#21

My ezetimibe is in a tablet form, 10 mg - I cut it in half to get 5 mg. I don’t think that ezetimibe comes in 5 mg dose.

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#22

FWIW

This strategy/idea is not new.

Published Aug 20, 2010

Efficacy of Ezetimibe 2.5 mg With a Novel Tablet-Splitting Strategy

By Lawrence Baruch, MD
Bhanu Gupta, MD

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#23

Or that. I have a pill splitter so that is a definite unless I want to experiment with EOD dosing (take it with my rosuvastatin). Thanks

1 Like
#24

Thanks for this! Although ezetimibe is cheap and I can’t divide the tablets into 4 pieces, I’ll at least start snapping them in half so I’ll only have to refill the Rx twice per year.

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#25

FWIW

tablet splitter

One of many types available.

https://www.walmart.com/ip/Pill-Splitter-1-4-1-2-Splitting-Automatically-Pill-Alignment-Pill-Cutter/3951305175

#26

I have a tablet splitter. If you saw the shape/size of a generic ezetimibe tablet, you’d know what i mean. Easy to snap in half, though.

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#27

Nice info, this got my thinking about lowering my current 10mg ezetimibe dose;

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#28

Good article. I have the same questions about some of the fat soluble vitamins. The general claim is that ezetimibe does not interfere with their assimilation but I believe there has to be nuance here based on the mechanisms of assimilation. Transporters for the Intestinal Absorption of Cholesterol, Vitamin E, and Vitamin K - PMC

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#29

Not a recommendation, as I am not a doctor, but you could try Pravastatin, one of the least diabetogenic of the statin family.

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On a personal note, I take 20mg pravastatin daily.

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#30

Digging into the above "Transporters for the Intestinal . . . " article gets a little wonky but the takeaway is that ezetimibe does interfere with the intestinal absorption of tocopherols and tocotrienols, with ezetimibe potentially completely blocking one pathway in a dose-dependent manner. The other side of this in vivo analysis is a clinical study reporting that serum concentrations of vitamin E (most likely alpha tocopherol) were not significantly reduced after a 12-week administration of ezetimibe. This is good news but it leaves important questions unanswered.

To quote the article’s authors: “Based on the well-known fact that α-tocopherol transfer protein (α-TTP), a cytosolic protein expressed in the liver, plays a key role in maintaining vitamin E homeostasis by regulating hepatic storage and trafficking of α-tocopherol), the partial inhibition of vitamin E absorption by ezetimibe may not immediately cause vitamin E deficiency in humans. However, considering that humans cannot synthesize vitamin E and that it is therefore necessary to ingest this nutrient as part of the diet, the ezetimibe-mediated malabsorption of vitamin E should be taken into consideration as a potential risk for vitamin E deficiency.”

I would add that even this position leaves the other tocopherols, especially the important gamma tocopherol, and the several important tocotrienols unaddressed. I would think it wise for those of us taking ezetimibe to consider supplementing against these potential losses.

3 Likes
#31

@LaraPo,

Were you able to judge the contribution of pantethine to your reduced LDL? The studies I have read are all positive but one notes that it can take six to 12 months to gain full effect.

#32

I’m not taking it that long, may be 3 mo the most, but my LDL went down to a normal level. I’ll definitely continue with it and remeasure lipids in May.

3 Likes
#33

“Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account.”

2.5mg dose of Rosuvastatin should be quite safe. (and still more effective than Pravastatin 20mg) Especially if you add Ezetimibe 5mg (some studies have reported improved insulin resistance, at least in obese people)

Personally, my blood sugars are now better when I take Ezetimibe 5mg + Rosuvastatin 2.5mg daily compared to previously Rosuvastatin 5mg daily. But I still need to monitor my blood sugars for a longer period of time to be sure.

4 Likes
#34

Were you once taking rosuvastatin at a higher dose and if so did you have muscle weakness and/or pain @tj_long

#35

I had very mild muscle pain on Rosuvastatin 5mg daily dose. Now 5mg Ezetimibe + 2.5mg Rosuvastatin daily and I don’t have any side effects.

6 Likes
#36

Summary suggestion: My doctor provided research showing that 5 mg of Rosuvastatin provides 85% of benefits for most people but to get to 90% efficacy, higher dosages are more likely to have side effects. She also has suggested in my case to experiment with 5 mg every other day and we will further experiment with PCSK9 inhibitors if needed after seeing if the addition of consistent HIIT (2 a week, 20 minutes) and HR Level 2 workouts (3 a week, 40 mins) has an impact. Here’s why — After having tolerating Rosovastatin 5 mg daily for a couple of years (having resisted prescribed dosage of 20 mg daily for some time), finally gave in because ApoB was still high. After a couple of months at 20mg daily, got some very strange nerve pain around the insertion of my rt achilles tendon (i.e. superficial, back of heel). This progressed to full on tendinopathy in that area. With proper physical therapy programming, over the last two months off of all statins, I’ve improved symptoms by about 75%. (PT programming prior to stopping the statins actually made things worse). I have been taking COQ10 consistently throughout so in this case not protective for me though it might have kept me from having muscle soreness.

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#37

Yiikes!
My traditional Cardiologist MD would most probably NOT appreciate nor prescribe this instead of atvorstatin and ez, but I agree with you about the positive benefits of your Rx combo. Thanks for your info. Sincerely, Jan

1 Like
#38

Hi!
Do you have a suggested brand vitamin E that I should consider?
Thanks,
Jan

#39

Hi, great article thanks for posting.
So, I just bought a dry blood measuring home kit for checking my level and I bought a new high quality fish oil liquid to start after i do the blood spot test.
Sincerely,
Jan

1 Like
#40

I like this formulation for several reasons. Search - Life Extension

Also keep in mind that some tocotrienols inhibit cholesterol synthesis in addition to their other benefits, such as related to cancer. The reductions are somewhat modest but usually predictable.

All of these and more make it important to learn more about the effects of ezetimibe on the assimilation of tocopherols and tocotrienols.

1 Like