Vytorin (ezetimibe/simvastatin)

What is Vytorin?

Vytorin is a brand-name prescription drug. It’s FDA-approved to treat certain forms of high cholesterol. For this use, it can be given to adults and children ages 10 years and older.

Specifically, Vytorin is prescribed in combination with a low-cholesterol diet to treat:

• Primary hyperlipidemia. Primary hyperlipidemia is high cholesterol that has a genetic cause. Vytorin is used to treat primary hyperlipidemia that’s:
  • familial (caused by a genetic abnormality that’s passed on in families), or
  • nonfamilial (caused by the way genes interact with certain lifestyle habits)
• Mixed hyperlipidemia. Mixed hyperlipidemia is high cholesterol and high triglyceride levels, caused by a genetic abnormality that’s passed on in families.
• Homozygous familial hypercholesterolemia (HoFH). HoFH is a rare genetic condition that causes very high cholesterol, starting in childhood. Vytorin is typically used as an add-on therapy* for HoFH.

For more information about how the drug is used, see the “Vytorin uses” section below.

* As an “add-on therapy,” the drug may be “added on” to other cholesterol-lowering treatments that you may already be using.

Vytorin drug class and form

Vytorin comes as a tablet that’s taken by mouth once a day. It’s typically taken in the evening.

There are two active drugs in Vytorin that work to lower cholesterol. These active drugs belong to different classes, which means the drugs work in different ways. Vytorin’s active drugs are:

• Ezetimibe, which belongs to a drug class called cholesterol absorption inhibitors. Drugs in this class work to prevent your small intestine from absorbing cholesterol.
• Simvastatin, which belongs to a drug class called statins. Statins work to prevent your liver from making cholesterol.

Vytorin tablets are available in four strengths:

• 10 milligrams (mg) of ezetimibe/10 mg of simvastatin
• 10 mg of ezetimibe/20 mg of simvastatin
• 10 mg of ezetimibe/40 mg of simvastatin
• 10 mg of ezetimibe/80 mg of simvastatin

Effectiveness

For information about Vytorin’s effectiveness, see the “Vytorin uses” section below.

Vytorin generic

Vytorin is a brand-name drug that contains two active drugs: ezetimibe and simvastatin. This combination of active drugs is also available as a generic drug called ezetimibe/simvastatin. A generic drug is an exact copy of the active drug in a brand-name medication.

The active drugs in Vytorin are also available separately, as generic drugs and as brand-name drugs. Zetia is the brand-name form of ezetimibe. And Zocor and FloLipid are brand-name forms of simvastatin.

Generics are considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using a generic form of Vytorin, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition.

Vytorin uses

The Food and Drug Administration (FDA) approves prescription drugs such as Vytorin to treat certain conditions.

Vytorin for high cholesterol

Vytorin is FDA-approved to treat certain forms of high cholesterol in adults and children ages 10 years and older.

Specifically, Vytorin is used in combination with a low-cholesterol diet to treat:

• Primary hyperlipidemia. Primary hyperlipidemia is high cholesterol that has a genetic cause. Vytorin can be used to treat primary hyperlipidemia that’s either:
  • familial (caused by a genetic abnormality that’s passed on in families), or
  • nonfamilial (caused by the way genes interact with certain lifestyle habits such as diet, activity level, and whether you smoke)
• Mixed hyperlipidemia. Mixed hyperlipidemia is high cholesterol and high triglyceride levels, caused by a genetic abnormality that’s passed on in families.
• Homozygous familial hypercholesterolemia (HoFH). HoFH is a rare genetic condition that causes very high cholesterol, starting in childhood. To learn more about Vytorin treatment for HoFH, see “Vytorin as an add-on treatment for familial high cholesterol” below.

What high cholesterol is

Cholesterol is a type of fat. Your body uses it to make cell membranes, certain hormones, and vitamin D. Cholesterol is made by your liver, and it’s also found in various foods. These foods include certain meats, eggs, and dairy products.

