Why is Vytorin prescribed?
Vytorin is a cholesterol-lowering drug. It is used along with a special diet to lower the amount of fatty material in the blood--triglycerides and LDL (or "bad") cholesterol--that can build up on artery walls and block blood flow. At the same time, Vytorin raises HDL (or "good") cholesterol, which helps prevent fats from building up and clogging the arteries.
Your body needs fat to function properly, but when it accumulates as fatty deposits in the arteries, it increases your risk for heart attack, stroke, and blood-vessel disease. Your doctor may prescribe Vytorin if you are at high risk for heart disease and your cholesterol level is above 130, or if you are at low risk for heart disease and your cholesterol level is above 190.
Vytorin is a combination of two drugs, simvastatin (Zocor) and ezetimibe (Zetia). Each works in a different way to lower levels of fat in the blood. Normally, the liver produces most of the cholesterol needed to maintain a healthy balance. Simvastatin works by interrupting the process of cholesterol production, mainly in the liver. Ezetimibe reduces the amount of cholesterol absorbed in the intestines.
Most important fact about Vytorin
Vytorin is usually prescribed only if diet, exercise, and weight loss fail to bring your cholesterol levels under control. It's important to remember that Vytorin is a supplement--not a substitute--for those other measures. To get the full benefit of the medication, you need to stick to the diet and exercise program prescribed by your doctor. All these efforts to keep your cholesterol levels normal are important because they may lower your risk of heart disease.
How should you take Vytorin?
Take Vytorin once a day in the evening with or without food.
If you are also using the cholesterol-lowering drugs Colestid, Questran, or WelChol, take Vytorin at least 2 hours before or 4 hours after taking the other medication.
--If you miss a dose...
Take the forgotten dose as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular schedule. Do not take two doses at once.
--Storage instructions...
Store at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Vytorin.
• More common side effects may include:
Allergic reaction including swelling of the face, lips, throat, or tongue, difficulty breathing or swallowing, or rash; flu; gallstones; headache; inflammation of the gallbladder; inflammation of the liver; inflammation of the pancreas; muscle pain, tenderness, or weakness; nausea; numbness or pain in the hands or feet; upper respiratory infection
Why should Vytorin not be prescribed?
Do not take Vytorin if you are allergic to either ezetimibe (Zetia) or simvastatin (Zocor). You should also not take Vytorin if you have liver disease or if blood tests suggest a liver problem.
If you are pregnant, plan to become pregnant, or have missed a period, do not take Vytorin. In addition, women who are breastfeeding should not use Vytorin.
Special warnings about Vytorin
Vytorin can cause the breakdown of muscle tissue, which can lead to serious kidney damage and, in rare cases, death from kidney failure. It is very important to stop taking Vytorin and call your doctor immediately if you have muscle pain, tenderness, or weakness that comes on while taking Vytorin, especially if you also have a fever and feel sick.
Vytorin can make certain medical conditions worse. If you have diabetes, kidney disease, any kind of muscle disorder, or if you have ever had liver problems, you must be carefully monitored while taking Vytorin.
Because Vytorin can cause liver problems, your doctor will order a blood test to check your liver enzymes before your first dose and again at regular intervals during treatment. You may have to stop taking Vytorin if your liver enzymes become too high.
Because of possible effects on the liver, it is important to limit your alcohol consumption while taking Vytorin.
Simvastatin and similar drugs have caused cataracts and other serious eye problems in animal studies. Be sure to alert your doctor if you have cataracts or any eye condition that gets worse.
Alert the doctor if you're scheduled to have surgery. You'll probably need to stop taking Vytorin several days beforehand.
Possible food and drug interactions when taking Vytorin
If Vytorin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. Combining it with the following increases the chance of muscle damage:

Amiodarone (Cordarone)
Antifungal medicines such as itraconazole (Sporanox) and ketoconazole (Nizoral)
Benzafibrate
Clarithromycin (Biaxin)
Clofibrate (Atromid-S)
Cyclosporine (Neoral, Sandimmune)
Erythromycin (E-Mycin, Ery-Tab, Erythrocin, and others)
Fenofibrate (Tricor)
Gemfibrozil (Lopid)
Grapefruit juice (large quantities)
HIV medicines called protease inhibitors, such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase)
Nefazodone
Niacin and nicotinic acid (Niacor, Niaspan)
Verapamil (Calan, Isoptin, and Verelan)
Other drugs that may interact with Vytorin include:

Blood-thinning drugs such as warfarin (Coumadin)
Digoxin (Lanoxin)
Propranolol (Inderal, Inderide)
You should also avoid drinking large amounts of alcohol while taking Vytorin.
Special information if you are pregnant or breastfeeding
Cholesterol is needed for a baby to develop properly. Therefore, you should not take Vytorin if you are pregnant or if you plan to become pregnant. If you find out you're pregnant during Vytorin treatment, stop taking it and call your doctor. In addition, women who are breastfeeding should not take Vytorin.
Recommended dosage
ADULTS
The usual starting dose is one 10/20 tablet containing 10 milligrams of ezetimibe and 20 milligrams of simvastatin taken once a day in the evening. The doctor may prescribe a lower starting dose (10/10) if you require less aggressive treatment and a higher one (10/40) if you need a large reduction (more than 55 percent) in LDL cholesterol. Depending on your body's response, the doctor may increase your dose at 2-week intervals up to a maximum of 10/80 milligrams a day.
If you're taking cyclosporine, the dose of Vytorin should not exceed 10/10 milligrams a day. If you're taking amiodarone or verapamil, the dose should not exceed 10/20 milligrams a day.
If you have severe kidney disease, the doctor may prescribe a lower dose or have you stop taking Vytorin altogether.
CHILDREN 10 YEARS OF AGE OR OLDER
Vytorin has not been studied in children or adolescents. However, one of the ingredients, simvastatin, is approved for use in children 10 years and older. The recommended starting dose is 10 milligrams once a day in the evening. The dosage may be increased every 4 weeks, as determined by the doctor, up to a maximum of 40 milligrams a day. Girls must have been menstruating for at least 1 year before starting therapy with simvastatin. The drug has not been studied in children less than 10 years old or in doses greater than 40 milligrams a day.
There is limited experience with the use of ezetimibe in children. The drug appears to be metabolized the same as in adults. Ezetimibe is not recommended for children less than 10 years old.
Because of the individual recommendations for simvastatin and ezetimibe, Vytorin is also not recommended for children less than 10 years old.
Overdosage
Although there is no specific information about Vytorin overdose, any medication taken in excess can have serious consequences. If you suspect an overdose, seek emergency treatment immediately.