Zetia vs. Niaspan for High Cholesterol: Important Differences and Potential Risks.

Key takeaways

Ezetimibe (Zetia) and Niacin ER (Niacor, Slo-Niacin) are both used to manage high cholesterol, but they work differently and have distinct characteristics. Ezetimibe is a cholesterol absorption inhibitor that lowers "bad" cholesterol (LDL) by reducing its absorption in the gut. It is typically taken once daily and can be used alone or with statins. Niacin ER, a form of vitamin B3, works by blocking fat release from tissues and slowing cholesterol production in the liver. It also helps raise "good" cholesterol (HDL) and lower triglycerides. Niacin ER is taken once daily at bedtime, while ezetimibe is taken once daily at any timeorning. Ezetimibe generally has fewer side effects, while Niacin ER commonly causes flushing and stomach upset. Both medications are available as lower-cost generics, and neither is recommended during pregnancy or breastfeeding. Ezetimibe is not a first-choice medication and is often added to statins. Niacin ER also isn't a first-choice medication, and is used when statins are not effective or cause side effects.

Ezetimibe

(Zetia)

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niacin ER

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Summary for Zetia

Prescription only

Ezetimibe (Zetia) is a medication used to treat high cholesterol. It belongs to the drug class called cholesterol absorption inhibitors. It works to lower how much "bad" cholesterol you have in the blood. Ezetimibe (Zetia) is a tablet that you take once a day. It's often taken in addition to or as an alternative to statins. Some side effects include joint pain and upper respiratory tract infections. To get the most out of treatment, remember to also follow a heart-healthy diet.

Indications for Zetia

High cholesterol in certain adults and children
High plant sterol levels in people 9 years and older with a genetic condition called homozygous familial sitosterolemia

Pros and Cons for Zetia

Pros

Can lower LDL-C by up to 20% in a few months
An option as an addition to or alternative to statins
Only need to take once a day
Few side effects

Cons

Doesn't work as well as statins to lower cholesterol if taken alone
Can interact with bile acid sequestrants like cholestyramine (Prevalite)
Not recommended for people with moderate-to-severe liver problems
Not known if safe while pregnant or breastfeeding

Common Side Effects for Zetia

Upper respiratory tract infection (4%)
Diarrhea (4%)
Joint pain (3%)
Inflamed sinuses (3%)
Pain in arm or leg (3%)

Warnings for Zetia

Severe muscle pain and damage
Liver problems

Summary for Niaspan

Prescription or over-the-counter

Niacin ER (also known as vitamin B3) is a prescription antilipemic medication for adults. It's used to lower high cholesterol and triglycerides (a common form of fat) levels, but it's not a first-choice option for this condition. Niacin ER is taken by mouth once daily, while niacin (Niacor) is typically taken three times daily. Some side effects of niacin ER include flushing and stomach upset. Please note that niacin is also available over-the-counter to treat vitamin B3 deficiency.

Indications for Niaspan

High cholesterol and high triglycerides
Lower risk of repeat heart attack in people with a history of heart attack and high cholesterol
Slow plaque buildup in the arteries of people with a history of coronary artery disease (CAD) and high cholesterol (as an add-on medication)
Severely high triglycerides in people who are at risk of pancreatitis (as an add-on medication)

Pros and Cons for Niaspan

Pros

Can lower “bad” (LDL) cholesterol and raise “good” (HDL) cholesterol in people who have trouble doing so with diet and exercise alone
Can also lower triglycerides
An option for people who didn’t have success or had side effects with statins
Available as a lower-cost generic medication

Cons

Doesn’t work as well as statin medications in lowering cholesterol and triglycerides
Can cause flushing, a bothersome side effect
Need to take immediate-release form multiple times a day
Not recommended during pregnancy or breastfeeding