The main forms of fat found in your body are as follows:

• Low-density lipoprotein (LDL) cholesterol. LDL cholesterol is sometimes called “bad cholesterol.” When you have high cholesterol, this means you have too much LDL cholesterol in your blood. This increases your risk for heart attack and stroke. Having high levels of LDL cholesterol can lead to a condition called atherosclerosis. With atherosclerosis, LDL cholesterol builds up in your arteries. This results in your arteries becoming narrower, which can restrict blood flow. In some cases, atherosclerosis can lead to heart attack or stroke.
• High-density lipoprotein (HDL) cholesterol. HDL cholesterol is sometimes called “good cholesterol.” High levels of HDL cholesterol help to prevent LDL cholesterol from building up in your arteries. HDL cholesterol helps protect against heart attack and stroke.
• Triglycerides. Similar to cholesterol, triglycerides are a type of fat. A high triglyceride level is a symptom of mixed hyperlipidemia, which Vytorin is used to treat. Having high triglyceride levels increases your risk for heart attack and stroke. Your body makes triglycerides from fats and sugars that you eat. Triglycerides are then used by your body for energy. Some triglycerides are also made in your liver. However, if you get more fats and sugars from your diet than your body needs, some triglycerides are stored in your body fat. This increases your risk for heart attack and stroke.

What Vytorin does

Vytorin is used to reduce increased levels of cholesterol, triglycerides, and other lipids.* And having lower levels of these lipids lowers your risk for heart attack and stroke. It also lowers your risk for sickness or death caused by cardiovascular disease (problems with your heart and blood vessels).

The active drugs in Vytorin work together in different ways to lower cholesterol. These active drugs are ezetimibe and simvastatin. Specifically, Vytorin works to lower levels of:

• LDL cholesterol (“bad” cholesterol)
• total cholesterol (the total level of all forms of cholesterol in your blood)
• apolipoprotein B (a protein your body uses to make LDL cholesterol)
• non-HDL cholesterol (all fats that raise your risk for heart disease, including LDL cholesterol)
• triglycerides

Vytorin also works to increase your level of HDL cholesterol (“good” cholesterol).

Vytorin is prescribed in combination with a low-cholesterol diet. It may be used when following a low-cholesterol diet and an exercise plan hasn’t lowered your cholesterol enough.

For more information about how Vytorin works in the body, see the “How Vytorin works” section below.

Note: It’s not known if Vytorin is effective in treating high levels of two specific forms of bad cholesterol: ultra-low-density lipoprotein (ULDL) cholesterol and very-low-density lipoprotein (VLDL) cholesterol. If you have high levels of ULDL or VLDL cholesterol, your doctor may recommend a drug other than Vytorin.

* Blood lipids are fatty substances found in your bloodstream. Cholesterol and triglycerides are two types of lipids.

Effectiveness for high cholesterol

Several clinical studies have shown Vytorin to be effective in treating high cholesterol caused by primary hyperlipidemia. These studies* have compared Vytorin with a few other treatments, which are described below.

* The specific age ranges of people who participated in these clinical studies aren’t known. However, Vytorin has been studied in adults and children ages 10 years and older.

Vytorin compared with ezetimibe and simvastatin

In a 12-week study, Vytorin was compared with each of its active drugs (simvastatin and ezetimibe) taken separately. People took either Vytorin, simvastatin alone, ezetimibe alone, or a placebo. (A placebo is a treatment with no active drug.)

In this study, the following results were seen:*

Additionally, in a 5-week study, Vytorin was compared with simvastatin alone. In one treatment group, people took a simvastatin dosage of 20 milligrams (mg) per day. This group was compared with people taking Vytorin doses of either 10 mg/10 mg, 10 mg/20 mg, or 10 mg/40 mg.†

In this study, LDL cholesterol levels were reduced by an average of:

• 47% to 59% in people who took Vytorin. (These results varied depending on dosage. In general, the higher their dosage, the more people’s cholesterol was reduced.)
• 38% in people who took simvastatin alone.

Note: In clinical studies, simvastatin alone effectively lowered cholesterol levels. Compared with simvastatin alone, Vytorin lowers cholesterol levels more. However, simvastatin also lowers your risk for heart attack, stroke, and sickness or death related to cardiovascular disease. And it isn’t known if Vytorin lowers your risk for these conditions more than simvastatin does.

* This 12-week study also looked at how these drugs affected people’s levels of other types of cholesterol. These types of cholesterol include non-HDL cholesterol and apolipoprotein B. To learn more, see Vytorin’s prescribing information.

† Vytorin dosages are given as mg of ezetimibe/mg of simvastatin.

