Mibecol (Ezetimibe)

• Mibecol (ezetimibe) acts on the intestinal cholesterol absorption pathway and is indicated for several lipid disorders.
• Hypercholesterolemia: lowers low‑density lipoprotein (LDL) cholesterol levels.
• Primary hyperlipidemia: reduces elevated cholesterol and triglyceride concentrations.
• Homozygous familial hypercholesterolemia: provides LDL‑cholesterol reduction when other therapies are insufficient.
• Adjunct to statin therapy: enhances LDL‑cholesterol lowering when combined with a statin.

• Ezetimibe selectively inhibits the Niemann‑Pick C1‑like 1 (NPC1L1) transporter located on the brush border of enterocytes, blocking the uptake of dietary and biliary cholesterol. By reducing intestinal cholesterol absorption, hepatic cholesterol stores decline, prompting up‑regulation of LDL receptors and increased clearance of LDL particles from the circulation, thereby lowering plasma LDL‑cholesterol levels.

Ezetimibe is generally well tolerated, but a range of adverse reactions have been reported.

Common Side Effects

• Abdominal pain: mild to moderate discomfort in the stomach area.
• Diarrhea: loose stools occurring intermittently.
• Fatigue: feeling unusually tired or weak.
• Headache: mild to moderate head pain.
• Nausea: sensation of needing to vomit.
• Elevated liver enzymes: mild increase in hepatic transaminases.

Serious or Rare Side Effects

• Cholestatic hepatitis: inflammation of the bile ducts that may lead to liver dysfunction.
• Severe allergic reactions: rash, itching, swelling, or anaphylaxis.
• Muscle toxicity: myopathy or rhabdomyolysis, especially when combined with statins.
• Pancreatitis: inflammation of the pancreas presenting with abdominal pain and vomiting.

• Before initiating therapy, clinicians should consider several safety measures.
• Monitor liver function: check hepatic enzymes periodically.
• Assess lipid profile: evaluate baseline and follow‑up cholesterol levels.
• Evaluate for gallstones: avoid use in patients with active biliary disease.
• Use caution in hepatic impairment: dose adjustment may be required.
• Avoid in known hypersensitivity: discontinue if allergic reaction occurs.
• Store at ambient temperature: keep in the original pack, protect from moisture.

Ezetimibe may interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Cholestyramine, colestipol, colesevelam: bind ezetimibe in the gut and markedly reduce absorption.
• Cyclosporine: increases ezetimibe plasma concentrations, requiring monitoring.
• Bile acid sequestrants: may diminish therapeutic effect.

Moderate Interactions (Monitor Closely)

• Statins: combined use can raise risk of myopathy; monitor muscle symptoms and CK levels.
• Warfarin: ezetimibe may alter INR; check coagulation status regularly.
• Antacids: may affect ezetimibe absorption; advise spacing of doses.