Dr Frank replied: "I am afraid this is the optimum dose of Ezetimibe. It is not a particularly powerful drug, and as you probably know, ideally it was designed as an add on to statins rather than a substitute,(except in those that can't tolerate statins.) It is also worth remembering that though it definitely reduces cholesterol somewhat it has not yet been shown to affect outcomes or prevent deaths. Also as long ago as 1994 the 4S study showed that statins not only reduce cholesterol,they save lives.This is NOT only due to their lipid lowering effect but the fact that they change the nature of pre-existing plaque,changing it from 'crispy' to 'rubbery'. This reduces the risk of it breaking off and effectively producing cholesterol emboli. This feature cannot be mimicked by any other drug and is definitely not a feature of Ezetimibe. Even if it were possible to use a very small dose of a statin as well this would dramatically increase the statistics in your favour. Pravastatin,no longer favoured as it has low potency,is often well tolerated in low doses. If this were tolerated when combined with Ezetimibe, it would improve your odds even if it did not dramatically lower your cholesterol."

lhee0726_gb replied: "Cholesterol Medications Paying close attention to what you eat and how much physical activity you get are ways to lower your high blood cholesterol. These steps are generally the first line of therapy for anyone with high cholesterol. But because you have diabetes, your risk of heart disease and stroke is much higher than for someone without diabetes. That's why your healthcare provider will encourage you to eat a healthy diet and do regular physical activity to help reach optimal values. Taking a cholesterol-lowering medication can help bring those levels to goal. Learn more about each category and the benefits, side effects and risks. Current goal recommendations are: LDL — less than 100 mg/dL (an option of < 70 mg/dL in very high-risk patients) HDL — greater than 40 mg/dL for men and greater than 50 mg/dL for women triglycerides — less than 150 mg/dL No medication should be discontinued without first consulting a physician. Treatment using cholesterol-lowering medications is generally long-term. Continuing the therapy is important even when you reach a healthy cholesterol level. Types of cholesterol medications Statins Fibrates Resins Nicotinic Acid Statins For people with diabetes, lowering LDL (bad) cholesterol is usually the first priority. Several studies indicate that lowering LDL has significant benefits, including lowering the risk for cardiovascular disease. Statins are one of the most effective drugs for reducing elevated LDL cholesterol. Most of statins' side effects are mild and generally go away as your body adjusts. Muscle problems and liver abnormalities are rare. If you have brown urine or muscle aches and pains, contact your doctor right away. Side Effects: Upset stomach Abdominal pain Gas Cramps Constipation Muscle soreness, pain and weakness Liver abnormalities Commonly prescribed statins include: Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin Calcium (Crestor) Simvastatin (Zocor) Fibrates Fibrates are best at lowering triglycerides and in some cases increasing HDL (good cholesterol) levels. These drugs are not very effective in lowering LDL (bad) cholesterol. That's why fibrates are generally used in people whose triglycerides are high or whose HDL is low, after reaching LDL goal. For people with diabetes, it's still questionable whether increasing HDL cholesterol with fibrates in the presence of low LDL levels (lower than 3.4 mmol/L, or 130 mg/dL) will be more beneficial than statin therapy alone. Studies are ongoing. Side Effects: Upset stomach or diarrhea Increased risk of gallstones Increased effect of blood-thinning medications Anemia Some commonly prescribed fibrates include: Bezabifrate (Bezalip) Fenofibrate (Lofibra, Tricor) Gemfibrozil (Lopid) Resins Resins are also called bile acid-binding drugs. Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so it can't be used during digestion. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. That means less cholesterol is left to circulate through your bloodstream. The effect of bile acid sequestrants is to lower LDL cholesterol by 10 to 20 percent. Sometimes these drugs are prescribed in combination with statins. When combined, they can lower LDL-cholesterol by over 40 percent. Side effects: Constipation Stomach irritation or diarrhea Gas/Bloating/Heartburn Dizziness Some commonly prescribed medications include: Cholestyramine (Questran, Prevalite, L-Cholest) Colestipol (Cholestid) Colesevalam (Welchol) Nicotinic Acid Nicotinic acid, also called niacin or vitamin B3, is a potent lipid-lowering drug that works in the liver by affecting the production of blood fats. It's used to lower triglycerides and LDL cholesterol, and raise HDL ("good") cholesterol. Niacin comes in prescription form and as "dietary supplements." Dietary supplement niacin is not regulated by the U.S. Food and Drug Administration (FDA) the same way that prescription niacin is. It may contain widely variable amounts of niacin — from none to much more than the label states. The amount of niacin may even vary from lot to lot of the same brand. Dietary supplement niacin must not be used as a substitute for prescription niacin. It should not be used for lowering cholesterol because of potential very serious side effects. For those people with diabetes, recent studies suggest that lower dosages and newer formulations of niacin can be used safely by patients with good glycemic control. Side effects: Skin flushing Dizziness Skin rashes Stomach irritation Elevated blood glucose Liver damage Headache Some common products in this category include: Niaspan (prescription) Niacin (over the counter)"