Zetia vs Niaspan

Listen to the article instead of reading through it.


For patients with high cholesterol, certain drugs that alter the absorption and production of cholesterol in your body can help in managing LDL (low-density lipoprotein) levels. Zetia and Niaspan are two such medications prescribed for this purpose. They each work differently but both have a significant effect on patients' cholesterol levels.

Zetia is known as a selective cholesterol absorption inhibitor; it primarily works by reducing the amount of dietary cholesterol absorbed by your intestines. On the other hand, Niaspan belongs to a class of drugs called niacin or nicotinic acid analogs which essentially reduce liver's production of LDL and increase HDL (high-density lipoprotein). This duo enhances heart health when utilized effectively under professional supervision.

What is Zetia?

Ezetimibe (the generic name for Zetia) is a cholesterol absorption inhibitor, which marked a significant development in the class of lipid-lowering compounds. Ezetimibe was first approved by the FDA in 2002. Zetia works by reducing the amount of cholesterol your body absorbs from your diet. It's used to treat high levels of cholesterol and certain other fats in the blood.

On the other hand, Niaspan contains niacin, also known as Vitamin B3 or nicotinic acid, which has been used for many years to lower bad LDL-cholesterol and triglycerides and increase good HDL-cholesterol. However, due to its side effects such as flushing or redness of skin that can be uncomfortable for patients it might not always be the first choice treatment.

Both drugs work differently: while Zetia reduces intestinal absorption of cholesterol thus lowering LDL-cholesterol level directly; Niaspan reduces LDL production indirectly by inhibiting release of fatty acids from fat cells resulting in decreased liver production of VLDL (precursor particles that become LDL), but with more possible side effects compared to Zetia.

What conditions is Zetia approved to treat?

Zetia is approved for the treatment of various types of high cholesterol:

  • Primary hyperlipidemia (heterozygous familial and non-familial) as adjunctive therapy to diet
  • Homozygous familial hypercholesterolemia (HoFH), in combination with atorvastatin or simvastatin
  • Homozygous sitosterolemia, also known as phytosterolemia.

Niaspan, on the other hand, is utilized to treat mixed dyslipidemia and severe hypertriglyceridemia, or to increase HDL levels in patients with primary hypoalphalipoproteinemia.

How does Zetia help with these illnesses?

Zetia helps to manage high cholesterol by reducing the amount of cholesterol that your body absorbs from your diet. It does this by blocking the transport protein NPC1L1 which is responsible for cholesterol absorption in the gut, so levels can be maintained lower for longer periods of time. Cholesterol is a lipid, a type of fat found in the bloodstream and cells throughout the body, that plays an important role in producing cell membranes, hormones, vitamin D and bile acids that help you digest fat. However, when there's too much cholesterol in your blood it increases risk of developing heart disease due to formation of plaques on walls of arteries. Therefore, by reducing dietary absorption with Zetia one can limit negative effects high cholesterol levels have on cardiovascular health and help patients manage their condition.

What is Niaspan?

Niaspan is a brand name for extended-release niacin, which is a type of vitamin B3. It works by reducing the production of LDL ("bad") cholesterol and triglycerides in the liver while increasing HDL ("good") cholesterol levels. Niacin also dilates blood vessels, which can contribute to flushing or hot flashes as one of its side effects. Niaspan was approved by the FDA in 1997 for use as part of a regimen to manage high cholesterol levels.

As it's not a statin drug like Zetia (ezetimibe), it doesn't inhibit the absorption of cholesterol from food in your intestines. The lack of action on intestinal absorption means that its side-effect profile is different from that of statins, particularly in that it does not commonly cause muscle pain or weakness (frequent side effects with statins). The impact on HDL "good" cholesterol can be beneficial for managing lipid disorders, especially in patients who do not respond well to conventional statin drugs such as Zetia.

What conditions is Niaspan approved to treat?

Niaspan, a brand name for the drug niacin, is approved by the FDA to treat and manage high cholesterol levels. It has been recognized as effective in:

  • Lowering LDL ("bad") cholesterol
  • Raising HDL ("good") cholesterol
  • Lowering triglycerides (fats in your blood)

How does Niaspan help with these illnesses?

Niacin, the active component of Niaspan, is a B-vitamin which acts by reducing the amount of low-density lipoprotein (LDL or "bad") cholesterol and triglycerides in the body while simultaneously increasing levels of high-density lipoprotein (HDL or "good") cholesterol. This function plays a vital role in maintaining cardiovascular health and preventing heart disease. Niaspan works by affecting lipid metabolism, thereby improving overall blood lipid profiles. It's often prescribed when patients do not respond as well to other cholesterol-lowering medications like Zetia or it may be combined with such drugs for an enhanced effect. Though its flushing side-effect can be bothersome for some people, this can usually be managed effectively under medical supervision.

