What is the recommended dose of ezetimibe (cholesterol absorption inhibitor) for adults?

Ezetimibe Dosing for Adults

The recommended dose of ezetimibe for adults is 10 mg orally once daily, administered with or without food. 1, 2

Administration Details

• Ezetimibe can be taken at any time of day, morning or evening
• No dosage adjustment is necessary based on:
  • Age
  • Sex
  • Race
  • Mild hepatic impairment
  • Mild to severe renal insufficiency 3

Timing Considerations

• When taken with statins, ezetimibe can be administered at the same time 4
• When taken with bile acid sequestrants:
  • Take ezetimibe at least 2 hours before OR at least 4 hours after the bile acid sequestrant 1, 2, 4
  • This timing separation is critical as concomitant administration with bile acid sequestrants (like colestyramine) significantly decreases ezetimibe bioavailability 3

Monitoring

• LDL-C levels should be assessed when clinically appropriate, as early as 4 weeks after initiating ezetimibe 1
• Liver function tests should be monitored as clinically indicated when taking ezetimibe with a statin 4
• Discontinue ezetimibe if persistent ALT elevations >3 times the upper limit of normal occur 4

Drug Interactions

• Important statin interactions: Avoid concomitant use of ezetimibe with:
  • Simvastatin >20 mg daily
  • Pravastatin >40 mg daily 2, 4
• Exercise caution when using ezetimibe with cyclosporine and monitor cyclosporine levels carefully 3
• No significant interactions with:
  • Most other statins (atorvastatin, fluvastatin, lovastatin, pitavastatin, rosuvastatin)
  • Fibric acid derivatives (gemfibrozil, fenofibrate)
  • Digoxin, glipizide, warfarin, oral contraceptives 3

Clinical Efficacy

• As monotherapy: Reduces LDL-C by approximately 17-20% within 2 weeks 5
• In combination with statins: Provides additional LDL-C reduction of up to 25% 2
• The standard 10 mg dose is the FDA-approved dose with established efficacy and safety

Common Side Effects

• Upper respiratory tract infection
• Diarrhea
• Arthralgia
• Back pain
• Pain in extremities
• Muscle spasms 4, 2

While some research has explored higher doses (20 mg daily) with potential additional LDL-C lowering benefits in patients on concomitant statin therapy 6, the 10 mg daily dose remains the only FDA-approved dose with established safety and efficacy data.