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Ezetimibe side effects and how to avoid them

What to expect when starting ezetimibe or Zetia
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By | Updated on Dec. 17, 2025 Medically reviewed by Gerardo Sison, Pharm.D.
Hand holding Rx pills: Ezetimibe side effects and how to avoid them

Key takeaways

  • Ezetimibe treats high cholesterol by blocking the absorption of cholesterol in the small intestine. It may be used alone or in combination with a statin or fenofibrate.

  • Most ezetimibe side effects are mild, such as diarrhea, muscle aches, or fatigue. More serious side effects, like muscle breakdown or liver inflammation, are rare but happen more often when ezetimibe is taken with a statin.

  • Side effects can appear early or develop over time, with mild side effects improving as the body adjusts and serious side effects requiring stopping the drug.

In this article:

Ezetimibe (brand name Zetia) is a generic prescription drug that lowers LDL cholesterol and triglycerides, which may lower the risk of a heart attack or stroke in people with risk factors. Although ezetimibe may cause side effects, they’re generally mild and go away as the body gets used to the medication. However, serious side effects, such as liver problems or muscle damage, are possible, especially when ezetimibe is taken with a statin or fenofibrate. Knowing what to expect can help you manage the potential side effects of ezetimibe.

What are the side effects of ezetimibe 10 mg?

Ezetimibe is a cholesterol absorption inhibitor with generally mild side effects, but not everyone experiences them. In one real-world study, around 3% of people taking ezetimibe with a statin experienced mild side effects.

Most common side effects of ezetimibe

In clinical trials of ezetimibe taken alone, the most common side effect was upper respiratory tract infection, which occurred in about 4% of patients. Other common side effects of ezetimibe include:

  • Sore throat and runny nose
  • Swollen sinuses
  • Diarrhea
  • Fatigue
  • Joint pain
  • Muscle pain
  • Pain in the arms or legs
  • Stomach pain
  • Back pain
  • Nausea
  • Headache
  • Dizziness

Serious side effects of ezetimibe

Serious side effects are less common but may happen, especially when the drug is taken alongside a statin or fenofibrate. The most serious side effects of ezetimibe include:

  • Breakdown of muscle tissue (rhabdomyolysis)
  • Inflammation of the gallbladder (cholecystitis)
  • Inflammation of the pancreas (pancreatitis)
  • Inflammation of the liver (hepatitis)
  • Low platelet counts (thrombocytopenia)
  • Serious allergic reactions

Ezetimibe and liver problems

Ezetimibe may cause increased liver enzyme levels when taken alone. However, ezetimibe is more likely to cause significantly increased levels of liver enzymes when combined with a statin like atorvastatin or simvastatin. Increased liver enzymes occur in about 1% of people who take both ezetimibe and a statin. 

Liver function is typically checked before starting treatment. If liver enzyme levels get too high during treatment, a healthcare provider may recommend temporarily stopping ezetimibe, the statin, or both.

Ezetimibe and muscle damage

Rhabdomyolysis is the breakdown of muscle tissue, which can be a rare but potentially severe side effect of ezetimibe. Muscle damage can release a protein called myoglobin, which can damage the kidneys in large quantities. 

Muscle problems are more commonly linked to statins and other cholesterol-lowering drugs that are prescribed with ezetimibe. However, there are also reports of muscle damage in people taking ezetimibe alone. If muscle pain and weakness develop or worsen, consult a healthcare provider, as they may need to modify treatment.

Ezetimibe and cancer

There has been some interest about whether ezetimibe might increase the risk of cancer, especially intestinal or colorectal cancer. One study reported a small increased risk of intestinal cancer in people using ezetimibe. However, no other large trials have found a clear or consistent link. Those with a personal or family history of cancer may want to talk to their healthcare provider before starting ezetimibe and throughout treatment. 

RELATED: How much is ezetimibe without insurance?

How soon do ezetimibe side effects start?

Many ezetimibe side effects are delayed. The drug needs to be taken for a few weeks or months before certain side effects, like flu-like symptoms and back pain, may start to appear. Other side effects of ezetimibe may appear early, however. These include diarrhea, nausea, headache, dizziness, stomach pain, and feeling tired. 

Some serious side effects, such as rhabdomyolysis, pancreatitis, and hepatitis, can take weeks or months to develop and cause serious problems. On the other hand, allergic reactions can happen quickly and may include signs and symptoms such as a skin rash (hives), swelling of the face, or trouble breathing.

How long do ezetimibe side effects last?

Most side effects of ezetimibe tend to improve as the body adjusts to the medication. If side effects continue or worsen, treatment may need to be stopped. It can take about four to five days for the last dose of ezetimibe to be cleared out of the body since it has a half-life of around 22 hours. That means most side effects should fade within a few days after stopping the drug.

Serious side effects, such as muscle damage, gallbladder inflammation, and problems with the pancreas, can have longer-lasting effects that may be irreversible. Treatment with ezetimibe should be discontinued at the first sign of a serious problem. Any severe or unusual symptoms should be reported immediately to prevent complications.

What are the long-term side effects of ezetimibe?

Ezetimibe may be taken for months or years, as long as it works and side effects are mild or tolerable. There are no specific long-term side effects linked to ezetimibe itself. However, liver function may be monitored throughout treatment, as ezetimibe may increase liver enzyme levels. 

The risk of muscle damage increases with age, especially when ezetimibe is taken with a statin. Therefore, older adults on long-term therapy with ezetimibe should be aware of any muscle aches or weakness that develops.

Ezetimibe contraindications

Ezetimibe should not be taken by people who are allergic to any ingredients in the drug. In addition, people with active liver disease and women who are pregnant or breastfeeding may need to avoid ezetimibe.