How effective are both Zetia and Niaspan?

Both ezetimibe (Zetia) and niacin (Niaspan) are FDA-approved medications used in the management of hyperlipidemia, a condition characterized by high levels of fats such as cholesterol and triglycerides in the blood. Both drugs have different mechanisms of action that offer varied benefits to patients. Ezetimibe works primarily by inhibiting intestinal absorption of dietary and biliary cholesterol, while niacin reduces LDL ("bad") cholesterol and triglyceride levels while increasing HDL ("good") cholesterol.

A 2008 comparative study found that both Zetia and Niaspan effectively reduced LDL-cholesterol levels, but Niaspan had an added benefit of significantly improving HDL-cholesterol levels compared to Zetia. However, it's important to note that these benefits come at a cost – Niaspan is more likely than Zetia to cause side effects like flushing, itching, nausea and increased blood sugar levels.

A comprehensive review conducted in 2010 revealed that ezetimibe has been successful in lowering LDL-cholesterol starting from the first week of treatment with a favourable safety profile even among elderly populations. As one of its kind medication working through novel mechanism on reducing intestinal absorption of cholesterol , it has become widely prescribed drug for managing high lipid disorders worldwide.

On the other hand,a meta-analysis published in 2017 indicated niacin therapy can potentially be considered as second or third line option due to its unique action on all three types i.e., LDL,HDL & Triglycerides simultaneously.However,major research data involves usage along with statins.Therefore,data confirming efficacy as standalone treatment lacks robustness when compared to ezetimebe.Due its unique pharmacology,Niacin may be optimal choice for patients who didn't respond well or have specific need related avoiding certain adverse effects associated with other antilipidemic agents.

abstract image of a researcher studying a bottle of drug.

At what dose is Zetia typically prescribed?

Oral dosages of Zetia typically range from 10 mg/day, and studies have indicated that this dosage is effective in lowering LDL cholesterol levels for most patients. There is no need to adjust the dose for elderly patients or those with mild kidney disease. Niaspan doses start at 500 mg/day at bedtime for the first month, and then increase to 1000 mg/day if well tolerated. The maximum daily dose should not exceed 2000 mg in any case as it may lead to more severe side effects.

At what dose is Niaspan typically prescribed?

Niaspan treatment is typically initiated at a dosage of 500 mg/day, taken at bedtime. After four weeks, if the response to the medication is not sufficient, the dose can be increased to 1000 mg/day, again taken at bedtime. The maximum recommended dose for Niaspan is 2000 mg per day, which may be considered after several weeks if there's no adequate response to treatment with lower dosages. This should also be administered as one single evening or bedtime dose and never divided throughout the day. As always consult your healthcare provider before making any changes in your dosage.

What are the most common side effects for Zetia?

Possible side effects of Zetia can include:

  • Diarrhea
  • Joint pain, back pain
  • Sinusitis (sinus inflammation)
  • Coughing
  • Fatigue (general weakness and tiredness)
  • Abdominal pain

On the other hand, Niaspan may cause:

  • Flushing (warmth, redness, itching under the skin)
  • Increased heartbeat
  • Dizziness or faintness
  • Sweating or chills -Nausea/vomiting -Diarrhea/constipation -Cough/runny nose

It's important to note that not everyone experiences these side effects and they typically go away over time as your body adjusts to the medication. However if any of these persist or worsen consult your healthcare provider immediately.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Zetia?

While Zetia and Niaspan are both drugs used to manage cholesterol levels, they do come with their own set of potential side effects. Here are some severe but rare side effects that could be experienced when using Zetia:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
  • Muscle pain or weakness in the absence of fever or flu symptoms
  • Feeling tired or weak
  • Dark colored urine
  • Upper stomach pain, loss of appetite
  • Jaundice (yellowing of the skin and eyes)

For Niaspan:

  • Signs of an allergic reaction like rash; hives; itching; redness/swelling/ blistering/peeling with fever; wheezing tightness in chest/throat trouble breathing/swallowing/talking unusual hoarseness swelling around mouth/face/lips/tongue/gullet.
  • Symptoms indicating liver problems such as persistent nausea/vomiting loss of appetite stomach / abdominal pains yellow eyes/skin dark urine.
  • Gout attacks muscle pain/tenderness/weakness especially if it comes along with a fever/body ache/unusual fatigue fast/pounding heartbeat/easy bruising bleeding

In case you experience any severe reactions while on these medications stop taking them immediately and seek urgent medical attention.

What are the most common side effects for Niaspan?

