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Also known as: 163222-33-1, Zetia, Ezetrol, Ezedoc, Sch 58235, Sch58235
Molecular Formula
C24H21F2NO3
Molecular Weight
409.4  g/mol
InChI Key
OLNTVTPDXPETLC-XPWALMASSA-N
FDA UNII
EOR26LQQ24

Ezetimibe
An azetidine derivative and ANTICHOLESTEREMIC AGENT that inhibits intestinal STEROL absorption. It is used to reduce total CHOLESTEROL; LDL CHOLESTEROL, and APOLIPOPROTEINS B in the treatment of HYPERLIPIDEMIAS.
Ezetimibe is a Dietary Cholesterol Absorption Inhibitor. The physiologic effect of ezetimibe is by means of Decreased Cholesterol Absorption.
1 2D Structure

Ezetimibe

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
(3R,4S)-1-(4-fluorophenyl)-3-[(3S)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)azetidin-2-one
2.1.2 InChI
InChI=1S/C24H21F2NO3/c25-17-5-1-15(2-6-17)22(29)14-13-21-23(16-3-11-20(28)12-4-16)27(24(21)30)19-9-7-18(26)8-10-19/h1-12,21-23,28-29H,13-14H2/t21-,22+,23-/m1/s1
2.1.3 InChI Key
OLNTVTPDXPETLC-XPWALMASSA-N
2.1.4 Canonical SMILES
C1=CC(=CC=C1C2C(C(=O)N2C3=CC=C(C=C3)F)CCC(C4=CC=C(C=C4)F)O)O
2.1.5 Isomeric SMILES
C1=CC(=CC=C1[C@@H]2[C@H](C(=O)N2C3=CC=C(C=C3)F)CC[C@@H](C4=CC=C(C=C4)F)O)O
2.2 Other Identifiers
2.2.1 UNII
EOR26LQQ24
2.3 Synonyms
2.3.1 MeSH Synonyms

1. (1-(4-fluorophenyl)-(3r)-(3-(4-fluorophenyl)-(3s)-hydroxypropyl)-(4s)-(4-hydroxyphenyl)-2-azetidinone)

2. 58235, Sch

3. Ezetimib

4. Ezetrol

5. Sch 58235

6. Sch-58235

7. Sch58235

8. Zetia

2.3.2 Depositor-Supplied Synonyms

1. 163222-33-1

2. Zetia

3. Ezetrol

4. Ezedoc

5. Sch 58235

6. Sch58235

7. (3r,4s)-1-(4-fluorophenyl)-3-[(3s)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)azetidin-2-one

8. Sch-58235

9. Ezetimibe (zetia)

10. (3r,4s)-1-(4-fluorophenyl)-3-((s)-3-(4-fluorophenyl)-3-hydroxypropyl)-4-(4-hydroxyphenyl)azetidin-2-one

11. Eor26lqq24

12. Chebi:49040

13. Mk0653

14. Nsc-758923

15. (3r,4s)-1-(p-fluorophenyl)-3-((3s)-3-(p-fluorophenyl)-3-hydroxypropyl)-4-(p-hydroxyphenyl)-2-azetidinone

16. 1-(4-fluorophenyl)-3(r)-[3-(4-fluorophenyl)-3(s)-hydroxypropyl]-4(s)-(4-hydroxyphenyl)-2-azetidinone

17. Dsstox_cid_24223

18. Dsstox_rid_80127

19. Dsstox_gsid_44223

20. Zient

21. (-)-sch 58235

22. (3~{r},4~{s})-1-(4-fluorophenyl)-3-[(3~{s})-3-(4-fluorophenyl)-3-oxidanyl-propyl]-4-(4-hydroxyphenyl)azetidin-2-one

23. 2-azetidinone, 1-(4-fluorophenyl)-3-((3s)-3-(4-fluorophenyl)-3-hydroxypropyl)-4-(4-hydroxyphenyl)-, (3r,4s)-

24. 2-azetidinone, 1-(4-fluorophenyl)-3-[(3s)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)-, (3r,4s)-