Pregnancy

Ezetimibe has not been studied in pregnant women, but animal studies suggest there may be an increased risk of harmful effects to an unborn baby. The combination of ezetimibe and a statin is not typically recommended in pregnant women either, although the FDA has removed contraindications for statins in pregnancy. In addition, cholesterol is an important part of fetal growth and development. Therefore, blocking cholesterol production in an unborn baby could lead to birth defects.

Breastfeeding

Ezetimibe may pass into human breast milk in low amounts. Because cholesterol synthesis is important to an infant’s development, healthcare professionals generally avoid giving a woman who is breastfeeding both ezetimibe and a statin. 

Instead of ezetimibe, a healthcare provider may consider prescribing a bile acid sequestrant, such as Questran (cholestyramine), Colestid (colestipol), or Welchol (colesevelam). Bile acid sequestrants help lower cholesterol, but they don’t enter the bloodstream or breast milk. However, these drugs may cause other problems that can affect a nursing infant, such as interfering with the mother’s ability to absorb fat-soluble vitamins. 

Children

The Food and Drug Administration (FDA) has approved the combination of ezetimibe and a statin for children as young as 10 to treat an inherited high cholesterol disorder called heterozygous familial hypercholesterolemia. However, it has not been studied for use in girls who have not yet had their first period or children younger than 10.

People with liver disease

Ezetimibe is primarily broken down by the liver. People with moderate to severe liver disease may experience high levels of the drug in the body, which could increase the risk of side effects. For this reason, ezetimibe is not recommended for use in people with moderate to severe liver disease.

Ezetimibe interactions

Ezetimibe may interact with other drugs, leading to an increased risk of side effects or lower effectiveness:

  • Cyclosporine: Ezetimibe could increase the levels of the immunity-suppressing drug cyclosporine and vice versa, increasing the risk of side effects of either drug.
  • Fibrates: Although ezetimibe is approved for use with fenofibrate, it is not recommended for use with other fibrates because of the increased risk of gallstones. For example, healthcare providers may avoid prescribing a fibrate called gemfibrozil with ezetimibe.
  • Bile acid sequestrants: Bile acid sequestrants, such as cholestyramine and colesevelam, can lower how much ezetimibe the body absorbs, which may decrease its effectiveness. To prevent this, ezetimibe should be taken either at least two hours before or four hours after the bile acid sequestrant.
  • Coumadin (warfarin): Ezetimibe may increase the effects of certain types of blood thinners like warfarin. Healthcare providers may need to regularly check blood clotting with International Normalized Ratio (INR) tests when the two drugs are taken together.
  • Statins: Ezetimibe is often prescribed with statins. However, there may be an increased risk of liver enzyme changes and muscle problems when combining ezetimibe with a statin. People who take both may need regular blood tests to monitor liver function.

Always mention other prescription drugs, over-the-counter medications, and herbal supplements being taken before starting ezetimibe to prevent drug interactions. 

RELATED: Ezetimibe alternatives

How to prevent ezetimibe side effects

Ezetimibe doesn’t typically cause serious side effects when taken as prescribed. However, you may be able to reduce the chance of side effects or catch problems early by doing the following:

  1. Let your healthcare provider know whether you have a history of certain medical problems, particularly liver problems, pregnancy or breastfeeding plans, or unusual muscle pain or weakness.
  2. If your healthcare provider prescribes ezetimibe with another cholesterol-lowering medication, ask when the other drug should be taken. It’s usually okay to take them together, but some drugs, like bile acid sequestrants, may need to be taken several hours before or after a dose of ezetimibe is taken.
  3. Keep all follow-up appointments. Regular visits and blood tests may be needed to identify potentially serious side effects before they get worse.
  4. Take each day’s dose at the same time each day. Not having a consistent dosing schedule may increase the risk of accidentally taking a double dose. 
  5. Don’t take larger doses than prescribed. Taking too much of any prescription drug can make side effects more likely to occur. 

The most common way people overdose is when they forget a dose. Never take an extra dose to make up for a missed dose. 

If you miss a dose of ezetimibe, take it as soon as you remember, as long as you’re taking it on the same day it was supposed to be taken. If it’s the day after, skip the missed dose and take the next dose as scheduled. Only take one dose per day.

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How to treat side effects of ezetimibe

Side effects can and do happen, but they’re usually manageable. At-home remedies or over-the-counter treatments may help with some of the side effects of ezetimibe. 

Infections

Ezetimibe is linked to an increased risk of upper respiratory infections that can cause symptoms such as a stuffy nose and sore throat. Ezetimibe does not, however, make these infections worse than they normally would be. Treat these symptoms as you would normally: getting rest, staying hydrated, and taking over-the-counter medications as needed or directed by a healthcare provider. If infections become severe or last for a while, seek medical advice from your healthcare professional.

Diarrhea

Drink plenty of fluids to avoid dehydration and eat bland foods until symptoms improve. Before using any over-the-counter medication or supplement to treat diarrhea, talk to a healthcare professional first. If diarrhea becomes severe or persists, get medical help.

Unusual tiredness

This side effect may get better over a few days with rest. If it doesn’t, get medical advice from the prescribing healthcare provider.

Muscle problems

Stop exercising temporarily and rest if mild muscle aches occur. Seek medical attention if there is severe muscle pain, tenderness, or weakness. Pain that is severe and accompanied by symptoms such as dark urine or fever may indicate myopathy or muscle damage that is affecting the kidneys.

Expert takeaway

“Side effects from ezetimibe are usually mild, but it’s important to watch for unusual muscle pain or signs of liver problems, especially when it’s taken with other cholesterol drugs,” says Gerardo Sison, Pharm.D., member of the SingleCare Medical Board. “Keeping an eye on side effects, going to regular follow-up visits, and getting routine lab work can help catch any potential problems early.” 

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