Niaspan, a type of niacin used to lower cholesterol and triglyceride levels in the blood, may cause side effects such as:

  • Flushing (warmth, redness or tingly feeling under your skin)
  • Mild dizziness
  • Itching under the skin or rash
  • Dryness of the skin
  • Nausea, diarrhea, upset stomach
  • Insomnia (difficulty sleeping)
  • Coughing or stuffy nose
  • Sweating or chills.

It's important to note that these symptoms are usually mild and often decrease over time with continued use. However, if any of these persist or worsen it is advised to seek medical help immediately.

Are there any potential serious side effects for Niaspan?

While Niaspan is generally well-tolerated, it can occasionally cause serious side effects. These may include:

  • Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • Severe skin reactions including redness, itching, peeling or blistering
  • Rapid heartbeat and flushing (sudden warmth and redness in the face)
  • Dizziness or fainting spells
  • Unexplained muscle pain or tenderness especially if accompanied by fever
  • Yellowing of the skin or eyes which could indicate liver problems
  • Changes in vision If you experience any of these symptoms while taking Niaspan, seek medical attention immediately.

Contraindications for Zetia and Niaspan?

Both Zetia and Niaspan, like most cholesterol-lowering medications, can cause side effects in some individuals. If you notice muscle pain or weakness, yellowing of the skin or eyes (jaundice), dark urine, stomach pain or loss of appetite while taking these medications, please seek immediate medical attention.

Neither Zetia nor Niaspan should be taken if you are currently using a statin medication and have active liver disease. Always inform your doctor about all the medicines you are taking; certain drugs may interact with Zetia and Niaspan leading to potentially harmful effects. It's also important to note that drinking alcohol while on Niaspan could increase the risk of liver damage.

How much do Zetia and Niaspan cost?

For the brand-name versions of these drugs:

  • The price of a 30-tablet pack of Zetia (10 mg) averages around $300, which works out to approximately $10/day.
  • The price for a 30-tablet pack of Niaspan (1000 mg) is about $130, working out to roughly $4.33/day.

Therefore, if you are on the standard dosages for either medication, then the brand-name version Niaspan is less expensive on a per-day treatment basis compared to Zetia. However, cost should not be your main consideration when deciding which drug may be right for you.

Regarding generic equivalents:

  • Ezetimibe (the active ingredient in Zetia) can cost as low as $1 per day if bought in bulk quantities.
  • Likewise, extended-release niacin ER (Niaspan's active ingredient), costs significantly less than its branded counterpart – averaging between about $0.50 and $1.60 per day depending upon dose and quantity purchased.

Remember that affordability does not necessarily equate efficacy or suitability - always consult with your healthcare provider before making any changes to your medication regimen.

Popularity of Zetia and Niaspan

Ezetimibe, also known by its brand name Zetia, is a medication used to lower cholesterol levels. It was prescribed to about 9 million people in the United States in 2020 and accounted for approximately 22% of prescriptions for cholesterol-lowering drugs. The demand for ezetimibe has been relatively steady over the past decade due to its efficacy and tolerability.

Niacin extended-release tablets or capsules (brand name Niaspan) are another type of medication used to manage high cholesterol levels. In contrast to ezetimibe, it was prescribed to around 1.5 million people in the US during the same year, making up just under 4% of all prescriptions for lipid-regulating medications. While niacin has been available as a treatment option longer than ezetimibe, its use has declined somewhat over recent years due mostly to concerns regarding side effects such as flushing and gastrointestinal symptoms.


Both Zetia (ezetimibe) and Niaspan (niacin extended-release) are prescribed to patients who need help managing their cholesterol levels, and have been backed by clinical studies indicating that they can effectively lower bad cholesterol (LDL) while increasing good cholesterol (HDL). They may also be used in combination under the careful supervision of a physician, although this is generally reserved for patients with particularly challenging cases of dyslipidemia.

Zetia operates primarily by blocking the absorption of dietary cholesterol in the intestines, whereas Niaspan works mainly by reducing LDL production in the liver while raising HDL levels. Therefore, these drugs tend to be prescribed differently depending on individual patient needs.

Zetia is often considered as an adjunctive therapy to statins or for those unable to tolerate them due to side effects. On the other hand, Niaspan might be utilized when there's a specific need to significantly elevate HDL or reduce triglycerides alongside lowering LDL.

Both medications are available generically which offers substantial cost savings especially for individuals paying out-of-pocket. An adjustment period may be required before seeing improvements in lipid profiles.

Side effect profiles differ between these two drugs: Zetia has fewer common side effects compared with Niaspan which can cause flushing and gastrointestinal discomfort but this could lessen over time as your body adjusts to it. For both medications, regular monitoring through blood tests should occur so any potential adverse effects can swiftly be detected and responded upon.