Is there a fixed-dose combination pill that includes both ezetimibe (EZ) 10mg and metformin (MET) 500mg?

No Fixed-Dose Combination of Ezetimibe 10mg and Metformin 500mg Currently Exists

There is currently no FDA-approved fixed-dose combination pill that contains both ezetimibe 10mg and metformin 500mg. While fixed-dose combinations of ezetimibe with various statins exist, there is no approved combination with metformin 1.

Available Fixed-Dose Combinations with Ezetimibe

Ezetimibe is commonly available in fixed-dose combinations with statins, but not with metformin:

• Ezetimibe/Statin Combinations:
  • Ezetimibe 10mg/Simvastatin (various doses)
  • Ezetimibe 10mg/Rosuvastatin (various doses)
  • Ezetimibe 10mg/Atorvastatin (various doses)
  • Bempedoic acid 180mg/Ezetimibe 10mg 1

Why These Medications Are Not Combined

1. Different Therapeutic Classes:

   • Ezetimibe: Cholesterol absorption inhibitor used for hyperlipidemia
   • Metformin: Biguanide antihyperglycemic used for diabetes mellitus

2. Different Mechanisms of Action:

   • Ezetimibe inhibits NPC1L1 protein in the small intestine, reducing cholesterol absorption 1
   • Metformin reduces hepatic glucose production and improves insulin sensitivity

3. Different Target Populations:

   • While some patients may need both medications, they target distinct metabolic conditions

Clinical Considerations

For patients requiring both medications:

• Take as Separate Pills:

  • Ezetimibe 10mg once daily (with or without food)
  • Metformin 500mg (typically dosed 1-3 times daily with meals)

• Fixed-Dose Alternatives to Consider:

  • For patients with both diabetes and hyperlipidemia concerned about pill burden:
    • Consider ezetimibe/statin combinations for lipid management 1
    • Maintain metformin as separate therapy

Medication Adherence Considerations

The European Society of Cardiology notes that fixed-dose combinations can improve adherence by reducing pill burden 1. While a combination of ezetimibe and metformin would potentially benefit patients with both conditions, such a combination is not currently available.

Practical Recommendation

For patients requiring both medications, the most practical approach is to use them as separate agents while exploring other ways to simplify the overall medication regimen. Consider whether other fixed-dose combinations (such as ezetimibe with a statin) might be appropriate to reduce the total pill burden.