Adverse Effects of Ezetimibe
Common Adverse Effects
- The American College of Cardiology reports that upper respiratory tract infection, diarrhea, arthralgia (joint pain), sinusitis, and pain in extremities are common adverse effects of ezetimibe monotherapy 1
- The American College of Cardiology also reports that nasopharyngitis, myalgia (muscle pain), upper respiratory tract infection, arthralgia, and diarrhea are common adverse effects of ezetimibe in combination with statin 1
Serious but Rare Adverse Effects
- Myopathy and rhabdomyolysis (both as monotherapy and with statins) are serious but rare adverse effects of ezetimibe, according to Praxis Medical Insights 2
- Elevated hepatic transaminases (when combined with statins) are a serious but rare adverse effect of ezetimibe, as reported by the American College of Cardiology 3
Clinical Implications
- The American College of Cardiology and other guideline societies suggest that the safety profile of ezetimibe is comparable to placebo when used as monotherapy, with no significant concern for taste disturbance, based on large cardiovascular outcomes trials including IMPROVE-IT and SHARP 1, 4, 5
Ezetimibe and Interstitial Lung Disease
Guideline Recommendations
- The American College of Cardiology's comprehensive review of ezetimibe adverse effects does not mention pulmonary toxicity, including ILD, as an adverse effect, based on the 2021 Chest consensus guidelines on pulmonary disease in Sjögren's syndrome 6
Comparison with Known ILD-Causing Medications
- Methotrexate, a drug known to cause ILD, has a documented pulmonary toxicity with an estimated incidence of 0.03% in patients with psoriasis, highlighting the contrast with ezetimibe's safety profile 7
Clinical Implications
- If a patient on ezetimibe develops respiratory symptoms, other etiologies should be investigated rather than attributing them to the medication, as recommended by the 2021 Chest consensus guidelines 6
- No contraindication exists for patients with pre-existing lung disease when using ezetimibe, as supported by the comparison with methotrexate, a known ILD-causing medication 7