Ezetimibe/simvastatin

Ezetimibe/simvastatin (pronounced /ɛˌzɛtɨmɪb ˌsɪmvəˈstætɨn/) is a drug combination used for the treatment of dyslipidemia. It is a combination of ezetimibe (best known as Zetia in the United States) and the statin drug simvastatin (best known as Zocor in the U.S.). The combination preparation is marketed by Merck & Co./Schering-Plough Pharmaceuticals (joint venture) under the trade names Vytorin and Inegy.

Ezetimibe works by reducing the amount of cholesterol that the body absorbs from the food ingested.

Simvastatin is an HMG-CoA reductase inhibitor or statin. It works by blocking an enzyme that is necessary for the body to make cholesterol.

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Marketing and competition

Two Sources of Cholesterol

The combination of Ezetimibe and Simvastatin is the only product to treat both sources of cholesterol; absorption in the intestine of both biliary and dietary cholesterol, and production in the liver and peripheral tissues ^[1]. Physicians believe that the treatment of cholestrol from both sources is likely to result in lower cholesterol levels ^[2], particularly LDL cholesterol. In clinical studies, it was shown that the combination of Ezetimibe and Simvastatin was superior to Lipitor in lowering LDL cholestrol ^[3].

Advertising campaign

Vytorin has become rather well known for its television advertising campaign showing a series of split-screen images of a person and a food item ^[4] to make the point that cholesterol comes from two sources and can be absorbed from food or manufactured by the body, and that heredity plays a role in the latter. This point is a departure from the commonly held belief that high cholestrol only comes from the food that you eat ^[5]. In each commercial, the person is dressed, and the food plated, to emphasize the resemblance between the person and the food.

Some examples include:

- A woman wearing a yellow shirt with a red and green pin intended to look like a taco.

- A man wearing a white shirt with a green bow tie intended to look like a plate of pasta topped with peas.

- A woman wearing a yellow blouse with a decorative white fringe around the neck line intended to look like some sort of lemon pie surrounded with whipped cream and cookies (the cookies being the same yellow as the blouse)

- An older gentleman with rather spiky white hair intended to look like a lamb chop (with the bones of the lamb chop resembling the spiky white hair)

- A woman in a red diving suit carrying large flippers, intended to look like a lobster.

- A woman in a suit with red and white swirls, intended to look like cheese cake topped with a red swirled topping.

- A man in a brown jacket and helmet of some kind, with bright yellow goggles, intended to resemble pancakes with a similarly yellow topping of butter or margarine.

Contraindications

• Acute liver disease
• Pregnancy and breast feeding

Vytorin is currently being trialled on patients with extremely high cardiovascular risk who have been in hospital with cardiac problems in the past 10 days. It is not being trialled on the lower risk patients with raised cholesterol even though these represent the overwhelming majority of patients said to benefit from this kind of therapy.

Side effects

• Myopathy
• Rhabdomyolysis
• Myalgia
• Pain in extremities, abdomen,
• Angioedema
• Hepatitis
• Eczema
• Fatigue
• Headache
• Influenza, Pharyngitis, sinusitis and upper respiratory tract infection

Interactions

• Cyclosporine
• Danazol
• Protease inhibitors
• Verapamil
• Amiodarone
• Large amounts of niacin (nicotinic acid), grapefruit juice
• Erythromycin, telithromycin, clarithromycin
• Nefazodone

References