ezetimibe and simvastatin, Vytorin
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: ezetimibe/simvastatin
BRAND NAME: Vytorin
DRUG CLASS AND MECHANISM: Vytorin is a combination of ezetimibe (Zetia) and simvastatin (Zocor) that is used for treating high levels of cholesterol in the blood. Vytorin reduces total cholesterol and low density lipoprotein (LDL or "bad") cholesterol while it increases high density lipoprotein (HDL or "good") cholesterol. The ezetimibe component of Vytorin lowers blood cholesterol by blocking the absorption of cholesterol, including dietary cholesterol, from the intestine. It does not affect the absorption of triglycerides. The simvastatin component of Vytorin belongs to a class of drugs called HMG-CoA reductase inhibitors, commonly called "statins." Statins reduce cholesterol by blocking an enzyme in the liver (HMG-CoA reductase) that produces cholesterol. Statins lower total and LDL cholesterol in the blood as well as triglycerides. They also increase HDL cholesterol. LDL cholesterol is believed to be an important cause of coronary artery disease. Lowering LDL cholesterol levels slows and may even reverse coronary artery disease. Raising HDL cholesterol levels also may slow coronary artery disease. The FDA approved Vytorin in July 2004.
GENERIC AVAILABLE: No
PREPARATIONS: Tablets of 10/10, 10/20, 10/40, and 10/80 mg (ezetimibe/simvastatin)
STORAGE: Vytorin should be stored at room temperature, 20-25 C (68-77 F).
PRESCRIBED FOR: Vytorin is used for reducing total cholesterol, LDL cholesterol and triglycerides, and increasing HDL cholesterol.
DOSING: The recommended dose range of Vytorin is 10/10 mg to 10/40 mg, and it is administered once daily in the evening with or without food. Therapy usually is initiated with 10/10 or 10/20 mg daily, but individuals who need more than a 55% reduction in LDL cholesterol can be started on 10/40 mg daily.
Vytorin 10/80 mg is restricted to patients who have been taking Vytorin 10/80 mg chronically (for example, for 12 months or more) without evidence of muscle toxicity because the 10/80 mg dose is associated with increased risk of muscle toxicity, including rhabdomyolysis. Patients who are currently tolerating the 10/80-mg dose of Vytorin and who need an interacting drug that should not be taken with high doses of simvastatin should be switched to an alternative statin or statin-based regimen with less potential for the drug-drug interaction. Patients new to treatment with Vytorin who require more than the 10/40 mg dose should be switched to alternative agents.
DRUG INTERACTIONS: Vytorin contains simvastatin (Zocor), and numerous drugs block the elimination of simvastatin by the liver. Decreased elimination of simvastatin could increase the levels of simvastatin in the body and increase the risk of muscle toxicity from simvastatin. Vytorin should not be combined with drugs that decrease its elimination. Examples of these drugs include erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune), nefazodone (Serzone), boceprevir (Victrelis), telaprevir (incivek), voriconazole (Vfend), posaconazole (Noxafil), and HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir).
Large quantities of grape fruit juice (>1 quart daily) also will increase blood levels of simvastatin and should be avoided.
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