Known interactions

Advicor, Allium, Allium sativum, Altocor, Altoprev, Amlodipine and Atorvastatin, Antara, Atorvastatin, Atromid-S (No Longer Available), Buffered Aspirin and Pravastatin, Caduet, Cholestyramine Powder for Suspension, Clofibrate (No Longer Available), Colesevelam, Colestid, Colestid Granules, Colestipol, Colestipol Granules, Ezetimibe and Simvastatin, Fenofibrate (Micronized) Capsules, Fenofibrate Tablets, Fluvastatin, Fluvastatin Extended-Release, Garlic, Gemfibrozil, Lescol, Lescol XL, Lipitor, Lofibra, Lopid, Lovastatin, Lovastatin Extended Release, Mevacor, Niacin extended-release and lovastatin, Niacin Injection, Pravachol, Pravastatin, Pravigard PAC, Prevalite, Questran, Questran Light, Rustic Treacle, Simvastatin, Stinking Rose, Tricor, Triglide, Vytorin, Welchol, Zocor.

Introduction into 24-alpha-ethylcholestanol

Scientific Name: Stanol

Other Names: 24-alpha-ethylcholestanol, 3-beta,5-alpha-stigmastan-3-ol, Beta-sitostanol, Dihydro-beta-sitosterol, Fucostanol, Phytostanol, Plant Stanol, Plant Stanol Esters, Stigmastanol

Who is this for?

Stanol is taken by mouth to help prevent heart disease. It works by lowering total cholesterol and LDL cholesterol, the "bad" types of cholesterol that contribute to heart disease. Even though the exact ways it works are not yet understood, it is known that stanol molecules are similar in shape to cholesterol molecules. Therefore, stanol attaches to some of the places in the intestines where cholesterol is usually absorbed. Unlike cholesterol, however, very little stanol is absorbed by the body. Because it blocks cholesterol absorption, stanol forces more cholesterol to be eliminated from the body and less cholesterol enters the blood. Lower levels of cholesterol in the blood help to prevent hardening of the arteries and the formation of plaques in blood vessels. Plaques are accumulations of fat and other substances that stick in blood vessels. Eventually, plaques may lead to blood clots, heart attacks, or strokes.

When should I be careful taking it?

Because no studies were done in pregnant or breast-feeding women, little is known about how stanol might affect a developing fetus or an infant. Therefore, the use of stanol is not recommended during pregnancy or breast-feeding.

What side effects should I watch for?

No clinically significant side effects have been reported from clinical studies or from general use in Finland, where foods containing stanol have been available since 1995. However, some participants in clinical studies of stanol experienced diarrhea.

What interactions should I watch for?

Interactions have not been identified between stanol and prescription drugs, non-prescription drugs, other herbal products, or foods. However, stanol may have side effects that are not yet known. If you experience unexplained side effects while taking stanol, you should stop taking it and call your doctor or pharmacist.

Taking stanol with cholesterol-lowering drugs such as lovastatin, pravastatin or Zocor or with dietary supplements, such as garlic, niacin, or oat bran that also lower cholesterol, may result in a lower cholesterol level than would be achieved with either alone.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Although plants do not contain cholesterol, they produce plant sterols, which have a structure very similar to cholesterol. Stanol is a plant sterol that is found in pine trees and in some vegetable oils. When a modified form of stanol is taken by mouth, it blocks some of the spaces that cholesterol usually occupies in cells. As a result, stanol interferes with the body's use of cholesterol, whether the cholesterol is produced by the body or eaten in foods. More cholesterol leaves the body and less stays in the blood.

Dosage and Administration

Usually included in "functional foods" such as butter substitutes, salad dressings, or other fat-based foods, stanol has been available in Finland and other Scandinavian countries for several years. Functional foods have added health benefits in addition to their nutritive value. Introduced in the United States in the last few years, stanol-fortified products may be used alone, but more commonly they are part of a low-fat diet. Frequently, they are also used at the same time as cholesterol-lowering drugs such as HMG-CoA Reductase Inhibitors, which are also called statins.

