This is a new cholesterol lowering drug which has marked cholesterol lowering properties when combined with existing (Statin) therapy.
Ezetimibe prevents absorption of cholesterol in the gut, reducing delivery of cholesterol to the liver. It is very selective in its action and does not prevent absorption of other dietary fats. It does prevent absortion of cholesterol from the diet and bile by blocking passage across the intestinal wall.
In addition to preventing cholesterol absorption, Ezetimibe also prevents phytosterol absorption.
The commonly used cholestrerol lowering drugs (statins) reduce the rate of cholesterol prduction within the body. The addition of Ezetimibe provides a dual inhibition of cholesterol entry into the circulation.
When combined with a statin, Ezetimibe provides and additional lowering of LDL cholesterol of up to 20%. There are also favourable effects on HDL- cholesterol concentrations (higher) and triglycerides (lower).
10 mg taken once daily. The dose does not depend on age or liver and kidney function.
This drug appears to be well tolerated with no reported drug interactions and few side effects. None of the studies of ezetimibe in combination with statins showed an increased risk of muscle damage or abnormalities of liver function. This information is from short term studies and the safety profile from large outcome trials are awaited.
The most potent benefit of ezetimibe on cholesterol lowering will be in combination with statins. It is not recommended for use on it’s own though may be used in patients who are unable to tolerate other drugs such as statins and fibrates.
It is likely that your levels of LDL cholesterol are not improving on statins alone. It is also possible that you may not have tolerated a higher dose of statin. Large outcome studies may help select patients who are likely to benefit most from Ezetimibe.
Are there any particular statins which should be used with Ezetimibe?
Trials done with several statins have shown no important differences between the various statins available.
At present there is no data from clinical outcome studies. However, there is good evidence that raised LDL cholesterol carries an increased risk of coronary events.
At present this drug is not recommended for patients with moderate or severe liver disease.
Dr Nishan Wijenaike, Consultant Physician
West Suffolk Diabetes Service