25. Smr000466334

26. Cas-163222-33-1

27. Zetia (tn)

28. Unii-eor26lqq24

29. Ezetimiba

30. Ezetimibum

31. Ezetimibe [usan:inn:ban]

32. Ezetimibe)

33. Mfcd00937872

34. Hsdb 7737

35. Ezetimibe Anhydrate

36. Ezetimibe- Bio-x

37. Ncgc00095134-01

38. Ezetimibe [usan]

39. Mk-0653

40. Ezetimibe [inn]

41. Ezetimibe [jan]

42. Ezetimibe [mi]

43. Ezetimibe [hsdb]

44. Ezetimibe [vandf]

45. Ezetimibe [mart.]

46. Ezetimibe [usp-rs]

47. Ezetimibe [who-dd]

48. Schembl2871

49. Chembl1138

50. Ezetimibe (jan/usp/inn)

51. Mls000759443

52. Mls001424125

53. Mls006011921

54. Gtpl6816

55. Ezetimibe [orange Book]

56. Dtxsid1044223

57. Ezetimibe, >=98% (hplc)

58. Roszet Component Ezetimibe

59. Ex-a795

60. Ezetimibe [usp Monograph]

61. Vytorin Component Ezetimibe

62. Hms2051k16

63. Hms2236a04

64. Hms3715d06

65. Nexlizet Component Ezetimibe

66. (3r,4s)-1-(4-fluorophenyl)-3-[3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)-2-azetidinone

67. Act03511

68. Zinc3810860

69. Ezetimibe Component Of Roszet

70. Tox21_111443

71. Bdbm50371521

72. S1655

73. Stk640490

74. Ezetimibe Component Of Vytorin

75. Akos005572111

76. Ezetimibe Component Of Nexlizet

77. Tox21_111443_1

78. Ac-1057

79. Am84560

80. Ccg-100884

81. Db00973

82. Ks-1170

83. Nc00134

84. Nsc 758923

85. Ncgc00263575-01

86. Ncgc00263575-07

87. (3r,4s)-1-(4-fluorophenyl)-3-[(3s)-3-(4-fluorophenyl)-3-hydroxy-propyl]-4-(4-hydroxyphenyl)azetidin-2-one

88. 2-azetidinone, 1-(4-fluorophenyl)-3-(3-(4-fluorophenyl)-3-hydroxypropyl)-4-(4-hydroxyphenyl)-, (3r-(3alpha(s*),4beta))-

89. Be164439

90. Hy-17376

91. E1449

92. D01966

93. Ab00639916-06

94. Ab00639916-08

95. Ab00639916_09

96. 222e331

97. Ar-270/43507897

98. Q417997

99. 3-hydroxypropyl)-4-(4-hydroxyphenyl)azetidin-2-one

100. Brd-k42260897-001-09-2

101. Z1550648770

102. (3r,4s)-1-(4-fluorophenyl)-3-((s)-3-(4-fluorophenyl)-

103. Ezetimibe, United States Pharmacopeia (usp) Reference Standard

104. Ezetimibe, Pharmaceutical Secondary Standard; Certified Reference Material

105. (3r,4s)-1-(4-fluorophenyl)-3-[(3 S)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)azetidin-2-one

106. (3r,4s)-1-(4-fluorophenyl)-3-[(3s)-3-(4-fluorophenyl)- 3-hydroxypropyl]-4-(4-hydroxyphenyl)azetidin-2-one

107. (3r,4s)-1-(4-fluorophenyl)-3-[(s)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)-azetidin-2-one

108. 1-(4-fluorophenyl)-3-[3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)-2-azetidinone

109. 2-azetidinone, 1-(4-fluorophenyl)-3-(3-(4-fluorophenyl)-3-hydroxypropyl)-4-(4-hydroxyphenyl)-, (3r-(3.alpha.(s*),4.beta.))-

110. H56

2.4 Create Date
2005-06-24
3 Chemical and Physical Properties
Molecular Weight 409.4 g/mol
Molecular Formula C24H21F2NO3
XLogP34
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count5
Rotatable Bond Count6
Exact Mass409.14894986 g/mol
Monoisotopic Mass409.14894986 g/mol
Topological Polar Surface Area60.8 Ų
Heavy Atom Count30
Formal Charge0
Complexity567
Isotope Atom Count0
Defined Atom Stereocenter Count3
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameEzetimibe
PubMed HealthEzetimibe (By mouth)
Drug ClassesAntihyperlipidemic
Drug LabelZETIA (ezetimibe) is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. The chemical name of ezetimibe is 1-(4-fluorophenyl)-3(R)-[3-(4-fluorophenyl)-3(S)-hydroxypropyl]...
Active IngredientEzetimibe
Dosage FormTablet
Routeoral
Strength10mg
Market StatusTentative Approval
CompanyMylan Pharms; Glenmark Generics

2 of 4  
Drug NameZetia
PubMed HealthEzetimibe (By mouth)
Drug ClassesAntihyperlipidemic
Drug LabelZETIA (ezetimibe) is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. The chemical name of ezetimibe is 1-(4-fluorophenyl)-3(R)-[3-(4-fluorophenyl)-3(S)-hydroxypropyl]...
Active IngredientEzetimibe
Dosage FormTablet
RouteOral
Strength10mg
Market StatusPrescription
CompanyMsd Intl Gmbh

