6 Ezetimibe (Zetia) Side Effects and How to Manage Them

Ezetimibe (Zetia) is a prescription medication used to treat high cholesterol levels. You may take it in combination with a statin. And if you can’t take or tolerate a statin, ezetimibe is one potential alternative. While side effects from this treatment aren’t common, they’re still possible.

Common ezetimibe side effects include upper respiratory tract infections (URTIs), such as sinus infections, and diarrhea. Joint pain and fatigue have also been reported. The likelihood of certain side effects, such as muscle pain, may be higher if you’re taking ezetimibe with a statin.

So, what other side effects are possible with ezetimibe? And is there anything you can do to manage them?

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Ezetimibe side effects at a glance

Some ezetimibe side effects are mild and can be managed easily at home. Others, while less common, may be more serious and require medical attention.

Common ezetimibe side effects include:

• URTIs, including sinus infections

• Diarrhea

• Joint pain

• Fatigue

• Pain in your arms and legs

• Back pain

• Muscle pain

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Less common but potentially serious ezetimibe side effects include:

• Muscle damage

• Liver damage

Let’s look a little closer at six of these potential ezetimibe side effects.

1. Upper respiratory tract infections

Upper respiratory tract infections (URTIs), including sinus infections and the common cold, are the most commonly reported ezetimibe side effect. URTIs are usually self-limiting, meaning that they typically go away on their own without treatment.

Common URTI symptoms can include cough, nasal congestion, and fatigue. If these bother you, home remedies and over-the-counter (OTC) medications can help you manage them. Your healthcare provider or pharmacist can help you find products that are safe for you to take.

If your symptoms worsen, don’t improve, or feel severe, speak with your healthcare provider.

2. Diarrhea

Diarrhea is another common ezetimibe side effect. This usually goes away without treatment. But, it’s a good idea to drink enough fluids to prevent dehydration, especially if your diarrhea is persistent. You can also avoid or minimize foods that can worsen diarrhea, such as dairy and fatty foods.

If your diarrhea doesn’t seem to be improving, or if it’s severe or getting worse, contact your healthcare provider. Diarrhea can have many different causes, including other medications and health conditions. If needed, your healthcare provider may suggest an OTC anti-diarrheal medication for relief.

3. Joint pain

Joint pain may occur when you’re taking ezetimibe. Statins, which may be prescribed with ezetimibe, can also cause joint pain.

If you experience unexplained joint pain while taking ezetimibe, talk to your healthcare provider. It’s possible that it may be from the treatment. Or, it could be from an underlying condition, such as arthritis. Your healthcare provider can help determine the cause and best next steps, including potential treatment options.

If your joint pain is from ezetimibe (or a statin), they may have you wait it out. For some people, joint pain from ezetimibe (or statins) may improve over time. Or, they may adjust your dose or how often you take it to see if that helps.

4. Fatigue

Fatigue is another potential ezetimibe side effect. Since fatigue can have many different causes, take note of whether your fatigue started or worsened after starting ezetimibe. 

Medications such as ezetimibe work best if you take them in combination with a heart-healthy diet and regular exercise. These lifestyle changes can also help boost your energy levels. But if your fatigue is starting to interfere with your daily routine, talk to your healthcare provider.

5. Muscle pain or damage

In rare cases, people taking ezetimibe have reported severe muscle pain and damage. This risk may be higher if you previously took a statin or if you’re currently taking a statin or fibrate with ezetimibe. Your statin dose, your age, and kidney function may also influence your risk.

Muscle damage can sometimes result in rhabdomyolysis, a serious condition that can lead to kidney failure. Common symptoms include severe muscle pain, weakness, and cola-colored urine. Rhabdomyolysis can progress quickly, so it should be addressed as soon as you notice symptoms. 

Don’t ignore muscle pain from ezetimibe. Report any unexplained muscle pain, weakness, or tenderness to your healthcare provider right away. Go to the nearest emergency room if you develop symptoms of rhabdomyolysis.

6. Liver damage

Ezetimibe can affect your liver, especially when taken together with a statin. This often shows up as elevated liver enzymes, which can be a sign of liver inflammation or damage. And in most cases, you may not have any noticeable symptoms. While rare, liver damage that results in symptoms such as nausea, yellowing of the skin or eyes (jaundice), and upper-right-side abdominal pain has been reported.

Your healthcare provider may monitor your liver enzymes before you start ezetimibe and periodically thereafter. But if you develop what you think are signs or symptoms of liver damage, let them know right away.

When should you contact your healthcare provider about ezetimibe side effects?

Most ezetimibe side effects, such as URTIs and diarrhea, can be managed at home. But you should talk to your healthcare provider if you’re not able to get relief, or if any side effect is bothersome or concerning to you.

Certain side effects, such as joint or muscle pain, may be from ezetimibe, a statin (if you’re taking one), or both. Let your healthcare provider know if these side effects develop so they can determine the cause. In some cases, they may adjust your dosage or treatment regimen.

While rare, serious side effects are possible. Muscle damage, including rhabdomyolysis, and liver damage are two examples. Symptoms such as severe muscle pain, weakness, and cola-colored urine warrant immediate medical attention. This is also the case for jaundice and severe abdominal pain.

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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