Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
Vytorin Generic Name & Formulations
Legal Class
Rx
General Description
Ezetimibe, simvastatin; 10mg/10mg, 10mg/20mg, 10mg/40mg, 10mg/80mg; tabs.
Pharmacological Class
Cholesterol absorption inhibitor + HMG-CoA reductase inhibitor.
How Supplied
Tabs 10mg/10mg—30, 90, 10000; 10mg/20mg, 10mg/40mg, 10mg/80mg—30, 90
Manufacturer
Generic Availability
YES
Vytorin Indications
Indications
Adjunct to diet in primary hyperlipidemia (heterozygous familial and non-familial) or mixed hyperlipidemia: to reduce elevated total-C, LDL-C, apo B, TG and non-HDL-C, and to increase HDL-C. Adjunct to or when other lipid-lowering treatments for homozygous familial hypercholesterolemia (HoFH) are not available: to reduce elevated total-C and LDL-C.
Limitations of Use
No incremental benefit on cardiovascular morbidity/mortality over and above that demonstrated for simvastatin has been established. Not studied in Fredrickson type I, III, IV, and V dyslipidemias.
Vytorin Dosage and Administration
Adult
Take once daily in the PM. ≥17yrs: Initially 10mg/10mg or 10mg/20mg; for LDL-C reduction >55%: may start at 10mg/40mg; monitor lipids after 2 wks then periodically. HoFH: 10mg/40mg. Concomitant verapamil, diltiazem, dronedarone: max 10mg/10mg. Concomitant amiodarone, amlodipine, ranolazine: max 10mg/20mg. Concomitant bile acid sequestrants: give Vytorin dose either ≥2hrs before or ≥4hrs after bile acid sequestrant administration. Concomitant lomitapide: reduce Vytorin dose by 50%; max 10mg/20mg daily (or 10mg/40mg daily for those previously taken simvastatin 80mg/day chronically). Renal impairment (eGFR<60mL/min/1.73m2): 10mg/20mg/day. Restrict 10mg/80mg dose to chronic users (≥12mos) without evidence of muscle toxicity; if currently tolerating Vytorin 10mg/80mg dose and need to start a contraindicated drug or one associated with a simvastatin dose cap: switch to an alternative statin with less potential drug interaction. If patients unable to achieve their LDL-C goal using Vytorin 10/40mg: do not titrate to 10mg/80mg dose, switch to alternative regimen that provides greater LDL-C lowering.
Children
<10yrs or premenarchal: not studied. 10–17yrs: see full labeling.
Vytorin Contraindications
Contraindications
Concomitant strong CYP3A4 inhibitors (eg, itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone, cobicistat-containing agents), gemfibrozil, cyclosporine, danazol. Active liver disease. Unexplained persistent elevated hepatic transaminases. Pregnancy (Cat.X). Nursing mothers.
Vytorin Boxed Warnings
Not Applicable
Vytorin Warnings/Precautions
Warnings/Precautions
Increased risk of myopathy/rhabdomyolysis with simvastatin 80mg doses including predisposing factors (eg, age ≥65yrs, female gender, uncontrolled hypothyroidism, renal impairment). Discontinue if markedly elevated CPK (>10xULN) levels occur or myopathy diagnosed or suspected. Temporarily withhold if acute or serious condition predisposing to the development of renal failure secondary to rhabdomyolysis occurs. Immune-mediated necrotizing myopathy; monitor. Monitor liver function prior to initation and repeat as clinically indicated. Interrupt therapy if serious liver injury with clinical symptoms and/or hyperbilirubinemia or jaundice occurs; do not restart if alternate etiology not found. History of liver disease. Substantial alcohol consumption. Moderate to severe renal impairment. Chinese patients (may be at higher risk for myopathy): monitor. Elderly. Advise women of childbearing potential to use effective contraception; discontinue if pregnancy occurs.
Vytorin Pharmacokinetics
See Literature
Vytorin Interactions
Interactions
See Contraindications, Adults. Avoid concomitant grapefruit juice. Caution with fenofibrates, lomitapide (in HoFH patients), colchicine, amiodarone, dronedarone, verapamil, diltiazem, amlodipine, or ranolazine. Antagonized by cholestyramine. Concomitant lipid-modifying doses (≥1g/day) of niacin: not recommended in Chinese patients. Increased risk of rhabdomyolysis with concomitant daptomycin: suspend Vytorin temporarily. Monitor digoxin, coumarin anticoagulants.
Vytorin Adverse Reactions
Adverse Reactions
Headache, increased ALT, myalgia, upper respiratory tract infection, diarrhea, pain in extremity, influenza; myopathy, rhabdomyolysis, increased HbA1c and fasting serum glucose.
Vytorin Clinical Trials
See Literature
Vytorin Note
Not Applicable
Vytorin Patient Counseling
See Literature
