Atorvastatin Ezetimibe

Atorvastatin Ezetimibe Brand Name– Liptruzet

What is Atorvastatin Ezetimibe

Atorvastatin ezetimibe is an oral antilipemic combination.

Atorvastatin is an HMG-CoA reductase inhibitor (‘statin’). Ezetimibe is a potent cholesterol absorption inhibitor and selectively blocks the intestinal absorption of cholesterol and related phytosterols.

The combination of ezetimibe with a statin results in synergistic cholesterol-lowering effects.

In a study of 628 patients with primary hyperlipidemia, the mean LDL was reduced by 56% in patients randomized to atorvastatin; ezetimibe compared to a 44% reduction with atorvastatin alone.

In another study, 556 patients at high risk for coronary heart disease (CHD) who failed to achieve an LDL cholesterol level of < 70 mg/dL after at least 4 weeks of atorvastatin 40 mg/day PO were randomized to combination therapy with atorvastatin 40mg/day PO and ezetimibe 10 mg/day PO or a double dose of atorvastatin (80 mg/day PO) for 6 weeks. Combination therapy resulted in a 27% reduction in LDL compared with a reduction of 11% with atorvastatin alone. In a study of patients at moderate risk for CHD (n = 168), coadministration of atorvastatin 20 mg/day PO and ezetimibe 10 mg/day PO produced a significantly greater reduction in LDL than doubling the dose of atorvastatin (31% vs. 11%) after 6 weeks.

Despite the significantly greater reductions in LDL demonstrated with combination therapy, no incremental benefit on cardiovascular morbidity and mortality has been demonstrated with atorvastatin; ezetimibe over atorvastatin alone.

Atorvastatin ezetimibe was FDA-approved in May 2013.

Indications

  • hypercholesterolemia
  • hyperlipoproteinemia

For use as an adjunctive therapy to diet for the reduction of elevated total-C, LDL-C, Apo B, TG, and non-HDL-C, and to increase HDL-C in patients with primary (heterozygous familial and nonfamilial) hypercholesterolemia or mixed hyperlipoproteinemia AND for reduction of elevated total-C and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) as an adjunct to other lipid-lowering treatments

Side Effects

  1. abdominal pain
  2. amnesia
  3. angioedema
  4. arthralgia
  5. asthenia
  6. chills
  7. cholestasis
  8. cirrhosis
  9. Co-Enzyme Q-10 deficiency
  10. confusion
  11. cough
  12. diabetes mellitus
  13. diarrhea
  14. dizziness
  15. dyspepsia
  16. dyspnea
  17. elevated hepatic enzymes
  18. eosinophilia
  19. erythema multiforme
  20. fatigue
  21. fever
  22. flushing
  23. headache
  24. hemolytic anemia
  25. hepatic failure
  26. hepatic necrosis
  27. hepatitis
  28. hyperglycemia
  29. immune-mediated necrotizing myopathy
  30. influenza
  31. insomnia
  32. jaundice
  33. leukopenia
  34. lupus-like symptoms
  35. malaise
  36. memory impairment
  37. musculoskeletal pain
  38. myalgia
  39. myasthenia
  40. myoglobinuria
  41. myopathy
  42. nausea
  43. pancreatitis
  44. paresthesias
  45. peripheral neuropathy
  46. pharyngitis
  47. photosensitivity
  48. purpura
  49. renal failure (unspecified)
  50. renal tubular obstruction
  51. rhabdomyolysis
  52. sinusitis
  53. Stevens-Johnson syndrome
  54. stroke
  55. thrombocytopenia
  56. toxic epidermal necrolysis
  57. urticaria
  58. vasculitis
  59. weakness

Monitoring Parameters

  • creatine phosphokinase (CPK)
  • LFTs
  • serum cholesterol profile
  • serum creatinine/BUN

Contraindications

  • alcoholism
  • breast-feeding
  • children
  • contraception requirements
  • diabetes mellitus
  • electrolyte imbalance
  • endocrine disease
  • females
  • geriatric
  • hepatic disease
  • hypotension
  • hypothyroidism
  • infants
  • infection
  • myopathy
  • pregnancy
  • renal impairment
  • rhabdomyolysis
  • seizure disorder
  • stroke
  • surgery
  • trauma

Interactions

  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Aliskiren
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alogliptin; Pioglitazone
  • Aluminum Hydroxide
  • Aluminum Hydroxide; Magnesium Carbonate
  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
  • Amiodarone
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Antacids
  • Apalutamide
  • Aprepitant, Fosaprepitant
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
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  • Carbamazepine
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  • Cimetidine
  • Ciprofloxacin
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  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etravirine
  • Everolimus
  • Fenofibrate
  • Fenofibric Acid
  • Fluconazole
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  • Gemfibrozil
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  • grapefruit juice
  • Hydantoins
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Idelalisib
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  • Indinavir
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