Does Ezetimibe Cause Interstitial Lung Disease?
No, ezetimibe does not cause interstitial lung disease—it is not listed among medications associated with drug-induced ILD in major guidelines, and extensive safety data show no significant pulmonary toxicity concerns. 1
Evidence from Guidelines and Safety Data
The most comprehensive guideline addressing drug-induced ILD in the context of lipid-lowering therapy comes from the 2021 Chest consensus guidelines on pulmonary disease in Sjögren's syndrome. This guideline specifically lists medications associated with drug-induced ILD, including TNF-alpha inhibitors, sulfasalazine, cyclophosphamide, rituximab, leflunomide, and methotrexate—notably, ezetimibe is completely absent from this list. 2
The American College of Cardiology's comprehensive review of ezetimibe adverse effects identifies the following:
Common Adverse Effects
- Monotherapy: Upper respiratory tract infection, diarrhea, arthralgia, sinusitis, and extremity pain 1
- Combination with statins: Nasopharyngitis, myalgia, upper respiratory tract infection, arthralgia, and diarrhea 1
Serious but Rare Adverse Effects
- Myopathy and rhabdomyolysis (both as monotherapy and with statins) 1
- Elevated hepatic transaminases (when combined with statins) 1
Pulmonary toxicity, including ILD, is not mentioned among ezetimibe's adverse effects. 1
Clinical Safety Profile
The American College of Cardiology reports that ezetimibe's safety profile is comparable to placebo when used as monotherapy, based on large cardiovascular outcomes trials including IMPROVE-IT and SHARP. 1 This extensive clinical trial experience would have detected any significant association with ILD if one existed.
Contrast with Known ILD-Causing Medications
For comparison, methotrexate—a drug that does cause ILD—has well-documented pulmonary toxicity with an estimated incidence of 0.03% in patients with psoriasis, though this is considered rare. 2 The fact that ezetimibe lacks any such documentation after extensive clinical use strongly supports its safety regarding pulmonary complications.