Zetia Interactions: Alcohol, Medications, and Others

Zetia (ezetimibe) is a prescription drug that’s used to treat high cholesterol in adults and certain children. This drug can interact with other medications. For example, Zetia can interact with cyclosporine and warfarin.

Zetia is used in adults and certain children to treat:

• primary hyperlipidemia
• mixed hyperlipidemia
• homozygous familial hypercholesterolemia (HoFH)

For these uses, your doctor may prescribe Zetia along with other drugs to reduce high cholesterol.

In addition, Zetia is used to reduce blood levels of fats called plant sterols in people with homozygous sitosterolemia.

Keep reading to learn about Zetia’s possible interactions. An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

And for more information about Zetia, including details about its uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Zetia. In such cases, your doctor may not prescribe Zetia for you. These are known as contraindications. The information below describes Zetia’s contraindication.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Zetia or any of its ingredients, your doctor likely won’t prescribe Zetia. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Zetia isn’t known to interact with alcohol. But both alcohol and statin drugs, which are often taken with Zetia, may cause liver problems. Drinking alcohol while taking Zetia and a statin raises your risk of liver problems even more.

If you drink alcohol, talk with your doctor about how much (if any) may be safe to drink during your Zetia treatment.

Before you start taking Zetia, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Zetia interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Zetia?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Zetia. Keep in mind that this table does not include all drugs that may interact with Zetia. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug name	Drug examples	What can happen
Cyclosporine (Gengraf, Neoral, Sandimmune) oral forms	—	can increase the risk of side effects from Zetia and cyclosporine
Fibrates	• fenofibrate (Antara, Lipofen, Tricor) • fenofibric acid (Trilipix) • gemfibrozil (Lopid)	can increase the risk of side effects from Zetia and fibrates
Cholestyramine (Locholest, Prevalite)	—	can make Zetia less effective
Warfarin (Jantoven)	—	can raise the risk of side effects from warfarin

Learn more about certain drug interactions that can occur with Zetia.

Interaction with fibrates

Zetia can interact with fibrates. These drugs are used to lower triglyceride levels and certain kinds of cholesterol levels.

Examples of fibrate medications include:

• fenofibrate (Antara, Lipofen, Tricor)
• fenofibric acid (Trilipix)
• gemfibrozil (Lopid)

How severe the interaction is can vary depending on the specific fibrate taken with Zetia.

Studies have looked at Zetia’s use with the fibrate drug fenofibrate, and these drugs are approved for use together. But Zetia hasn’t been studied with other fibrate drugs.

What could happen

Cholesterol is removed from your body through your bile. Fibrate drugs may increase the amount of cholesterol in your bile, which could lead to gallstones.

An animal study of Zetia found that the drug increased cholesterol in bile, but it’s not known if this effect also happens in humans. But due to the risk, Zetia isn’t approved for use with a fibrate drug other than fenofibrate.

What you can do

If you’re taking a fibrate drug other than fenofibrate and are prescribed Zetia, talk with your doctor. They may suggest switching your fibrate drug to fenofibrate. Or they may suggest using a drug other than Zetia.

Interaction with cyclosporine

Zetia can interact with forms of cyclosporine (Gengraf, Neoral, Sandimmune) that you take by mouth. Cyclosporine is used after certain organ transplants, such as a liver or kidney transplant. The drug is also used to treat rheumatoid arthritis and severe psoriasis.

Note: Cyclosporine is also the active ingredient in the brand-name eye drops Restasis and Cequa. (An active ingredient is what makes a drug work.) But the rest of the body doesn’t absorb enough cyclosporine to interact with Zetia.

What could happen

Taking Zetia and cyclosporine together raises the risk of side effects from both drugs. It can also make side effects that you experience worse.

To learn more about possible side effects of either drug, see these articles on cyclosporine and Zetia.

What you can do

If you need to take Zetia and cyclosporine together, your doctor will closely monitor the levels of cyclosporine in your body using blood tests. Your doctor can tell you more about these tests and how often you’d need them.

Interaction with warfarin

Zetia interacts with the blood thinner warfarin (Jantoven).

Blood thinners such as warfarin are used to treat and prevent blood clots. For example, warfarin may be used after a heart attack to lower the risk of death, stroke, or another heart attack.

Having high cholesterol is a risk factor for a heart attack. So, it’s not unusual for people to take Zetia with a blood thinner such as warfarin.

What could happen

Taking Zetia and warfarin together can raise the risk of bleeding, which is a side effect of warfarin. It can also make bleeding worse if it does occur.

What you can do

Zetia and warfarin are generally considered safe to take together. But if your doctor prescribes these drugs together, they may want to monitor your international normalized ratio (INR) more often.

