Stopping ezetemibe

[Heartmum56]

1 year post NSTEMI and stent and finally had a call from cardiologist. Basically all fine thankfully. They said I could stop ezetemibe but stay on 40mg atorvastatin. Bit confused as NHS website says ezetemibe is for life. My cholesterol numbers are good ( LDL 1, ratio 1.9, total 2.5, triglycerides 0.4, HDL 1.3) so presumably that is why. No symptomatic side effects, though blood tests show blood sugars and liver enzymes up and kidney function a bit down. I thought that would suggest staying on ezetemibe and dropping statin, not the other way round. Don't like the statin pushing the blood sugar up to 40. Any thoughts or similar experience re dropping ezetemibe? Thanks all.

[Lowerfield_no_more]

My understanding is that ezetimibe on its own is not as effective as statins, so it is prescribed as a top up to statins where statins alone do not quite do the job (as is the case for me), or on its own or perhaps with other medication as an alternative to statins if you are statin intolerant due to side effects. So preferentially statins will be prescribed for lipid management where it is required, added to which, statins are cheap. As for statins elevating Hb1Ac levels there is some evidence of that apparently, but like all side effects it may not affect everyone , and you will be monitored for it periodically, in my case annually.

[Blearyeyed]

I think it's worth questioning , I'd have thought that they would want you to remain on Ezetimibe while your blood sugars are still raised , especially if you are eating a low sugar, low cholesterol diet because one of the things that they have seen in research of Ezetimibe is that it can also help to decrease blood sugar ( as a side effect) as well as lipid profiles.Being on Ezetimibe, isn't necessarily a lifelong thing unless you have a cholesterol removal dysfunction health condition which requires combined therapy or can't use statins.

In some cases, it can be used for a short time alongside a statin in patients whom need to get cholesterol levels down more quickly , then, as long as the patient doesn't have HyperCholesteroleimia which isn't responding to statins alone the patient can just take a statin , alongside a cholesterol friendly diet and exercise.

Neither statins or Ezetimibe should cause raised liver enzyme markers as a significant side effect except for in rare cases, in reality they should be helping to improve those results instead.

The fact that you have raised blood sugar, and abnormal liver and kidney results could have various causes which aren't associated with Cholesterol , and the statin or Ezetimibe may not be responsible .....in fact they could be helping ?

Have they organised other tests to try to rule out other causes for your results?

If not , it's probably advisable to discuss this with the GP because the Cardiologist may only be advising you on things that are related to your heart and not taking an interest in other health issues that need investigating.

Ask to include inflammatory markers , full blood count , ferritin, vitamin B12 , Vitamin D and Folate on the list of things to be tested, these could rule out other simple reasons for the change in results.

Make sure you drink a few glasses of water before your blood tests just to be sure dehydration isn't the cause of abnormal results.

Had you had an infection or an injury in the weeks before , or were you possibly dehydrated when you had the blood tests done ?

Have you had a Diabetes HbA1c blood test in the last 12 months?

Do you have any other health conditions or take any other medications or supplements that could be the cause of the liver , blood sugar or kidney test results?

Have there been any changes in your diet or stress level recently that could cause these results?

Do you suffer from inflammation from things like osteoarthritis, arthritis or other inflammatory health conditions which could also effect the liver , kidneys and cause increased insulin resistance?

It's probably worth thinking through these questions and seeing if these could be part of the cause.

I think I'd be speaking to the GP and getting further blood tests and advice before I took the final step to reduce and then come off the Ezetimibe, just in case withdrawing it ,before finding out the cause and treating it , could end up increasing your blood sugars further or affecting your results further.

You could also choose to remain on the Ezetimibe with the statin long term even if the Cardiologist says it's fine to come off It . It was a recommendation not an order.

It isn't just the decision of the Cardio or GP, you have an equal say in this , just as you have an equal right to refuse a drug they want you to take but you may not be happy to do so.

So if you feel more confident staying on both drugs and you don't want off you can tell the GP this and request to stay on it.

If you do finally come off Ezetimibe, ask to have the blood tests done again after a month to double check that it hasn't had a negative effect ,

Let us know how you get on , take care Bee

[Heartmum56 in reply to Blearyeyed]

Thank you Blearyeyed that's incredibly helpful. Thank you for taking the time. I think it's definitely right that cardios are only interested in your heart and not other organs.

I might have misled you though. The 40 result I mentioned is a recent HbA1c result, so within normal limits just too close to prediabetes for my liking and up 5 points from where it was pre taking any meds. Does that make any difference to what you say?

Also it's only the ALT liver test which is out of range and I read that as long as it's not 3x upper limit you should still take the statin.

It's kidneys I am most worried about as have developed foamy urine in last few months.

Have just come off ticagrelor and taking myself off lansaprazole too so will see if that makes any difference.

Had all the other inflammatory marker tests 6 months ago and all was fine.

Have got a urology appt in August so struggling to get gp to do any more tests in the meantime. Maybe she will if I take myself off the ezetemibe.

[sandandkev]

Hi I am being recommended to take ezetimibe as was on atorvastin and it affected my liver,they are well known for that which is why have bloods done 3 monthly,ezetimibe only lowers cholesterol,as your liver enzymes are up atorvastin would be the one I would stop- why do you need both anyway?

[MountainGoat52]

Ezetimibe enhances the effect of a statin. My thought on reading your post is whether reducing the Atorvastatin might be a better way of progressing rather than stopping the Ezetimibe. You might consider asking the question.

Incidentally, some years ago I was prescribed Ezetimibe as a stand alone medication without a statin and it was proven (in my case) to have had no effect on my cholesterol. Now that I am on a statin that suits me (Rosuvastatin), I would consider adding Ezetimibe as an alternative to increasing the dose of the statin.