Novel acyl-coenzyme A:cholesterol acyltransferase inhibitor pactimibe has been evaluated in vivo; it exhibited significant serum cholesterol lowering activities in hamsters and monkeys without affecting non-high density lipoprotein cholesterol levels. The mechanism of the hypocholesterolemic action of pactimibe was examined in normocholesterolemic hamsters in this study. Results with the dual-isotope plasma ratio method indicated that pactimibe inhibits cholesterol absorption from the intestine, reduces cholesteryl ester formation in the liver, and enhances its elimination from the body. The Triton WR-1339 experiment showed that pactimibe inhibited secretion of very low density lipoprotein cholesterol from the liver. These results suggest that pactimibe is likely to have multiple mechanisms of action responsible for its effectiveness in reducing serum cholesterol.