Key takeaways:
Ezetimibe (Zetia) is a prescription medication approved to lower cholesterol levels. It’s available on its own and in combination pills with a statin.
Common ezetimibe side effects include upper respiratory tract infections (URTIs), diarrhea, and joint pain.
When ezetimibe is taken with a statin, muscle pain is also commonly reported. While rare, serious side effects can include muscle damage and liver damage.
Tell your prescriber if you have ezetimibe side effects that are severe, getting worse, or aren’t going away.
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?
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
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 usually 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 team.
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2. Diarrhea
Diarrhea is another common ezetimibe side effect. This usually goes away without treatment. But here’s what you can do to manage it in the meantime:
Drink enough fluids to prevent dehydration, especially if your diarrhea is persistent.
Avoid or minimize foods that can worsen diarrhea, such as dairy and fatty foods.
Eat a bland diet (such as bananas, rice, and toast) until your symptoms improve.
Talk to your healthcare team about short-term treatment with an anti-diarrheal medication.
If your diarrhea doesn’t seem to be improving, or if it’s severe or getting worse, contact your prescriber. Diarrhea can have many different causes, including other medications and health conditions.
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 prescriber. It’s possible that it may be from the treatment. Or, it could be from an underlying condition, such as arthritis. Your healthcare team 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. To manage fatigue, consider the following strategies:
Maintain a heart-healthy diet and regular exercise routine. These lifestyle changes can naturally boost energy levels and support overall well-being.
Prioritize sleep and hydration. Aim for consistent, restful sleep and drink enough fluids throughout the day to help combat tiredness.
Rest and pace yourself. If you feel unusually tired, allow yourself breaks and avoid overexertion.
Monitor for other symptoms. Be alert for muscle pain, weakness, or dark urine. These could indicate a more serious side effect such as muscle injury or rhabdomyolysis, which requires immediate medication attention.
If your fatigue is persistent, severe, or interferes with your daily activities, talk to your prescriber. They can help determine the cause or consider adjusting your treatment.
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 you should address it as soon as you notice symptoms.
Don’t ignore muscle pain from ezetimibe. Report any unexplained muscle pain, weakness, or tenderness to your healthcare team right away. Go to the nearest ER 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 — a possible sign of liver inflammation or damage. In many cases, there are no outward symptoms, which is why routine monitoring is important.
Watch for symptoms of possible liver damage, including:
Nausea or vomiting
Loss of appetite
Yellowing of your skin or eyes (jaundice)
Dark urine
Upper-right-side abdominal pain or tenderness
Unusual fatigue
Your healthcare team may check your liver enzymes before you start ezetimibe and periodically thereafter. But if you develop any of the symptoms above, let them know right away.
When should you contact your healthcare team about ezetimibe side effects?
Most ezetimibe side effects, such as URTIs and diarrhea, can be managed at home. But you should talk to your prescriber if you’re not able to get relief, or if any side effect is bothersome or concerning to you. Make sure they have your current medication list, since some combinations can make side effects more likely.
Certain side effects, such as joint or muscle pain, may be from ezetimibe, a statin (if you’re taking one), or both. Let your prescriber 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.
Frequently asked questions
Avoid combining ezetimibe with medications that increase the risk of muscle or liver damage without medical supervision. This includes certain statins, fibrates, or high-dose niacin. Alcohol should also be limited or avoided.
Ezetimibe doesn’t typically affect blood pressure directly. But lifestyle changes, such as a heart-healthy diet and regular exercise, are recommended while taking it. These changes can have a positive impact on both your cholesterol and blood pressure.
Weight gain isn’t a common side effect of ezetimibe. If you’re gaining weight unexpectedly, it’s worth checking with your prescriber to rule out other causes.
Avoid combining ezetimibe with medications that increase the risk of muscle or liver damage without medical supervision. This includes certain statins, fibrates, or high-dose niacin. Alcohol should also be limited or avoided.
Ezetimibe doesn’t typically affect blood pressure directly. But lifestyle changes, such as a heart-healthy diet and regular exercise, are recommended while taking it. These changes can have a positive impact on both your cholesterol and blood pressure.
Weight gain isn’t a common side effect of ezetimibe. If you’re gaining weight unexpectedly, it’s worth checking with your prescriber to rule out other causes.
The bottom line
Common ezetimibe (Zetia) side effects include upper respiratory tract infections (URTIs), diarrhea, and joint pain. Muscle pain has also been reported, especially when ezetimibe is taken with a statin. Rare but serious side effects include muscle damage and liver damage.
If any ezetimibe side effects are severe, getting worse, or aren’t going away, contact your prescriber. Go to the nearest ER if you develop severe muscle pain, weakness, and cola-colored urine.
Speak with your pharmacist or prescriber if you have questions about taking ezetimibe.
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References
Amenal Pharmaceuticals NY. (2025). Ezetimibe- ezetimibe tablet [package insert].
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2021). Ezetimibe. National Institute of Diabetes and Digestive and Kidney Diseases.
