ezetimibe + simvastatin at a glance
Medicine class
A cholesterol-absorption inhibitor combined with a statin.
Main role
Lowers LDL cholesterol through two complementary mechanisms.
Food
May be taken with or without food.
Important food interaction
Avoid grapefruit juice because it can increase simvastatin exposure and muscle-toxicity risk.
What is ezetimibe + simvastatin used for?
Licensed uses include:
Primary hypercholesterolaemia or mixed hyperlipidaemia when combination treatment is appropriate.
Homozygous familial hypercholesterolaemia, alongside diet and potentially other treatments.
Reducing cardiovascular-event risk in people with coronary heart disease and a history of acute coronary syndrome.
How does ezetimibe + simvastatin work?
Ezetimibe blocks the NPC1L1 transporter in the small intestine, reducing cholesterol delivery to the liver. Simvastatin inhibits HMG-CoA reductase after activation in the liver, reducing cholesterol synthesis and promoting LDL clearance.
How to take ezetimibe + simvastatin
Follow the dispensing label. Swallow the tablet whole; it may be taken with or without food.
The tablets are not scored and should not be divided.
Continue the cholesterol-lowering diet recommended by the treating team.
Avoid grapefruit juice.
ezetimibe + simvastatin side effects
Common or expected effects
- Muscle aches
- Raised liver transaminases on blood testing
- Raised creatine kinase on blood testing
Get urgent medical advice
- Unexplained muscle pain, tenderness or weakness, which can rarely indicate myopathy or rhabdomyolysis
- Severe allergic reaction, including facial or throat swelling, breathing difficulty or collapse
- Symptoms of significant liver injury, including jaundice, dark urine or pale stools
- New or worsening muscle weakness affecting swallowing or breathing
- Persistent cough, breathlessness, fever or declining general health, which can rarely indicate interstitial lung disease
ezetimibe + simvastatin in pregnancy
The selected product is contraindicated during pregnancy. Contact the prescriber promptly if pregnancy occurs or is suspected.
ezetimibe + simvastatin while breastfeeding
The selected fixed-dose product is contraindicated during breastfeeding because product-specific human milk data are unavailable. Although specialist guidance permits cautious use of the individual components in some situations, an individual specialist assessment is required.
ezetimibe + simvastatin interactions
Important interactions include medicines and foods that increase simvastatin exposure, muscle toxicity or anticoagulant effects.
Potent CYP3A4 inhibitors, including clarithromycin, erythromycin, azole antifungals, HIV protease inhibitors and cobicistat-containing products
These combinations are contraindicated because they can markedly increase simvastatin exposure and the risk of myopathy or rhabdomyolysis.
Gemfibrozil, ciclosporin or danazol
Concomitant use is contraindicated because muscle-toxicity risk is increased.
Systemic fusidic acid
Concurrent treatment is not recommended because severe rhabdomyolysis has occurred; clinician review is required.
Common questions about ezetimibe + simvastatin
Answers are fully visible for fast scanning and source review.
How is the combination different from simvastatin alone?
Simvastatin reduces cholesterol synthesis in the liver, while ezetimibe also reduces cholesterol absorption from the intestine.
Can it be taken with food?
Yes. It may be taken with or without food.
Can I drink grapefruit juice?
No. Grapefruit juice can increase simvastatin exposure and muscle-toxicity risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.