In addition to being included in foods, stanol is also available as capsules. In clinical studies, participants with normal or high cholesterol — including children less than 2 years of age — took stanol doses ranging from 800 mg to 4000 mg daily. The results from the higher doses, however, were no better than doses of about 2000 mg per day for adults or about 1500 mg per day for children. Clinical study results appear to show that either stanol-fortified foods or stanol capsules have the same general effectiveness for lowering cholesterol.

Neither the time of day that doses are taken nor the number of doses per day seems to have any significant bearing on stanol's effects. In studies, individuals who took one large dose per day were equally as likely to show beneficial changes in cholesterol levels as those who took smaller amounts of stanol two or three times a day. About 8 out of 10 study participants showed a response to stanol, with an average 10% to 15% reduction in cholesterol from stanol alone. By comparison, diet changes typically lower cholesterol levels by about 10%; statin-type drugs generally lower LDL cholesterol by 20% to 45%.

Stanol takes 2 to 3 weeks of daily use to reach its peak effectiveness. Although taking stanol reduced cholesterol levels for adults with normal cholesterol, no significant benefits were seen for children with normal cholesterol levels. Because clinical trials lasted one year with adults and 3 months with children, the use of stanol products is not recommend for longer than these periods of time.


Stanol is used to lower "bad" total and LDL cholesterol levels and to prevent heart disease.


Pregnant women and women who are breast-feeding should avoid using stanol because little is known about stanol's effects on developing babies or nursing infants. Children should not use stanol for longer than 3 months unless a doctor supervises such use.

Side Effects

Diarrhea may be caused by stanol.


No negative interactions have been attributed to the use of stanol. It may, however, increase the effectiveness of a low-cholesterol diet and cholesterol-lowering medications.


Avery JK. Making the most of cholesterol-lowering margarines. Cleveland Clinic Journal of Medicine. 2001;68(3):194-196.

Ayesh R, Weststrate JA, Drewitt PN, Hepburn PA. Safety evaluation of phytosterol esters, part 5: faecal short chain fatty acid and microflora content, faecal bacterial enzyme activity and serum female sex hormones in healthy normolipidaemic volunteers consuming a controlled diet either with or without a phytosterol-ester enriched margarine. Food Chemistry and Toxicology. 1999;37(12):1127-1138.

Baker VA, Hepburn PA, Kennedy SJ, et al. Safety evaluation of phytosterol esters, part 1: assessment of oestrogenicity using a combination of in vivo and in vitro assays. Food Chemistry and Toxicology. 1999;37(1):13-22.

Becker M, Staab D, Von Bergmann K. Treatment of severe familial hypercholesterolemia in childhood with sitosterol and sitostanol. Journal of Pediatrics. 1993;122(2):292-296.

Blair SN, Capuzzi DM, Gottlieb SO, Nguyen TT, Morgan JM, Cater NB. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. American Journal of Cardiology. 2000;86(1):46-52.

Carson JA. Nutrition therapy for dyslipidemia. Current Diabetes Reports. 2003;3(5):397-403.

Cater NB. Plant stanol ester: review of cholesterol-lowering efficacy and implications for coronary heart disease risk reduction. Preventive Cardiology. 2000;3(3):121-130.

de Jong A, Plat J, Mensink RP. Metabolic effects of plant sterols and stanols (Review). Journal of Nutrition and Biochemistry. 2003;14(7):362-369.

Food and Drug Administration. U.S. Department of Health and Human Services. FDA authorizes new coronary heart disease health claim for plant sterol and plant stanol esters. Posted September 5, 2000. Available at: Accessed March 24, 2003.

Gotto AM Jr. Statins: powerful drugs for lowering cholesterol: advice for patients. Cardiology Patient Page. Circulation. 2002;105(13):1514-1516.

Gylling H, Miettinen TA. Cholesterol reduction by different plant stanol mixtures and with variable fat intake. Metabolism 1999;48(5):575-580.

Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. Journal of Lipid Research. 1996;37(8):1776-1785.

Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia. 1994;37(8):773-780.

Gylling H, Puska P, Vartiainen E, Miettinen TA. Serum sterols during stanol ester feeding in a mildly hypercholesterolemic population. Journal of Lipid Research. 1999;40(4):593-600.

Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol. Circulation. 1997;96(12):4226-4231.

Gylling H, Siimes MA, Miettinen TA. Sitostanol ester margarine in dietary treatment of children with familial hypercholesterolemia. Journal of Lipid Research. 1995;36(8):1807-1812.