People taking warfarin have to regularly take an INR blood test. This test measures how well warfarin is working to keep your blood from clotting.

Having an INR that’s too high can be a sign that you have a higher risk of bleeding, which can be severe. Taking Zetia with warfarin may cause your INR to become too high. Your doctor may need to adjust your warfarin dose based on your INR test results.

If you have questions about taking Zetia and warfarin together, talk with your doctor or pharmacist.

Zetia may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Zetia.

Does Zetia interact with supplements?

Before you start taking Zetia, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Zetia and herbs

There are currently no reports of Zetia interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Zetia.

Zetia and vitamins

There are currently no reports of Zetia interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Zetia.

Does Zetia interact with food?

There are currently no reports of Zetia interacting with food. If you have questions about eating certain foods during your treatment with Zetia, talk with your doctor.

Does Zetia interact with vaccines?

There are currently no reports of Zetia interacting with vaccines. If you have questions about receiving vaccines during your treatment with Zetia, talk with your doctor.

Does Zetia interact with lab tests?

There are currently no reports of Zetia interacting with lab tests. To learn more about having lab tests done while you’re taking Zetia, talk with your doctor.

Does Zetia interact with cannabis or CBD?

There are currently no reports of Zetia interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Zetia.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Zetia. Before taking Zetia, talk with your doctor about your health history. They’ll determine whether Zetia is right for you.

Health conditions or other factors that might interact with Zetia include:

Liver problems. High levels of liver enzymes is a rare side effect that’s been reported in people taking Zetia. Although liver damage wasn’t reported in Zetia’s studies, high levels of liver enzymes can be a sign of liver damage in rare cases.

If you have a liver problem such as liver cirrhosis (scarring), you have a higher risk of liver problems with Zetia. Talk with your doctor about whether this drug is safe for you.

Allergic reaction. If you’ve had an allergic reaction to Zetia or any of its ingredients, your doctor will likely not prescribe Zetia. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Pregnancy. It’s not known if Zetia is safe to take while pregnant. If you’re pregnant or planning to become pregnant, talk with your doctor before taking Zetia.

Breastfeeding. It’s not known if Zetia is safe to take while breastfeeding. This is because it’s unknown whether the drug passes into breast milk or how it could affect a breastfed child. If you’re breastfeeding or planning to breastfeed, talk with your doctor before taking Zetia.

Note: Statins should not be taken during pregnancy or while breastfeeding. Statins are often prescribed along with Zetia.

Find answers to some frequently asked questions about Zetia and possible interactions.

Is there anyone who should not take Zetia?

Yes. In certain situations, Zetia should not be used. For example, you should not take Zetia if you’ve had an allergic reaction to the drug in the past. This is because taking the drug could cause another allergic reaction. Your doctor can tell you about other treatments that may be better options for you.

Are there foods to avoid while I’m taking Zetia?

Possibly. Zetia isn’t known to interact with any foods, but you should not consume grapefruit if you take Zetia with certain statins.

Zetia is commonly used with statins such as atorvastatin (Lipitor) to lower cholesterol. And some statins interact with grapefruit and grapefruit juice.

If your doctor prescribes a statin along with Zetia, let them know if you regularly consume grapefruit or grapefruit juice. Your doctor will likely recommend avoiding grapefruit. But this interaction isn’t a concern if you’re not taking a statin with Zetia.

If you have questions about this interaction, talk with your doctor.

Is it safe to take an antacid such as Tums while I’m taking Zetia?

Yes, if your doctor says so. There’s no known interaction between antacids such as Tums (calcium carbonate) and Zetia.

Studies have found that antacids may slightly lower how much Zetia your body absorbs after you take a dose. But this should not affect how well Zetia works. Still, your doctor or pharmacist may suggest that you wait at least 2 hours after taking an antacid before taking your dose of Zetia.

If you have other questions about taking Zetia with an antacid or other medications, talk with your doctor or pharmacist.

Taking certain steps can help you avoid interactions with Zetia. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list .
• What to do if you start taking a new drug during your Zetia treatment.

It’s also important to understand Zetia’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Zetia, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Zetia exactly as prescribed can also help prevent interactions.

If you still have questions about Zetia and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Will my Zetia dosage affect my risk of interactions?
• How do Zetia’s interactions compare with those of other cholesterol drugs?
• Are there medications I take that I need to space out to avoid taking at the same time as Zetia?
• What happens if I’m prescribed a new medication or supplement that interacts with Zetia?

To learn more about Zetia, see these articles:

• All About Zetia
• Side Effects of Zetia: What You Need to Know

To get information on different conditions and tips for improving your health, subscribe to any of Austra Health’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Austra Health has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Last medically reviewed on March 10, 2023