Can ezetimibe (cholesterol absorption inhibitor) cause muscle fasciculation?

Ezetimibe and Muscle Fasciculation

Ezetimibe can potentially cause muscle fasciculations, although this specific symptom is not commonly reported in the literature, but falls under the broader category of muscle-related adverse effects documented with ezetimibe use. 1

Muscle-Related Side Effects of Ezetimibe

• Ezetimibe has been associated with cases of myopathy and rhabdomyolysis, both when used alone and in combination with statin therapy 1
• The 2022 ACC Expert Consensus specifically lists myopathy as a warning/precaution for ezetimibe use 1
• Common muscle-related adverse effects reported with ezetimibe include:
  • Myalgia (muscle pain) 1, 2
  • Arthralgia (joint pain) 1
  • Pain in extremities 1

Incidence and Risk Assessment

• The overall incidence of muscle-related adverse events with ezetimibe monotherapy appears to be low and similar to placebo in most clinical trials 3, 2
• When used in combination with statins, ezetimibe does not appear to significantly increase the risk of muscle-related side effects compared to statin therapy alone 4
• Despite the generally favorable safety profile, there have been case reports of ezetimibe-associated myopathy in the literature 3
• Muscle fasciculation specifically is not prominently mentioned in major guidelines, but would fall under the broader category of muscle-related adverse effects 1

Monitoring and Management

• Patients taking ezetimibe should be monitored for any muscle-related symptoms, including:
  • Muscle pain or weakness
  • Muscle twitching or fasciculations
  • Unexplained fatigue 1, 2
• If a patient develops muscle fasciculations while on ezetimibe:
  • Evaluate for other causes of fasciculations
  • Consider temporary discontinuation to assess if symptoms resolve
  • If symptoms resolve after discontinuation, consider alternative lipid-lowering therapy 2

Important Clinical Considerations

• Ezetimibe has a favorable overall safety profile compared to many other lipid-lowering medications 5
• The risk of serious muscle-related adverse events is lower with ezetimibe than with statins 3, 2
• When prescribing ezetimibe, clinicians should:
  • Inform patients about possible muscle-related side effects
  • Advise patients to report any new muscle symptoms promptly
  • Consider baseline and follow-up creatine kinase measurements in high-risk patients 1

Special Populations and Drug Interactions

• Patients with renal impairment do not require dose adjustment of ezetimibe 6
• Ezetimibe has important drug interactions that may affect muscle symptoms:
  • Cyclosporine may increase ezetimibe exposure 6
  • Fibrates in combination with ezetimibe may increase risk of muscle symptoms 1, 6
• The elimination half-life of ezetimibe is approximately 22 hours, which may be relevant when assessing the temporal relationship between drug administration and muscle symptoms 6