Combination therapies have been used to treat several conditions, the theory being that combining drugs with different mechanisms may convey added benefits. That same belief is behind Vytorin, a combination of ezetimibe (Zetia) and simvastatin (Zocor) used to lower cholesterol, a chief risk factor for heart disease. Simvastatin is one of several statin drugs that help reduce the amount of cholesterol your body produces. Ezetimibe is designed to lower the amount of cholesterol absorbed through your small intestine.
HOW EFFECTIVE IS IT?
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Statin drugs when used alone may lower LDL cholesterol by as much as 60 percent, depending on the statin choice and dose, while ezetimibe alone may lower it 15 to 18 percent. Studies show that ezetimibe provides an additional 19 to 24 percent reduction in LDL cholesterol when combined with a statin. Vytorin may lower LDL cholesterol up to 60 percent and also may lower triglycerides, a type of fat in the blood, by 25 to 35 percent, depending on the starting triglyceride level. Vytorin also has been shown to increase HDL “good” cholesterol as much as 8 to 12 percent.
Experts recommend that doctors strive for an LDL cholesterol level of 70 mg/dl in high-risk patients (those with documented cardiovascular disease, diabetes or multiple cardiovascular risk factors associated with a greater than 20 percent risk of suffering a heart attack or dying from one over 10 years). “In order to achieve these aggressive goals in many patients, sometimes 50 to 60 percent or greater reductions in LDL cholesterol are necessary, and combination therapy may be needed to achieve those goals,” said Michael Rocco, M.D., a physician in The Cleveland Clinic’s Department of Cardiovascular Medicine.
USE AND PRECAUTIONS
Vytorin, available in tablets, contains 10 mg of ezetimibe and 10 to 80 mg of simvastatin, and is taken once a day with or without food. Vytorin carries a low risk of liver abnormalities and muscle tenderness and soreness. Contact your doctor if you experience muscle pain, weakness or tenderness, especially if it’s accompanied by yellowing of the skin or eyes, dark urine or abdominal pain. Dr. Rocco recommends that patients undergo a liver function blood test when they begin statin therapy, again 2 to 3 months later after initiation or dose increase, and then every 6 to 12 months.
Use of Vytorin while consuming large quantities of grapefruit or taking drugs such as cyclosporine (Sandimmune), amiodarone (Cordarone), erythromycin, niacin and gemfibrozil (Lopid) may increase your risk of serious side effects. Let your doctor know which drugs and supplements you take.
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