Ezetimibe Simvastatin

Ezetimibe/simvastatin is a prescription medicine used to lower levels of total cholesterol, LDL (bad) cholesterol, and fatty substances called triglycerides in the blood. In addition, ezetimibe/simvastatin raises levels of HDL (good) cholesterol. 

Ezetimibe/simvastatin is also used to lower cholesterol in people with homozygous familial hypercholesterolemia (HoFH, a hereditary disorder that causes high cholesterol levels).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• Certain anti-fungal medicines including:
  • itraconazole
  • ketoconazole
  • posaconazole
• HIV protease inhibitors (indinavir, nelfinavir, ritonavir, saquinavir, tipranavir, or atazanavir),
• Certain antibiotics, including:
  • erythromycin
  • clarithromycin
  • telithromycin
• nefazodone
• A fibric acid medicine for lowering cholesterol called gemfibrozil
• cyclosporine
• danazol

Taking ezetimibe/simvastatin with certain substances can increase the risk of muscle problems. It is especially important to tell your doctor if you take:

• fibric acid derivatives (such as fenofibrate)
• amiodarone (a drug used to treat an irregular heartbeat)
• verapamil, diltiazem, amlodipine, or ranolazine (drugs used to treat high blood pressure, chest pain associated with heart disease, or other heart conditions)
• large quantities of grapefruit juice (more than 1 quart daily)
• colchicine (a medicine used to treat gout)
• voriconazole (an anti-fungal medicine)
• large doses of niacin or nicotinic acid

Tell your doctor if you are taking niacin or a niacin-containing product, as this may increase your risk of muscle problems, especially if you are Chinese.

It is also important to tell your doctor if you are taking coumarin anticoagulants (drugs that prevent blood clots, such as warfarin).

Grapefruit and grapefruit juice may interact with ezetimibe/simvastatin and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Tell your doctor if you are breastfeeding. 

It is not known if ezetimibe/simvastatin crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using ezetimibe/simvastatin.

Take ezetimibe/simvastatin exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The usual dosage range is 10/10 mg/day to 10/40 mg/day. The recommended usual starting dose is 10/10 mg/day or 10/20 mg/day. Ezetimibe/simvastatin should be taken as a single daily dose in the evening, with or without food. 

Due to the increased risk of myopathy (muscle disease), including rhabdomyolysis, particularly during the first year of treatment, use of the 10/80-mg dose of ezetimibe/simvastatin should be restricted to patients who have been taking ezetimibe/simvastatin 10/80 mg chronically (e.g., for 12 months or more) without evidence of muscle toxicity.

Taking ezetimibe/simvastatin with other medicines:

• Patients taking Verapamil or Diltiazem: the dose of ezetimibe/simvastatin should not exceed 10/10 mg/day.
• Patients taking Amiodarone, Amlodipine or Ranolazine: the dose of ezetimibe/simvastatin should not exceed 10/20 mg/day.
• Patients taking Bile Acid Sequestrants (cholestyramine (Locholest light, Locholest, Prevalite), colestipol (Colestid, Flavored Colestid ), and colesevelam (Welchol) : dosing of ezetimibe/simvastatin should occur either ≥2 hours before or ≥4 hours after administration of a bile acid sequestrant.

If you take too much ezetimibe/simvastatin contact your doctor right away or call your local Poison Control Center.