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When Should Ezetimibe Be Used?

Ezetimibe (Zetia) is a medication used to lower cholesterol. More specifically, this medication is used in clinical practice to lower LDL and help get patients to a target goal. If you recall from your pharmacology classes, ezetimibe inhibits the absorption of cholesterol in the small intestine which ultimately leads to a reduction in cholesterol delivery of cholesterol to the liver and requires the liver to increase the clearance of cholesterol from the bloodstream. If you are looking to pass a test soon, the specific transporter in the intestine that is affected is the Niemann-Pick C1-Like1 (NPC1L1).

Overall, when I’ve seen ezetimibe used in practice, tolerance generally isn’t an issue which is excellent. The downside of ezetimibe is that it has nowhere near the LDL lowering power of statins. High-intensity statins can lower LDL upwards of 50% while ezetimibe is typically only going to lower LDL in the range of 15-20% at most.

If this medication isn’t a strong LDL lowering medication, why would we use it? Ezetimibe is mostly reserved as add-on therapy in patients who are not meeting their LDL goal and are at very high risk for cardiovascular events.

Let’s say we have a patient who had a heart attack 6 months ago. They are taking rosuvastatin 40 mg daily and have an LDL of 92. In this very high-risk patient, we would have an LDL goal of at least 70 and possibly even 50. I’ll save that debate for another day but regardless of the 70 or 50 goal, they are not reaching it. This is an ideal candidate to use ezetimibe and in practice, this is the situation that I see it used most often.

The only other major situation I see ezetimibe used for is when patients cannot tolerate statins or have a contraindication to use. I have an older article that may be of interest to you that is still mostly relevant where I talk about cholesterol management and ezetimibe as well as PCSK9 Inhibitors.

What other situations have you seen ezetimibe used for?

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Written By Eric Christianson

September 26, 2021

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