3 of 4  
Drug NameEzetimibe
PubMed HealthEzetimibe (By mouth)
Drug ClassesAntihyperlipidemic
Drug LabelZETIA (ezetimibe) is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. The chemical name of ezetimibe is 1-(4-fluorophenyl)-3(R)-[3-(4-fluorophenyl)-3(S)-hydroxypropyl]...
Active IngredientEzetimibe
Dosage FormTablet
Routeoral
Strength10mg
Market StatusTentative Approval
CompanyMylan Pharms; Glenmark Generics

4 of 4  
Drug NameZetia
PubMed HealthEzetimibe (By mouth)
Drug ClassesAntihyperlipidemic
Drug LabelZETIA (ezetimibe) is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. The chemical name of ezetimibe is 1-(4-fluorophenyl)-3(R)-[3-(4-fluorophenyl)-3(S)-hydroxypropyl]...
Active IngredientEzetimibe
Dosage FormTablet
RouteOral
Strength10mg
Market StatusPrescription
CompanyMsd Intl Gmbh

4.2 Therapeutic Uses

Ezetimibe is used alone or in combination with other antilipemic agents (i.e., a hydroxymethylglutaryl-coenzyme A [HMG-CoA] reductase inhibitor (statin), fenofibrate) as an adjunct to dietary therapy in the treatment of primary hypercholesterolemia and mixed dyslipidemia, homozygous familial hypercholesterolemia, and/or homozygous familial sitosterolemia. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1728


Ezetimibe is used alone or in combination with a statin as an adjunct to dietary therapy to decrease elevated serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, and apolipoprotein B (apo B) concentrations in the treatment of primary (heterozygous familial and nonfamilial) hypercholesterolemia. Ezetimibe in fixed combination with simvastatin is used as an adjunct to dietary therapy to decrease elevated serum total cholesterol, LDL-cholesterol, apo B, triglyceride, and non-HDL-cholesterol concentrations, and to increase HDL-cholesterol concentrations in the treatment of primary hypercholesterolemia or mixed dyslipidemia. Ezetimibe also is used in combination with fenofibrate as an adjunct to dietary therapy to decrease elevated serum total cholesterol, LDL-cholesterol, apo B, and non-HDL-cholesterol concentrations in the treatment of mixed dyslipidemia. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1728


Ezetimibe is used as an adjunct to dietary therapy to decrease elevated serum sitosterol and campesterol concentrations in patients with homozygous familial sitosterolemia. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1729


Ezetimibe may be used in combination with atorvastatin or simvastatin to decrease elevated serum total and LDL-cholesterol concentrations in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering therapies (e.g., plasma LDL apheresis) or when such therapies are not available. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1729


This is a retrospective review of all pediatric patients who received ezetimibe monotherapy as treatment for hypercholesterolemia and for whom follow-up clinical and lipid results were available. Of 36 identified patients, 26 had lipoprotein profiles suggestive of familial hypercholesterolemia (FH), and 10 had profiles suggestive of familial combined hyperlipidemia (FCHL). After a mean 105 days of treatment with ezetimibe (range, 32-175 days), total cholesterol (TC) levels decreased from 7.3 +/- 1.0 mmol/L to 5.7 +/- 1.0 mmol/L (P < .0001), and low-density lipoprotein cholesterol (LDL-C) levels decreased from 5.3 +/- 0.9 mmol/L to 3.9 +/- 0.8 (P < .0001) in patients with FH. In patients with FCHL, TC levels decreased from 6.4 +/- 2.0 mmol/L to 5.6 +/- 0.4 mmol/L (P < or = .002), and LDL-C levels decreased from 4.7 +/- 1.0 mmol/L to 3.8 +/- 0.6 mmol/L (P < or = .005). For all patients, the mean decrease in individual LDL-C values was 1.5 +/- 0.9 mmol/L or 28%. There was no significant change in triglyceride or high-density lipoprotein cholesterol levels with ezetimibe. Patients were maintained on ezetimibe with no adverse effects attributable to the medication for as long as 3.5 years. At a mean of 13.6 months (range, 1-44 months) after the initiation of ezetimibe, LDL-C levels remained decreased at 4.0 +/- 0.6 mmol/L. In this small retrospective series of children and adolescents with hypercholesterolemia, ezetimibe was safe and effective in lowering LDL-C levels.

PMID:192308 Clauss S et al; J Pediatr 154 (6): 869-72 (2009).