Hallikainen MA, Sarkkinen ES, Uusitupa MI. Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. Journal of Nutrition. 2000;130(4):767-776.

Hallikainen MA, Uusitupa MI. Effects of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. American Journal of Clinical Nutrition. 1999;69(3):403-410.

Hendriks HF, Weststrate JA, van Vilet T, Meijer GW. Spreads enriched with different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects. European Journal of Clinical Nutrition. 1999;53(4):319-327.

Hepburn PA, Horner SA, Smith M. Safety evaluation of phytosterol esters, part 2: subchronic 90-day oral toxicity study on phytosterol esters: a novel functional food. Food Chemistry and Toxicology. 1999;37(5):521-532.

Homma Y, Ikeda I, Ishikawa T, Tateno M, Sugano M, Nakamura H. Decrease in plasma low-density lipoprotein cholesterol, apolipoprotein B, cholesteryl ester transfer protein, and oxidized low-density lipoprotein by plant stanol ester-containing spread: a randomized, placebo-controlled trial. Nutrition. 2003;19(4):369-374.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

Jones PJH, Ntanios FY, Raeini-Sarjaz M, Vanstone C. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. American Journal of Clinical Nutrition. 1999;69(6):1144-1150.

Jones PJ, Raeini-Sarjaz M, Ntanios FY, Vanstone C, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. Journal of Lipid Research. 2000;41:697-705.

Katan MB, Grundy SM, Jones P, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clinic Proceedings. 2003;78(8):965-978.

Ketomaki AM, Gylling H, Antikainen M, Siimes MA, Miettinen TA. Red cell and plasma plant sterols are related during consumption of plant stanol and sterol ester spreads in children with hypercholesterolemia. Journal of Pediatrics. 2003;142(5):524-531.

Law M. Plant sterol and stanol margarines and health. British Medical Journal. 2000;320:861-864.

Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and blood cholesterol levels: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2001;103(8):1177-1179.

Miettinen TA, Gylling H. Non-nutritive bioactive constituents of plants: phytosterols. International Journal of Vitamin and Nutrition Research. 2003;73(2):127-134.

Miettinen TA, Gylling H. Regulation of cholesterol metabolism by dietary plant sterols. Current Opinion in Lipidology. 1999;10(1):9-14.

Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiainen E. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. New England Journal of Medicine. 1995;333(20):1308-1312.

Nguyen TT. The cholesterol-lowering action of plant stanol esters. Journal of Nutrition. 1999;129(12):2109-2112.

Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterol-lowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clinic Proceedings. 1999;74(12):1198-1206.

Normen L, Dutta P, Lia A, Andersson H. Soy sterol esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. American Journal of Clinical Nutrition. 2000;71:908-913.

Plat J, van Onselen EN, van Heugten MM, Mensink RP. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. European Journal of Clinical Nutrition. 2000;54(9):671-677.

Tammi A, Ronnemaa T, Gylling H, et al. Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Spec Turku Coronary Risk Factors Intervention Project. Journal of Pediatrics. 2000;136(4):503-510.

Thompson PD. What's new in lipid management? Pharmacotherapy. 2003;23(9 Pt 2):34S-40S.

Vorlat A, Conraads VM, Vrints CJ. Regular use of margarine-containing stanol/sterol esters reduces total and low-density lipoprotein (LDL) cholesterol and allows reduction of statin therapy after cardiac transplantation: preliminary observations. Journal of Heart and Lung Transplantation. 2003;22(9):1059-1062.

Weststrate JA, Ayesh R, Bauer-Plank C, Drewitt PN. Safety evaluation of phytosterol esters, part 4: faecal concentrations of bile acids and neutral sterols in healthy normolipidemic volunteers consuming a controlled diet either with or without a phytosterol-ester enriched margarine. Food Chemistry and Toxicology. 1999;37(11):1063-1071.

Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. European Journal of Clinical Nutrition. 1998;52(5):334-343.

Williams CL, Bollella MC, Strobino BA, Boccia L, Campanaro L. Plant stanol ester and bran fiber in childhood: effects on lipids, stool weight and stool frequency in preschool children. Journal of the American College of Nutrition. 1999;18(6):572-581.

(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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