Ezetimibe
What is ezetimibe?
Ezetimibe (e-zet-im-ibe) is a medicine that lowers cholesterol. You might also hear its brand name, Ezetrol.
Ezetimibe is often prescribed alongside a statin because they work in different ways, so the effects add up to lower your cholesterol further. Ezetimibe also comes as a combination tablet with simvastatin (a type of statin) under the brand name Inegy.
How much can it lower cholesterol?
Ezetimibe can lower LDL cholesterol (sometimes called 'bad cholesterol') by 15-22% when used by itself, or 21-27% if it's used in combination with a statin.
Recent national guidelines have said that adding ezetimibe to a statin is likely to give a greater reduction in cholesterol than doubling the dose of the statin.
The national guideline for cardiovascular disease: risk assessment and reduction (NG238), updated in December 2023, now recommends that ezetimibe should be considered in addition to a statin for those with known cardiovascular disease (heart attack/stroke), even if they have already met their cholesterol target.
Some studies have shown that ezetimibe combined with a statin can lower the risk of serious problems like heart attacks and strokes in people with chronic kidney disease and certain heart problems.
How does ezetimibe work?
Ezetimibe is a “cholesterol absorption inhibitor” which means it works by partially blocking the absorption of cholesterol in the small intestine. This means less cholesterol enters your blood from food and bile so the liver has to take more cholesterol out of the blood to make more bile, which is needed for digestion.
The liver does this by increasing the number of LDL receptors on your liver cells. These receptors catch LDL cholesterol as it passes by and removes it from the blood.
If you are worried about your cholesterol, you can email our Cholesterol Helpline
email ask@heartuk.org.uk
How do you take ezetimibe?
Ezetimibe comes as a tablet which you take once a day at a dose of 10mg. It might be combined with a statin or you might be prescribed it on it's own if you can't take statins.
Taking ezetimibe with a statin
Ezetimibe is allowed alongside a statin when statins aren't bringing your cholesterol levels down to target on their own, including for rare conditions such as homozygous FH and sitosterolaemia.
Taking ezetimibe by itself
Ezetimibe is licensed to be used by itself if you have primary hypercholesterolaemia, which includes heterozygous FH as well as other conditions, and you can't take statins or they're not working for you.
Ezetimibe is not suitable during pregnancy or if you are breastfeeding.
What are the side effects?
Like all medicines, ezetimibe can sometimes cause side effects. You can find a full list of reported side effects in the patient information leaflet which comes with your medicine. Occasionally, side effects can be more serious than those listed here, so tell your doctor if you experience anything unusual for you.
If you take ezetimibe by itself
Any side effects are usually mild and temporary. They can include:
- problems with digestion
- abdominal pain (pain in the tummy area)
- diarrhoea
- breaking wind more
- fatigue (extreme tiredness).
If you take ezetimibe with a statin
The most common side effects include:
- muscle pain
- headaches
- moderately raised liver enzymes.
Can I eat foods with added sterols or stanols?
Ezetimibe lowers cholesterol in a similar way to foods that have been fortified with plant sterols or stanols.
Even though there may be subtle differences in the ways ezetimibe works compared to these foods, it is impossible to say whether they will lower your cholesterol any further if you are taking ezetimibe.