How long does it take for statins to lower cholesterol

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.

LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver.

Why have I been offered statins?

Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels. It's a very common cause of death in the UK.

The main types of CVD are:

• coronary heart disease – when the blood supply to the heart becomes restricted
• angina – chest pain caused by reduced blood flow to the heart muscles
• heart attacks – when the supply of blood to the heart is suddenly blocked
• stroke – when the supply of blood to the brain becomes blocked

A doctor may recommend taking statins if either:

• you have been diagnosed with a form of CVD
• your personal and family medical history suggests you're likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk

Find out more about when statins may be recommended.

Taking statins

Statins come as tablets that are taken once a day.

For some types of statin it does not matter what time of day you take it, as long as you stick to the same time.

Some types of statin should be taken in the evening.

Check with your doctor whether there's a particular time of day you should take your statin.

You usually have to continue taking statins for life because if you stop taking them, your cholesterol will return to a high level.

If you forget to take your dose, do not take an extra one to make up for it. Just take your next dose as usual the following day.

If you accidentally take too many statin tablets (more than your usual daily dose), contact a doctor or pharmacist for advice or call NHS 111.

Cautions and interactions

Statins can sometimes interact with other medicines, increasing the risk of serious side effects, such as muscle damage.

Some types of statin can also interact with grapefruit juice.

It's very important to read the information leaflet that comes with your medicine to check if there are any interactions you should be aware of.

If in doubt, contact a GP or pharmacist for advice.

Find out more things to consider when taking statins.

Side effects of statins

Many people who take statins experience no or very few side effects. Others experience some side effects, but these are usually minor, such as diarrhoea, a headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if they're offered to you.

The risks of any side effects also have to be balanced against the benefits of preventing serious problems. 

Find out more about the side effects of statins.

Alternatives to statins

If you're at risk of developing CVD in the near future, your doctor will usually recommend lifestyle changes to reduce this risk before they suggest that you take statins.

Lifestyle changes that can reduce your cholesterol level and CVD risk include:

• eating a healthy, balanced diet
• exercising regularly
• maintaining a healthy weight
• limiting the amount of alcohol you drink
• stopping smoking

Statins may be recommended if these measures do not help.

Read more about treating high cholesterol and preventing CVD.

Types of statin

There are 5 types of statin available on prescription in the UK:

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• pravastatin (Lipostat)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

1. About ezetimibe

Ezetimibe is a type of medicine used to lower cholesterol.

It's used to treat high blood cholesterol. This is when you have too much of a fatty substance called cholesterol in your blood.

You may also be prescribed ezetimibe if you cannot take cholesterol-lowering medicines called statins, or if statins do not work for you.

Ezetimibe is available on prescription only. It comes as tablets.

Ezetimibe also comes mixed with simvastatin, a type of statin. This is known by the brand name Inegy.

2. Key facts

• Ezetimibe helps stop your body taking in cholesterol from food.
• It usually lowers cholesterol levels within 2 weeks.
• You can take this medicine with or without food.
• Common side effects include stomach (abdominal) pain and diarrhoea.
• Ezetimibe is also known by the brand name Ezetrol. It can also be mixed with simvastatin, a type of statin. This is known by the brand name Inegy.

3. Who can and cannot take ezetimibe

Ezetimibe can be taken by adults and children from the age of 10 years.

Ezetimibe is not suitable for some people. To make sure it is safe for you, tell your doctor if you:

• have had an allergic reaction to ezetimibe or any other medicines in the past
• have liver problems
• are pregnant, planning to become pregnant or are breastfeeding

4. How and when to take it

You can take ezetimibe with or without food.

The dose for adults and children is one 10mg tablet, taken once a day.

What if I forget to take it?

If you forget to take ezetimibe, take it as soon as you remember. If you do not remember until the following day, skip the missed dose and take your next one at the usual time.

Do not take a double dose to make up for a forgotten dose. If you often forget doses, it may help to set an alarm to remind you.

You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking 1 or 2 extra tablets is unlikely to harm you. But the amount of ezetimibe that can lead to overdose is different from person to person.

Urgent advice: Contact 111 for advice now if:

You take too much ezetimibe and you:

• have severe stomach pain
• have severe diarrhoea

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive yourself – get someone else to drive you.

