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Ezetimibe for the Treatment of Primary (Heterozygous-Familial and Non-Familial) Hypercholesterolaemia

Scope of the guidance

This item is based on NICE Technology Appraisal Guidance on the use of ezetimibe for primary (heterozygous-familial and non-familial) hypercholesterolaemia.

Source

National Institute for Health and Clinical Excellence. Ezetimibe for the Treatment of Primary (Heterozygous-Familial and Non-Familial) Hypercholesterolaemia. NICE Technology Appraisal Guidance 132. London: NICE; 2007.

www.nice.org.uk/nicemedia/pdf/TA132guidance.pdf

Key points

1. Context

• Most patients with primary hypercholesterolaemia who are at risk of cardiovascular disease can be treated with a statin (see NICE Technology Appraisal Guidance 94 in Further Reading). 

2. Recommendations for ezetimibe

Ezetimibe blocks the intestinal absorption of cholesterol. It is recommended as:

• an add-in therapy for patients already taking a statin where the total or low-density lipoprotein (LDL) cholesterol is not controlled despite maximum statin therapy and an alternative statin is being considered

3. Side-effects of ezetimibe

These are usually mild and include:

• headache
• abdominal pain
• diarrhoea.

When prescribed alongside a statin, the most common side effects of ezetimibe are:

• gastrointestinal disturbances
• headache
• fatigue
• muscle pain.

4. Recommended dose

• Monotherapy: ezetimibe 10 mg/day at any time of the day, with or without food
• Dual therapy with a statin: ezetimibe 10 mg + simvastatin 20 mg (10/20 mg) or 10/40 mg, taken in the evening.
• A 10/80 mg dose of ezetimibe and simvastatin can only be prescribed for patients with severe hypercholesterolaemia and a high risk of cardiovascular complications.

Practical tips for the busy GP >>

EGP 1. May 2008