Can ezetimibe (cholesterol absorption inhibitor) cause gingivitis?

Ezetimibe and Gingivitis: Evidence Review

Based on the available evidence, ezetimibe is not known to cause gingivitis as an adverse effect. The medication has a well-documented safety profile with primarily gastrointestinal side effects, but no reported association with gum disease or oral health complications.

Mechanism of Action and General Safety Profile

• Ezetimibe is a cholesterol absorption inhibitor that works by inhibiting the NPC1L1 protein in the small intestine, reducing cholesterol absorption from both dietary and biliary sources 1, 2
• It is FDA-approved as an adjunct to diet for reducing total cholesterol, LDL-C, apolipoprotein B, and non-HDL-C in patients with primary hyperlipidemia, either alone or in combination with statin therapy 1
• Ezetimibe can be administered at 10 mg orally once daily, with or without food 1, 2

Known Adverse Effects of Ezetimibe

• The most commonly reported adverse effects of ezetimibe monotherapy include:

  • Upper respiratory tract infection 1
  • Diarrhea 1
  • Arthralgia (joint pain) 1
  • Sinusitis 1
  • Pain in extremities 1

• When used in combination with statins, reported adverse effects include:

  • Nasopharyngitis 1
  • Myalgia 1
  • Upper respiratory tract infection 1
  • Arthralgia 1
  • Diarrhea 1

• Ezetimibe is generally well-tolerated with a safety profile similar to placebo when used as monotherapy 3, 4

Specific Warnings and Precautions

• Ezetimibe is not recommended in patients with moderate to severe hepatic impairment 1
• Persistent elevations in hepatic transaminases may occur with concomitant statin therapy 1
• Cases of myopathy and rhabdomyolysis have been reported when ezetimibe was used alone or in combination with statin therapy 1
• Ezetimibe should be used with caution in patients taking cyclosporine 2

Oral Health Considerations

• None of the major clinical guidelines, drug information resources, or research studies mention gingivitis or any other oral health complications as known or potential side effects of ezetimibe 1
• The comprehensive safety profiles documented in clinical trials and post-marketing surveillance have not identified gingival issues among the reported adverse effects 3, 4, 5
• Unlike some other medications known to affect oral health (such as certain calcium channel blockers that can cause gingival hyperplasia), ezetimibe works through a different mechanism that does not typically affect gum tissue 2, 3

Clinical Implications

• If a patient taking ezetimibe develops gingivitis, clinicians should consider other common causes such as:

  • Poor oral hygiene 1
  • Other medications the patient may be taking 1
  • Underlying systemic conditions that may predispose to gingival inflammation 1

• Ezetimibe can be safely continued in patients with gingivitis, as there is no established causal relationship between the medication and this condition 1, 3

Conclusion

Based on current evidence and clinical guidelines, ezetimibe has not been associated with gingivitis or other oral health complications. The medication has a well-characterized safety profile with primarily gastrointestinal and musculoskeletal adverse effects. If gingivitis develops in a patient taking ezetimibe, standard oral hygiene measures and dental evaluation should be recommended, but discontinuation of ezetimibe solely for this reason would not be supported by the available evidence.