Ezetimibe alternatives: What can I take instead of ezetimibe?

Creator: SingleCare
Published: 2023-01-15T22:21:36-05:00

Ezetimibe doesn't work for everyone. Crestor, Lipitor, Pravastatin, Repatha, and Praluent are some ezetimibe alternatives. Get the full list here.

By Stephanie Melby, Pharm.D. | Jan. 15, 2023

Ezetimibe is a generic prescription medicine used to help lower cholesterol levels and is available under the brand name Zetia. Cholesterol is a fat-like substance that the body needs for good health, but only in the right amounts, as unhealthy cholesterol levels can lead to a condition called high cholesterol. Ezetimibe can be used in various medical conditions, including hyperlipidemia (high level of lipids such as fats, cholesterol, and triglycerides in the blood), homozygous familial hypercholesterolemia (a life-threatening genetic condition that increases bad cholesterol levels in the body), and homozygous sitosterolemia.

Ezetimibe can also be used off-label for preventing atherosclerotic cardiovascular events, such as heart attack, stroke, aneurysm, or blood clot, after acute coronary syndrome (sudden, reduced blood flow to the heart). As a unique, one-of-a-kind medication, ezetimibe is currently the only medication that belongs to a drug class called 2-Azetidinones. It works by decreasing cholesterol absorption in the small intestine, decreasing the delivery of cholesterol to the liver, and reducing the amount of stored cholesterol. Ezetimibe is an oral tablet typically taken once per day and is considered the most commonly used non-statin medication for lowering cholesterol.

While an effective treatment for some people, ezetimibe may not be the best and safest cholesterol-lowering drug for everyone. The choice of therapy is usually guided by a patient’s low-density lipoprotein cholesterol (LDL-C) level and cardiovascular disease (CVD) risk. Typically, treatment begins with statin therapy, which includes medications such as atorvastatin and simvastatin. Additional medications can be used if statin drugs are not well tolerated or effective enough in reducing LDL-C. Ezetimibe is one of the different medications that can be considered if other cholesterol-lowering medications cannot be used. It is typically considered an “add-on therapy” as it has a relatively small LDL-C-lowering effect of 17%.

What can I take in place of ezetimibe?

There are other options available to treat high cholesterol levels that do not improve with ezetimibe. These alternative medications include statin, fibrates, bile acid sequestrants, vitamin B3, omega-3 acids, PCSK9 inhibitors, and combination drugs. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Compare ezetimibe alternatives
Drug name	Uses	Dosage	Savings options
Ezetimibe	-Primary Hyperlipidemia -Homozygous Familial Hypercholesterolemia -Homozygous Sitosterolemia -Prevention of atherosclerotic cardiovascular events	Take 10 mg by mouth once daily	Ezetimibe coupons
Crestor (rosuvastatin)	-Familial Hypercholesterolemia -Hypertriglyceridemia -Prevention of cardiovascular disease	Take 5 to 40 mg by mouth once daily	Crestor coupons
Fluvastatin	-Heterozygous Familial Hypercholesterolemia -Homozygous Familial Hypercholesterolemia -Mixed Dyslipidemia -Prevention of atherosclerotic cardiovascular disease	Take 20 to 80 mg by mouth daily	Fluvastatin coupons
Leqvio (inclisiran)	-Heterozygous Familial Hypercholesterolemia -Prevention of cardiovascular events	Inject 284 mg subcutaneously once, repeated in 3 months, and then every 6 months	Leqvio coupons
Lipitor (atorvastatin)	-Hyperlipidemia -Heterozygous Familial Hypercholesterolemia -Homozygous Familial Hypercholesterolemia -Prevention of atherosclerotic cardiovascular disease	Take 10 to 80 mg by mouth once daily	Lipitor coupons
Livalo (pitavastatin)	-Primary Hyperlipidemia -Heterozygous Familial Hypercholesterolemia -Prevention of atherosclerotic cardiovascular disease	Take 1 to 4 mg by mouth once daily	Livalo coupons
Lopid (gemfibrozil)	-Hypertriglyceridemia -Mixed Dyslipidemia	Take 600 mg by mouth twice daily	Lopid coupons
Lovastatin	-Hypercholesterolemia -Heterozygous Familial Hyperlipidemia -Dyslipidemia -Prevention of atherosclerotic cardiovascular disease	Take 10 to 80 mg by mouth once daily	Lovastatin coupons
Praluent (alirocumab)	-Homozygous Familial Hypercholesterolemia -Primary Hyperlipidemia -Prevention of cardiovascular events	Inject 75 to 150 mg subcutaneously every 2 weeks, or 300 mg subcutaneously every 4 weeks	Praluent
Pravastatin	-Heterozygous Familial Hypercholesterolemia -Homozygous Familial Hypercholesterolemia -Prevention of atherosclerotic cardiovascular disease	Take 10 to 80 mg by mouth once daily	Pravastatin coupons
Questran (cholestyramine)	-Dyslipidemia -Pruritus associated with cholestasis	Take 4 to 8 mg by mouth twice daily	Questran coupons
Repatha (evolocumab)	-Homozygous Familial Hypercholesterolemia -Primary Hyperlipidemia -Prevention of cardiovascular events in patients with established cardiovascular disease	Inject 140 mg subcutaneously every 2 weeks, or 420 mg subcutaneously every 4 weeks	Repatha coupons
Tricor (fenofibrate)	-Hypertriglyceridemia -Mixed Dyslipidemia	Take 48 to 145 mg by mouth once daily	Tricor coupons
Welchol (colesevelam)	-Type 2 Diabetes -Hyperlipidemia	Take 3750 mg by mouth once daily	Welchol coupons
Zocor (simvastatin)	-Heterozygous Familial Hypercholesterolemia -Homozygous Familial Hypercholesterolemia -Prevention of atherosclerotic cardiovascular disease	Take 20 to 40 mg by mouth once daily	Zocor coupons

Other alternatives to ezetimibe

For people seeking other alternatives to ezetimibe, there are a variety of prescription medications including combination drugs.