Take the ezetimibe packet, or the leaflet inside it, plus any remaining medicine with you.

5. Side effects

Like all medicines, ezetimibe can cause side effects in some people, although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people.

Keep taking the medicine, but talk to a doctor if these side effects bother you or do not go away:

• stomach (abdominal) pain
• diarrhoea
• farting more than usual
• feeling more tired than usual

Serious side effects

Serious side effects are not common and happen in less than 1 in 10,000 people.

Tell a doctor straight away if you get:

• muscle pain, tenderness, weakness or cramps
• yellow skin or the whites of your eyes turn yellow, pale poo and dark pee – this can be a sign of liver problems
• severe stomach pain (just under your ribs) – this can be a symptom of pancreas problems

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to ezetimibe.

Immediate action required: Call 999 or go to A&E if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you're wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of ezetimibe. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

• stomach (abdominal) pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you're in a lot of pain, speak to a pharmacist or doctor.
• diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. Speak to a doctor if diarrhoea lasts for more than a week after you start ezetimibe.
• farting – try to not eat foods that cause wind (such as lentils, peas, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. There are pharmacy medicines that may also help, such as charcoal tablets or simeticone. Peppermint tea may also help.
• feeling tired – try to relax when possible and avoid intense exercise to see if that helps. If these symptoms do not go away after 1 to 2 weeks, ask a pharmacist or doctor for advice.

7. Pregnancy and breastfeeding

Ezetimibe is not usually recommended during pregnancy or while breastfeeding. This is because there is very little information about its safety.

A doctor may suggest another medicine for lowering cholesterol, such as colestyramine.

Non-urgent advice: Speak to a doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

8. Cautions with other medicines

Some medicines can affect the way ezetimibe tablets work. They may also make your more likely to get side effects.

Tell a doctor if you're taking these medicines before you start ezetimibe:

• ciclosporin, a medicine used to treat psoriasis or after an organ transplant
• medicines used to prevent blood clots, such as warfarin
• other medicines used for lowering cholesterol (this does not include statins), such as colestyramine or bezafibrate

Mixing ezetimibe with herbal remedies and supplements

There's very little information about taking herbal medicines and supplements with ezetimibe.

9. Common questions

How does it work?

Ezetimibe works by reducing the amount of cholesterol your body takes in from your food.

It is usually prescribed alongside a cholesterol-lowering diet.

Ezetimibe can often be prescribed together with a statin to further lower your cholesterol levels.

How long does it take to work?

If you take your medicine as prescribed, your cholesterol levels should drop within 2 weeks.

How long will I take it for?

Usually, treatment with ezetimibe is for life. You will need to keep taking it for it to work.

Do not stop taking your medicine without speaking to a doctor first.

What happens if I stop taking it?

If you stop taking ezetimibe without starting a different treatment, your cholesterol levels may go up again.

Talk to a doctor if you are thinking about stopping this medicine.

How does it compare with similar medicines?

There are other types of medicines that can help lower cholesterol.

Statins are the most commonly prescribed medicines. A doctor may decide to prescribe ezetimibe together with a statin. Statins include:

• simvastatin
• atorvastatin
• pravastatin
• rosuvastatin

Other cholesterol-lowering medicines include bezafibrate (and other fibrates) and colestyramine. These are usually prescribed by a specialist.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking ezetimibe.

Is there any food or drink I should avoid?

You can eat and drink normally while taking ezetimibe.

Will it affect my fertility?

There's no firm evidence to suggest that taking ezetimibe will affect fertility in either men or women.

Can I drive or ride a bike?

Yes, you can drive or ride a bike while taking ezetimibe.

Can lifestyle changes help lower my cholesterol?

Usually, treatment with ezetimibe is for life.

Ezetimibe will work best if you can reduce your cholesterol as this will also reduce your risk of heart disease.

There are lifestyle changes you can make that will help lower your cholesterol:

• make sure you're a healthy weight
• eat a healthy, well balanced diet – reduce saturated fat and increase fibre, fruits, vegetables, wholegrains and fish
• quit smoking
• cut down on alcohol
• try to exercise every day