(Ezetimibe and Pitavastatin)
We know that AAS have a significant impact on cholesterol levels. This effect is seen mainly with oral AAS, although injectable forms also influence cholesterol — just not as strongly as the oral ones.
Let’s look at a few examples from studies:
EZETIMIBE reduces the absorption of cholesterol from both food and bile. It primarily lowers LDL cholesterol and also has a mild positive effect on total cholesterol and triglycerides. Its usual daily dose is 10 mg per day. It is considered one of the best-tolerated cholesterol-lowering medications, with minimal side effects.
PITAVASTATIN (a statin) inhibits the enzyme HMG-CoA reductase, which is a key step in cholesterol synthesis in the liver. It significantly reduces LDL cholesterol, increases HDL cholesterolund lowers triglycerides. Die daily dosage typically ranges from 2 to 4 mg.
MUSCLE TOXICITY
With Ezetimibe und Pitavastatin, it is important to note that their combined use can lead to muscle toxicity (myopathy).
This occurs because statins interfere with muscle cell metabolism, particularly by reducing the synthesis of coenzyme Q10, which results in lower energy availability for muscles.
Ezetimibe alone does not significantly cause this effectaber when combined with statins, the risk increases. Despite this, their combination is highly effective and very common, often used long-term, even throughout an AAS cycle, especially when oral AAS are included.
To minimise muscle toxicity during combined use, the recommended protocol is:
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Ezetimibe 10 mg daily
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Pitavastatin 2 mg daily
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Together with coenzyme Q10, vitamin Dund magnesium
This is the most widely used combination, where the risk of muscle toxicity is minimal — side effects are more typical with other statins.
Dosage timing:
For Ezetimibe, it generally doesn’t matter whether it’s taken in the morning or evening. However, Pitavastatin should be taken before bedtime, as cholesterol synthesis peaks at night. Therefore, the ideal approach is to take both medications together before sleep. It is not necessary to use both of these compounds — one may take either Ezetimibe or Pitavastatin alone.
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