Ezetimibe: uses, side effects and how it differs from statins

Ezetimibe is a type of medicine used to lower cholesterol. The NHS says it treats high blood cholesterol and may be prescribed when a statin cannot be taken or does not lower cholesterol enough on its own.

It also comes in combination tablets. Inegy combines ezetimibe with simvastatin, and Nustendi combines it with bempedoic acid. The single-ingredient brand is Ezetrol.

A statin reduces cholesterol production in the liver. Ezetimibe takes a different route: the NHS explains that it helps stop your body taking in cholesterol from food. Because the two act in different places, they can be used together.

The NHS says it usually lowers cholesterol levels within two weeks. A follow-up blood test is how the effect is judged, rather than any symptom.

Most adults and children aged 10 and over can take ezetimibe. It is not suitable if you have had an allergic reaction to it, have liver problems, or are pregnant, planning pregnancy or breastfeeding, so tell the prescriber about these first.

The NHS gives a single dose figure: one 10 mg tablet once a day for adults and children. Swallow it with water, with or without food.

If you forget a dose, take it when you remember unless you do not remember until the next day; in that case skip it. Do not double up. One or two extra tablets are unlikely to harm you, though the NHS advises NHS 111 if you develop severe stomach pain or severe diarrhoea after taking too many.

The NHS says not to stop without speaking to a doctor, because cholesterol may rise again.

Commoner effects, affecting more than one in 100 people, are stomach pain, diarrhoea, wind and tiredness. The NHS suggests small, frequent meals for stomach pain, plenty of fluids for diarrhoea and, for wind, avoiding foods such as lentils, beans and onions.

Rare serious effects: muscle pain, tenderness, weakness or cramps; yellow skin or eyes with pale stools and dark urine; and severe pain just under the ribs. These warrant NHS 111. Swelling of lips, mouth or throat or serious breathing difficulty is an emergency for 999.

Severe or prolonged diarrhoea can reduce the protection of contraceptive pills.

Ezetimibe is a quiet medicine: most people feel no difference, and a lower cholesterol number is the only sign that it is doing its job. The NHS page sets out no special monitoring beyond ordinary medical supervision, so ask your prescriber when a repeat cholesterol test is planned.

Because it is a once-a-day tablet that does not depend on food, it tends to fit easily into an existing routine, for example next to a statin you already take. If it is prescribed as a combination product such as Inegy or Nustendi, you take that single tablet in place of separate ones, and the dosing instructions on that product apply.

The NHS names ciclosporin, warfarin, colestyramine and bezafibrate as medicines to discuss. The NHS page contains no advice on alcohol or driving, so standard caution applies: if you feel unwell on it, do not drive.

It is not usually recommended in pregnancy because of limited safety data, although a specialist may prescribe it in very high cholesterol. Breastfeeding may be acceptable, but tell your healthcare team. The NHS notes no evidence that it affects fertility.

Suspected side effects can be reported to the Yellow Card scheme.