#11

It may, however, inhibit vitamin E absorption:

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#12

Thanks! I’d been looking for a study. That matches up with what users here, @约瑟夫_拉维尔 , have been reporting.

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#13

I wonder if this would work for ALA as well? Seems like it should.

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#14

I take ezetimibe in AM. I take fish oil in AM and PM, and I eat fish most nights. So I mostly used the 4 hours gap or more. My omega index was 12%

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#15

I have become increasingly concerned about how much ezetimibe might be reducing the assimilation of important nutrients and supplements. The drug has done a good job of dropping my Apo(b) into the normal range but I wonder about its long term effects. Its effects on the assimilation of some omega-3s and some tocopherols and tocotrienols have been studied slightly, presumably because of widespread interest and use but what about a half dozen or more supplements the assimilation of which might also be reduced or blocked by the drug. Is anyone aware of more comprehensive human clinical research speaking to this topic?

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#16

I posted a study on this forum about it some months ago that indicated Eze could block absorption of omega 3s. But then I had my omega 3 index measured at 10.3% so I’m not worried any longer.

Get tested. Omegaquant.

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#17

I have read all or most refereed articles reporting clinical research or metanalysis, including the one you posted. The scant research is suggestive of the belief that ezetimibe will not substantially block and adsorption of at least some forms of omega-3 under some conditions but it does not exhaust even the omega-3 questions or close all doubts as to its validity. Beyond that, it says little and we know little. Specifically, we know almost nothing about a large number of related dietary substances that may be blocked (partially or wholly) by this drug. To name a few: pro-resolving mediators, omega-7, astaxanthin, lutein.

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Statin monotherapy vs combination with ezetimibe
#18

Well…get tested for omega 3 to get a clear answer on that one. If your omega 3 is good, what does it matter what happens in other people?

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#19

I’m just not being clear. I listed a few of the supplements I take, all of which are important to me in varying degrees. Whatever the individual differences, one strand of inquiry in our group is to track down side effects. These comments are in that vein. We know very little in terms of controlled comparisons about possible longer term effects.

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#20

Question #1: is there a best time to take ezetemibe, from the point of view of effectiveness of its primary purpose - blood lipids?

The answer seems to be - at least as prescribing goes - there is no time of night or day when it is “best” or “most effective” to take for blood lipids.

If so, then we are free to take it whenever we wish.

Question #2: does a substantial break in time from the last consumption of fats or supplements (such as above mentioned astaxanthin) remove the danger of ezetemibe interfering with nutrient absorbtion?

If yes (re: question #2), then if you consume dinner - or your last meal and/or supplements 4 hours or more from the time you go to sleep, then why not take your ezetemibe just before you go to sleep? Example: dinner/supplements 6 pm, take ezetemibe 10 pm, sleep. That gives you many hours before and after taking of ezetemibe of isolating it from any nutrient digestion.

Personally, my plan is to start taking bempedoic acid + ezetemibe fairly soon, and in view of the information above, I think it would be best for me to take it just before sleep (I go to bed midnight), so 4-6 hours after my last meal.

The issue of timing of medication, exercise, meals, supplements and so on becomes ever more complicated with polypharmacy, but I think we have to resign ourselves to not being able to time everything perfectly if you take, say, 8 prescription medications and 20 otc supplements, you are inevitably going to have irresolvable conflicts. The hope is that such conflicts will result in “suboptimal” and not “abolishing”.

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#21

I’m of the same opinion, but there’s not a lot of data.

I know that statins are best taken in the evening:

Statins that stay in your system for a short time work best if you take them in the evening (before your body starts making cholesterol overnight).

Source: Statins: How They Work & Side Effects

So, I just take the bempedoic acid + ezetemibe at the same time for convenience sake, but have not dug deep into the pharmacokinetics or physiology.

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#22

Yep, same here: I’m on 10mg of atorvastatin, and take it at 10pm every evening exactly for the same reason. Couple more considerations: statins are at therir peak levels in blood about 60-90 minutes after consumption. And since cholesterol lipid transport particle production revs up after midnight, I’m hoping this hits it roughly at the right time.

However. I have been toying with the idea of switching the statin to 10 AM, if I’ll be taking bempedoic acid + ezetemibe 10 PM. Statin levels decline after roughly 12 hours, so if I cover the first 12 hours with the Bempo + zetia combo, and cover the second 12 hours with atorvastatin, then perhaps I’m providing a steady level of ApoB suppression over the entire 24 hours. This is of course all WAG speculation, and who knows what is optimal and if any of this makes any difference.

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#23

Source?

Effects of Ezetimibe on Serum Polyunsaturated Fatty Acids in Patients With Coronary Artery Disease 2013

Ezetimibe significantly decreased LDL cholesterol (138 ± 19 mg/dL to 97 ± 34 mg/dL, P < 0.01), but did not significantly affect high-density lipoprotein cholesterol, triglyceride, or any of the PUFAs measured during the follow-up period. Consequently, it did not affect the ratio of EPA to AA (0.40 ± 0.17 to 0.43 ± 0.18, P = ns) or the ratio of n-3 PUFA to n-6 PUFA (1.10 ± 0.39 to 1.09 ± 0.36, P = ns) during the follow-up period. Ezetimibe in combination with a low-dose statin, or as monotherapy in statin-intolerant patients, decreased LDL cholesterol, but did not significantly affect serum PUFA concentrations in patients with coronary artery disease.

Add-on Ezetimibe Reduces Small Dense Low-Density Lipoprotein Cholesterol Levels Without Affecting Absorption of Eicosapentaenoic Acid in Patients with Coronary Artery Disease: A Pilot Study 2014

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Statin monotherapy vs combination with ezetimibe
#24

Absence of evidence is not evidence of absence - and definitely not proof of absence

For now the conservative things seems to just test Omega Index and optimize Omegas intakes based on that if on Eze (and should measure and optimize then anyway).

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#25

Did you read the papers? We have evidence of absence here.

#26

Ok, great. Typically studies are not powered to be able to pick that up.

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#27

You’re right that these studies are tiny, I didn’t pay attention to that.

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#28

After seeing this thread, I wanted to check my Omega Index after six months on Ezetimibe. It was about 14% before and about 14% after. No change.

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#29

It might block alpha-linoleic acid, not EPA and DHA. Did your blood test include that?

#30

I did the basic this time, not the complete. I might do the complete again in a year or so. I can see if there is any impact on ALA relative to the last time I had a complete test (before starting Ezetimibe).