have suggested that LDL cholesterol can be reduced to a degree similar to that achieved with statins, and that HDL cholesterol can be increased by as much as 10 - 25% (an effect difficult to achieve with statins.)
Policosanol reduces the platelet aggregation (i.e., the "stickiness" of platelets, the blood elements that promote blood clotting,) so should be used with caution, if at all, in patients taking blood thinners such as Coumadin. No other major drug interactions have been described. Other reported side effects include skin rash, headache, insomnia, and gastrointestinal disturbances - but human studies suggest that in general the drug is well tolerated.
From these early studies policosanol looks a) like an effective and very promising non-prescription means to improve cholesterol levels, and b) like a serious drug (in that it alters liver metabolism.) DrRich would be quite excited about this drug if longer term safety studies were available.
One problem with policosanol is that there is a lot of variability in the available preparations. It is not clear, for instance, that policosanol derived from beeswax is as "potent" as the policosanol derived from sugar cane, or that the mixtures of fatty alcohols in the various preparations are equally effective.
Furthermore, if the popularity of policosanol increases over the next few years - as DrRich suspects it will - any potential side effects may become more evident. So if you are considering using this drug, it might be a good idea to discuss it with your doctor - or at least keep an eye out for more news on policosanol.
Note: A new randomized trial now suggests that policosanol has NO lipid lowering effects. Read about this new information here.