Ezetimibe for lipid modification

The addition of ezetimibe to statin therapy can further reduce low-density lipoprotein cholesterol (LDL-C) by 20 to 25%. Consider adding ezetimibe to statin therapy if the LDL-C target concentration is not met after 6 weeks with the maximum tolerated dose of a statin alone. Ezetimibe added to statin therapy in patients who have had an acute coronary syndrome is associated with a modest reduction in cardiovascular events over 7 years, but no reduction in mortalityCannon, 2015. The effect of ezetimibe on cardiovascular outcomes in the primary prevention of ASCVD has not been studied, although some evidence suggests a reduced risk of coronary artery disease with ezetimibeMyocardial Infarction Genetics Consortium Investigators, 2014.

Ezetimibe monotherapy is well tolerated in most patients who are unable to tolerate statin therapy; it decreases LDL-C by 15 to 20%.

If ezetimibe is considered appropriate, use:

Ezetimibe can cause muscle pain and mild elevation of alanine aminotransferase (ALT) concentration, but when added to a statin it does not appear to increase the incidence of these adverse effects beyond the level seen with statin monotherapy. Routine monitoring of ALT and serum creatine kinase concentration is not necessary.