Ezetimibe (brand name: Zetia) is a prescription medicine that can be used in combination with a statin or fenofibrate to treat high cholesterol. It is used to lower levels of cholesterol in the blood.

It can be used by itself or with other medicines to treat high cholesterol, and is used alongside a diet and exercise plan. Ezetimibe will not help you lose weight or prevent heart disease or heart attacks.

Ezetimibe (Zetia) is available at the pharmacy as an oral tablet and may be combined with other medicines to treat high cholesterol, such as:

• Vytorin (ezetimibe and simvastatin)
• Roszet (ezetimibe and rosuvastatin)
• Nexlizet (ezetimibe and bempedoic acid)

Zetia, Vytorin and Roszet are also approved by the FDA as generic options which may help you to save money.

What are the more common side effects of ezetimibe?

This medication is usually well-tolerated and most patients do not need to stop treatment due to side effects.

Common ezetimibe side effects when this medicine is used with a statin may include:

• Cold symptoms such as stuffy nose, sneezing, sore throat (3.7%)
• Muscle pain (3.2%)
• Upper respiratory tract infection (2.9%)
• Joint pain (2.6%)
• Diarrhea (2.5%)

Common ezetimibe side effects when this medicine is used alone may include:

• Upper respiratory tract infection (4.3%)
• Diarrhea (4.1%)
• Joint pain (3%)
• Sinusitis (2.8%)
• Pain in an arm or leg (2.7%)

These side effects were reported to occur in at least 2% of patients in studies (at least 2 out of every 100 patients and greater than placebo or a statin alone).

What are some mild side effects of ezetimibe?

Mild side effects may include temporary reactions like:

• Fever
• Headache
• Minor muscle aches or pain
• Runny nose
• Sore throat
• Tiredness

If these side effects do not go away or are concerning to you, contact your doctor right away. These side effects may not be mild in all patients.

What are some serious side effects of ezetimibe?

• Severe muscle damage, muscle pain or weakness (rhabdomyolysis, myopathy)
• Liver damage or increases in liver enzyme levels
• Allergic reactions

Ezetimibe can cause the breakdown of muscle tissue, which can rarely lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, or dark urine.

If you develop muscle symptoms, your doctor may also order a blood test to check for muscle damage (creatine phosphokinase or CPK).

The risk for muscle damage may also occur with other medications you might take, such as a statin. Your risk for muscle damage increases with higher doses of statin, age over 65 years, low thyroid levels (hypothyroidism), and kidney problems.

Ask your doctor or pharmacist to check for drug interactions when you start treatment. Tell them about all of the medicines you take, including prescription, over-the-counter, vitamins and herbal medicines or other dietary supplements.

Ezetimibe (as a single drug treatment) is not recommended in patients with moderate or severe liver impairment. You should not use a statin combined with ezetimibe if you have active liver disease or unexplained elevations in liver enzymes. Your doctor may check your liver with a blood test before you start treatment. Tell your healthcare provider if you have ever had liver problems.

Do not take ezetimibe if you are allergic to it or any inactive ingredients found in the medicine.

Get emergency medical help right away if you have signs of an allergic reaction to ezetimibe: hives (raised, itchy red rash, sometimes with target-shaped lesions); difficulty breathing or swallowing, wheezing, chest tightness, swelling of your face, lips, tongue, or throat, or anywhere on your body.

Other side effects or warnings

Other side effects reported with ezetimibe include:

• Back pain
• Depression
• Dizziness
• Gallstones; inflammation of the gallbladder
• Headache
• Inflammation of the pancreas or liver
• Influenza
• Laboratory blood test changes
• Low blood platelets (thrombocytopenia)
• Nausea
• Serious skin reactions (Erythema Multiforme)
• Stomach pain
• Tingling sensation (paresthesia)
• Tiredness, fatigue

Differences in side effects between older and younger patients were not seen in clinical studies but may be possible. Older patients may have a greater risk for liver or kidney impairment or other factors that may impact ezetimibe safety.

Pregnancy / Breastfeeding

Tell your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding before starting ezetimibe treatment. It is not known whether ezetimibe is excreted into human breast milk. Your doctor will discuss with you whether this treatment is right for you.

All statins are contraindicated (should never be used) in pregnant and nursing women. You should not use a statin with ezetimibe if you are pregnant, trying to become pregnant or are breastfeeding. If you are of childbearing age, use an effective method of birth control to prevent pregnancy while using ezetimibe added to statin therapy.