4.3 Drug Warning

Ezetimibe, in combination with a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin), is contraindicated in patients with active liver disease or unexplained, persistent increases in serum aminotransferase (transaminase) concentrations.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1730


In the Zetia controlled clinical trials database (placebo-controlled) of 2396 patients with a median treatment duration of 12 weeks (range 0 to 39 weeks), 3.3% of patients on Zetia and 2.9% of patients on placebo discontinued due to adverse reactions. The most common adverse reactions in the group of patients treated with Zetia that led to treatment discontinuation and occurred at a rate greater than placebo were: Arthralgia (0.3%); dizziness (0.2%); and gamma-glutamyltransferase increased (0.2%) The most commonly reported adverse reactions (incidence =2% and greater than placebo) in the Zetia monotherapy controlled clinical trial database of 2396 patients were: upper respiratory tract infection (4.3%), diarrhea (4.1%), arthralgia (3.0%), sinusitis (2.8%), and pain in extremity (2.7%).

Thomson Health Care Inc.; Physicians' Desk Reference 63 ed., Montvale, NJ 2009, p. 2158


In the Zetia + statin controlled clinical trials database of 11,308 patients with a median treatment duration of 8 weeks (range 0 to 112 weeks), 4.0% of patients on Zetia + statin and 3.3% of patients on statin alone discontinued due to adverse reactions. The most common adverse reactions in the group of patients treated with Zetia + statin that led to treatment discontinuation and occurred at a rate greater than statin alone were: Alanine aminotransferase increased (0.6%) Myalgia (0.5%) Fatigue, aspartate aminotransferase increased, headache, and pain in extremity (each at 0.2%) The most commonly reported adverse reactions (incidence =2% and greater than statin alone) in the Zetia + statin controlled clinical trial database of 11,308 patients were: nasopharyngitis (3.7%), myalgia (3.2%), upper respiratory tract infection (2.9%), arthralgia (2.6%) and diarrhea (2.5%).

Thomson Health Care Inc.; Physicians' Desk Reference 63 ed., Montvale, NJ 2009, p. 2158


In post-marketing experience with Zetia, cases of myopathy and rhabdomyolysis have been reported. Most patients who developed rhabdomyolysis were taking a statin prior to initiating Zetia. However, rhabdomyolysis has been reported with Zetia monotherapy and with the addition of Zetia to agents known to be associated with increased risk of rhabdomyolysis, such as fibrates. Zetia and any statin or fibrate that the patient is taking concomitantly should be immediately discontinued if myopathy is diagnosed or suspected. The presence of muscle symptoms and a CPK level >10 times the upper limit of normal (ULN) indicates myopathy.

Thomson Health Care Inc.; Physicians' Desk Reference 63 ed., Montvale, NJ 2009, p. 2158


For more Drug Warnings (Complete) data for Ezetimibe (15 total), please visit the HSDB record page.


4.4 Drug Indication

Ezetimibe is indicated to reduce elevated total-C, LDL-C, Apo B, and non-HDL-C in patients with primary hyperlipidemia, alone or in combination with an HMG-CoA reductase inhibitor (statin). It is also indicated to reduce elevated total-C, LDL-C, Apo B, and non-HDL-C in patients with mixed hyperlipidemia in combination with fenofibrate, and to reduce elevated total-C and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH), in combination with atorvastatin or simvastatin. Ezetimibe may also be used to reduce elevated sitosterol and campesterol in patients with homozygous sitosterolemia (phytosterolemia).


FDA Label


Prevention of coronary heart disease


Treatment of hypercholesterolaemia, Treatment of sitosterolaemia


5 Pharmacology and Biochemistry
5.1 Pharmacology

Ezetimibe was shown to reduce the levels of total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), apoprotein B (Apo B), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG), and increase high-density lipoprotein cholesterol (HDL-C) in patients with hyperlipidemia. This therapeutic effect was more profound when ezetimibe was co-administered with a statin or fenofibrate compared to either treatment alone. In clinical trials involving patients with homozygous and heterozygous familial hypercholesterolemia and in those with sitosterolemia, a recommended therapeutic dose of ezetimibe was effective in reducing the LDL levels by 15-20% while increasing HDL-C by 2.5-5%. The effects of increased exposure to ezetimibe secondary to moderate-severe hepatic impairment have not been assessed - patients meeting these criteria should avoid the use of ezetimibe. Post-marketing reports indicate the potential for myopathy and rhabdomyolysis in patients taking ezetimibe, and this risk appears to be exacerbated in patients concurrently receiving, or having recently received, statin therapy.