Colestid (colestipol)
Fibricor (fenofibrate)
Nexlizet (bempedoic acid and ezetimibe)
Niaspan (niacin)
Roszet (rosuvastatin and ezetimibe)
Trilipix (fenofibrate delayed-release)
Vytorin (simvastatin and ezetimibe)

Top 5 ezetimibe alternatives

The following are some of the most common alternatives to ezetimibe.

1. Crestor (rosuvastatin)

Crestor is a brand-name medication available as a generic called rosuvastatin. Crestor is a type of statin medication, and statins are the most potent oral drugs for lowering low-density lipoprotein (LDL) cholesterol. As one of the more potent statin drugs, Crestor can reduce LDL in the 52 to 63% range. Along with other statins, Crestor may cause the development of muscle symptoms, including muscle pain and liver enzyme abnormalities. Crestor is an oral tablet typically dosed once daily, and common side effects include stomach pain, nausea, and headache.

2. Lipitor (atorvastatin)

Lipitor is a brand-name medication available as a generic called atorvastatin. Lipitor is a type of statin medication that is as effective as Crestor. At maximally prescribed doses, LDL cholesterol reduction is more significant with Crestor and Lipitor than with the other available statins. Lipitor can achieve reductions in LDL in the range of 38 to 54%. Along with other statins, Lipitor may cause the development of muscle symptoms, including muscle pain and liver enzyme abnormalities. Lipitor is an oral tablet typically dosed once daily, and common side effects include diarrhea, common cold symptoms, and nausea.

3. Pravastatin

Pravastatin is a generic statin medication that can reduce LDL from 19 to 40%. An advantage of pravastatin over some other statin drugs is that it is less likely to have drug interactions and produce muscle toxicity. Pravastatin is considered a hydrophilic statin, which means it has properties that may be associated with fewer adverse effects. Pravastatin is available as an oral tablet that is typically dosed once daily.

4. Repatha (evolocumab)

Repatha is a brand-name medication that belongs to a newer group of drugs called PCSK9 inhibitors. Unlike the oral medications ezetimibe and statins, Repatha is injected subcutaneously (just under the skin) and is available as an auto-injector, cartridge system, and pre-filled syringe. According to the American College of Cardiology, PCSK9 inhibitors can be added to a medication regimen of a statin and ezetimibe if there is a higher risk of ASCVD (atherosclerotic cardiovascular disease). Common side effects of Repatha include injection site reactions, headaches, and cold-like symptoms. PCSK9 inhibitors, like Repatha, are a more costly alternative, but a SingleCare discount card could help obtain them at a lesser cost.

5. Praluent (alirocumab)

Praluent is a brand-name medication that also belongs to the drug class called PCSK9 inhibitors. Like Repatha, Praluent is injected under the skin and is available as an auto-injector. According to the American College of Cardiology, PCSK9 inhibitors can be added to a medication regimen of a statin and ezetimibe if there is a higher risk of ASCVD (atherosclerotic cardiovascular disease). Praluent has similar side effects as Repatha.

Natural alternatives to ezetimibe

Alternative remedies include supplements, lifestyle changes, and diet modifications to help lower bad cholesterol levels and keep them in a healthy range.

The supplement red yeast rice has been used for centuries in Chinese medicine to lower cholesterol, improve blood circulation, and improve digestion. Red yeast rice contains substances known as monacolins that are thought to have a similar chemical makeup to statins, specifically the similarity of monacolin K to lovastatin. A study published in the American Journal of Cardiology found that red yeast rice modestly decreased total and LDL cholesterol, was well tolerated and was an acceptable alternative in patients who were intolerant of other lipid-lowering medications (such as statins). Certain people should not use red yeast rice, such as those with liver disease, kidney disease, thyroid problems, musculoskeletal disorders, or those at higher risk of cancer.

The American Heart Association encourages a heart-healthy diet, which can help improve cholesterol and lead to a healthy weight and blood pressure. A heart-healthy diet includes a variety of fruits and vegetables, whole grains, fish, lean meats, nuts, and beans. Foods that should be limited include red and fatty meats, fried foods, foods high in sodium, full-fat dairy products, saturated fats, and trans fats.

How to switch to an ezetimibe alternative

1. Discuss all health conditions with a healthcare provider

Before switching from ezetimibe to an alternative, the prescribing doctor must review all health conditions. Alternatives may have serious side effects, precautions, or drug interactions that must be avoided. It’s best to seek medical advice before changing medication therapy.

2. Do not suddenly stop taking ezetimibe

Before stopping ezetimibe, make a care plan with the prescribing doctor to avoid increases in cholesterol levels and additional risk for cardiovascular events such as a heart attack or stroke. Once a plan has been established, ezetimibe can be safely discontinued and replaced with the new treatment.

3. Keep up with routine lab appointments

Routine lab appointments to perform cholesterol tests help ensure treatment is working or guide physicians to change the therapy plan. Cholesterol tests typically measure high-density lipoprotein (HDL) levels, low-density lipoprotein (LDL) levels, total blood (or serum) cholesterol levels, and triglyceride levels.

4. Monitor for additional high-risk factors for heart disease

Along with unhealthy blood cholesterol levels, there are several other critical health conditions people taking cholesterol-lowering medication should be familiar with and discuss with their physician to learn more about. These conditions include high blood pressure (hypertension), diabetes mellitus, and obesity.