What should I do if I experience dizziness while taking Zetia (ezetimibe)?

Dizziness While Taking Zetia (Ezetimibe)

If you experience dizziness while taking Zetia, contact your healthcare provider immediately, as this is a recognized adverse effect that may require medication adjustment or discontinuation. 1

Understanding Dizziness as a Side Effect of Zetia

• Dizziness is listed as a known adverse effect in the FDA-approved prescribing information for ezetimibe (Zetia), occurring in post-marketing surveillance reports 1
• The FDA label specifically instructs patients to "stop using ezetimibe tablets and get medical help right away" if experiencing "fainting or feeling dizzy" as part of a serious allergic reaction 1
• Dizziness from ezetimibe appears to be relatively uncommon, as it was not among the most frequent adverse reactions (≥2%) reported in controlled clinical trials 1

Immediate Actions to Take

Contact your healthcare provider promptly to report the dizziness, especially if it is persistent, severe, or accompanied by other symptoms. 1

• Watch for signs of a serious allergic reaction that requires immediate medical attention, including: swelling of face/tongue/throat, difficulty breathing or swallowing, very fast heartbeat, severe skin rash, or flu-like symptoms 1
• Document when the dizziness occurs (timing relative to dose, activities that trigger it, duration, and severity) to help your provider assess the situation 2
• Check if you are taking other medications that could contribute to dizziness, as drug interactions may amplify this effect 1

Medication Review Considerations

• Your healthcare provider should review all medications you are taking, as ezetimibe can interact with cyclosporine, fibrates, and bile acid sequestrants, potentially affecting drug levels and side effects 1
• If you are taking ezetimibe with a statin, the combination may increase the risk of adverse effects compared to either medication alone 1
• Ezetimibe reaches peak concentrations 1-2 hours after administration and has a terminal half-life of approximately 22 hours, meaning it accumulates with repeated daily dosing 3

Clinical Decision Algorithm

Your healthcare provider will likely follow this approach:

1. Assess severity and pattern: Determine if dizziness represents true vertigo, presyncope, disequilibrium, or vague lightheadedness, as each has different implications 2

2. Rule out serious causes: Evaluate for signs of allergic reaction, cardiovascular issues, or other serious conditions that may coincidentally present with dizziness 1

3. Consider medication adjustment: Options include:

   • Temporarily discontinuing ezetimibe to see if dizziness resolves 1
   • Adjusting the timing of the dose (ezetimibe can be taken morning or evening with or without food) 1
   • Switching to alternative lipid-lowering therapy if dizziness persists 4

4. Monitor for resolution: If ezetimibe is discontinued, dizziness should improve within several days given the drug's elimination half-life of approximately 22 hours 3

Alternative Treatment Options

• If ezetimibe must be discontinued due to intolerable dizziness, your provider may consider other non-statin lipid-lowering options such as bempedoic acid, PCSK9 inhibitors (inclisiran, evolocumab, alirocumab), or bile acid sequestrants 4
• The choice of alternative therapy depends on your specific lipid profile, cardiovascular risk, and other medical conditions 4

Important Safety Considerations

• Do not stop taking ezetimibe without consulting your healthcare provider, as abrupt discontinuation of cholesterol-lowering therapy may affect your cardiovascular risk management 1
• Ezetimibe has an overall favorable safety profile with few serious adverse effects reported in clinical trials, but individual responses vary 5, 6
• If dizziness is accompanied by unexplained muscle pain, tenderness, weakness, or unusual fatigue, report this immediately as it may indicate myopathy, a rare but serious adverse effect 1

When to Seek Immediate Medical Attention

Go to the emergency department or call emergency services if you experience: 1

• Severe dizziness with loss of consciousness or near-fainting
• Dizziness accompanied by chest pain, shortness of breath, or irregular heartbeat
• Signs of allergic reaction (facial swelling, difficulty breathing, severe rash)
• Sudden onset of severe headache, vision changes, or difficulty speaking