Ezetimibe: What it does and how to use it

Want to lower LDL without pushing your statin dose higher? Ezetimibe (brand name Zetia) cuts cholesterol absorption in the gut and often helps when diet and a statin alone aren’t enough. It’s simple: most people take one 10 mg pill a day and see a solid LDL drop — commonly around 15–25% as monotherapy and more when added to a statin.

How ezetimibe works and when it helps

Ezetimibe blocks a protein in the small intestine that brings dietary cholesterol into the bloodstream. Doctors use it for primary high cholesterol, in some cases of familial hypercholesterolemia, and to add to statins when extra LDL lowering is needed. The IMPROVE-IT trial (NEJM, 2015) showed that adding ezetimibe to simvastatin after an acute coronary syndrome lowered the risk of future heart events compared with simvastatin alone — that’s real-world proof it can matter, not just lower numbers on a lab report.

It’s also an option if you can’t tolerate high-dose statins. For some people who get muscle pain on statins, adding ezetimibe lets the doctor keep a lower statin dose while still pushing LDL down.

Practical tips: dose, interactions, and what to watch for

Dose and timing: the standard dose is 10 mg once daily. Take it with or without food — absorption isn’t picky. If you also use a bile acid sequestrant (like cholestyramine), take ezetimibe at least 2 hours before or 4 hours after the sequestrant so it can be absorbed.

Interactions and special cases: tell your doctor about all meds — cyclosporine can raise ezetimibe levels, and some combinations need monitoring. Severe active liver disease is a reason to avoid or pause ezetimibe; no dose change is usually needed for mild-to-moderate kidney problems. For children, ezetimibe is approved in certain cases (often 10 years and older) for familial cholesterol conditions — follow specialist advice.

Monitoring: check a lipid panel 4–12 weeks after starting or changing the dose to see how well it’s working. If you’re on a statin plus ezetimibe, your doctor may check liver tests first and if symptoms suggest a problem later, though routine frequent LFT checks aren’t required for ezetimibe alone.

Side effects to note: most people tolerate ezetimibe well. Common complaints are stomach upset, diarrhea, joint or muscle pain, fatigue, and cough. Rare but serious issues include liver enzyme increases or muscle problems — report new muscle pain, weakness, dark urine, yellowing of the skin, or persistent abdominal pain right away.

Availability: ezetimibe is widely available as a generic and usually affordable. If cost is a concern, ask your pharmacist or doctor about generic options or combination pills with statins that can lower the price and simplify dosing.

If you’re thinking about ezetimibe, bring your latest lipid numbers to your appointment and ask how much extra LDL reduction you might expect and what side effects to watch for. That makes the conversation practical and focused on the results you want.