Ezetimibe

About Ezetimibe

Ezetimibe blocks NPC1L1, a transporter the small intestine uses to take up cholesterol and plant sterols, so less cholesterol reaches the liver and the liver clears more from the blood. The label covers lowering LDL cholesterol, with diet, in adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) together with a statin, or alone when additional LDL-lowering therapy is not possible; with a statin in children 10 and older with the heterozygous form; with fenofibrate in adults with mixed hyperlipidemia; with a statin and other treatments in adults and children 10 and older with homozygous familial hypercholesterolemia; and, with diet, homozygous familial sitosterolemia, an inherited buildup of plant sterols, from age 9. The dose is 10 mg once a day with or without food, and LDL can be checked as early as four weeks after starting.

There is no boxed warning. It is not taken after an allergic reaction to it, and when combined with a statin, fenofibrate or another LDL-lowering medicine, it is not used by anyone who must not take that partner drug. Liver enzyme rises were more common when ezetimibe was started together with a statin than with the statin alone, and stopping ezetimibe is considered if they persist at three times the upper limit of normal or more. It can cause muscle damage (myopathy and rhabdomyolysis); after approval, most people who developed rhabdomyolysis were taking a statin or another drug with that risk, such as a fibrate, and if muscle damage is suspected, ezetimibe and other medicines are stopped as appropriate. It is not recommended with moderate or severe liver impairment. Taken alone, its most common side effects were upper respiratory infections, diarrhea, joint pain, sinusitis, pain in the arms or legs, tiredness and flu.

The February 2024 label added reports, after approval, of liver enzyme rises above five times the upper limit of normal. Pregnancy data are insufficient to judge the risk, so a known or suspected pregnancy, and breastfeeding, are discussed with the prescriber. Ezetimibe with simvastatin (Vytorin and generics) is a separate prescription: one tablet of 10 mg ezetimibe with 10, 20, 40 or 80 mg simvastatin, taken once in the evening. Simvastatin’s contraindications and dose limits apply to it, so the recommended maximum is 10/40 mg, 10/80 mg is restricted to adults who have taken it long term without muscle problems, and some medicines cap it at 10/10 or 10/20 mg, as the simvastatin guide explains. Nexlizet (with bempedoic acid 180 mg) has no approved generic. Liptruzet and Lypqozet (with atorvastatin) and Roszet (with rosuvastatin) are listed by the FDA as discontinued.

Taking Ezetimibe

How to take it

One 10 mg tablet once a day, with or without food; ezetimibe with simvastatin is taken once a day in the evening. If you also take cholestyramine, colesevelam or colestipol, take ezetimibe at least 2 hours before or 4 hours after it.

If you miss a dose

Take it as soon as you remember, but skip it if the next dose is almost due. Do not double the next dose.

Storage

At room temperature, 68°F to 77°F (20°C to 25°C), protected from moisture, out of reach of children.

Interactions to know about

Cyclosporine and ezetimibe raise each other’s levels, so cyclosporine levels are monitored. Fibrates other than fenofibrate are not recommended with it, and with fenofibrate, suspected gallstones call for gallbladder tests and possibly another treatment. When it is taken with a statin, or as ezetimibe with simvastatin, the statin’s interactions and dose limits apply as well.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ezetimibe differs from pharmacy to pharmacy

Generic ezetimibe comes from many makers and costs pharmacies little, so a quote is mostly the dispensing fee and markup, which differ between pharmacies; a prescription naming Zetia with substitution blocked is priced as a brand. With a separate statin, it is a second prescription with its own quote.

Combination tablets are priced as products of their own, and Nexlizet, with no generic, is priced as a brand. A combination tablet is not rated equivalent to its ingredients taken as separate tablets, so swapping one for the other needs the prescriber.

Ways to pay less for Ezetimibe without insurance

• Ask for generic ezetimibe, or generic ezetimibe and simvastatin if Vytorin is prescribed, and make sure the prescription does not block substitution.
• Ask whether ezetimibe and your statin are on the pharmacy’s flat-price generic list, and once your doses are settled, ask for ninety-day supplies.
• If a combination tablet is prescribed, ask the prescriber whether its ingredients as separate tablets would suit you, and compare quotes.
• For Nexlizet, ask the maker whether a savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ezetimibe

1. 1.How far apart should I take it and my cholestyramine, colesevelam or colestipol?
2. 2.Which muscle or liver symptoms should I report?
3. 3.Is my prescription for plain ezetimibe or a combination tablet?
4. 4.If I take ezetimibe with simvastatin, do any of my other medicines limit the dose or rule it out?

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