Vytorin compared with other statin drugs

Other clinical studies have compared Vytorin with different statin drugs. (A statin is a type of cholesterol-lowering drug. Simvastatin, one of the active drugs in Vytorin, is a statin.)

In a 6-week study, Vytorin was compared with a statin drug called rosuvastatin (Crestor). In this study, the following results were seen:*

These results varied depending on the dosage of Vytorin or rosuvastatin that people took. In general, the higher their dosage, the more people’s cholesterol was reduced.

Studies have also compared Vytorin with a different statin drug, called atorvastatin (Lipitor). For more information, see the “Vytorin vs. Lipitor” section below.

* This 6-week study also looked at how these drugs affected people’s levels of other types of cholesterol. These types of cholesterol include non-HDL cholesterol and apolipoprotein B. To learn more, see Vytorin’s prescribing information.

Vytorin as an add-on treatment for familial high cholesterol

Vytorin is FDA-approved to treat high cholesterol caused by homozygous familial hypercholesterolemia (HoFH).

HoFH is a rare genetic condition. With HoFH, you inherit abnormal genes from both of your parents. These genes cause problems with the way LDL cholesterol* is removed from your blood. HoFH causes you to have very high levels of LDL cholesterol, starting in childhood. Having HoFH increases your risk for heart attack and stroke.

Vytorin is typically an add-on therapy for HoFH. This means Vytorin may be “added on” to other cholesterol-lowering treatments you may already be using. For example, while taking Vytorin to treat HoFH you may also have LDL apheresis. (This is a procedure in which your blood is passed through a machine that filters out LDL cholesterol.) Vytorin may also be used by itself as a treatment for HoFH, if these other treatments aren’t available.

* LDL cholesterol is sometimes called “bad cholesterol.” For more information, see the “What high cholesterol is” section above.

Effectiveness as an add-on treatment for familial high cholesterol

In a clinical study, Vytorin was effective in lowering LDL cholesterol in people with HoFH. In this study, people had been taking 40 mg of simvastatin. (Simvastatin is one of the active drugs in Vytorin.) One group of people switched to a higher simvastatin dose, of 80 mg. The other group of people switched to Vytorin 10 mg/40 mg or Vytorin 10 mg/80 mg.*

In the study, LDL cholesterol levels were reduced by an average of:

• 23% to 29% in people who switched to Vytorin. (These results varied depending on dosage. In general, the higher their dosage, the more people’s cholesterol was reduced.)
• 13% in people who switched to simvastatin 80 mg.

* Vytorin dosages are given as mg of ezetimibe/mg of simvastatin.

Vytorin and children

Vytorin is FDA-approved for use in children ages 10 years and older. It’s not known if the drug is safe or effective in children younger than this. It’s also not known if Vytorin is safe or effective in females* who haven’t started having periods yet.

* Our use of the term “females” refers to a person’s sex assigned at birth.

Vytorin use with other drugs

Vytorin is approved to treat certain forms of high cholesterol. It’s prescribed in combination with a low-cholesterol diet.

If you have a very high cholesterol level, your doctor might have you take Vytorin with certain other cholesterol-lowering drugs. The other treatments your doctor recommends for you may depend on your risk for heart attack and stroke, and what form of high cholesterol you have.

Additionally, Vytorin is typically an add-on treatment when it’s used for homozygous familial hypercholesterolemia (HoFH). This means Vytorin may be “added on” to other cholesterol-lowering treatments you may already be using to treat HoFH.

For more information about Vytorin’s approved uses, see the “Vytorin uses” section above.

Examples of other drugs used with Vytorin

Other types of cholesterol-lowering drugs that your doctor may prescribe for you to take with Vytorin include:

• Bile acid sequestrants. These drugs regulate the amount of bile acid in your digestive system.* Examples include:
  • cholestyramine (Prevalite, Questran)
  • colesevelam (Welchol)
  • colestipol (Colestid)
• PCSK9 inhibitors. These are drugs that help lower low-density lipoprotein (LDL) cholesterol levels. Examples include:
  • alirocumab (Praluent)
  • evolocumab (Repatha)
• Lomitapide (Juxtapid). This drug is sometimes used with Vytorin to treat HoFH.

* Bile acid is made from cholesterol and helps your body digest fats. Bile acid sequestrant drugs work by removing bile acids from the body. This causes your body to make more bile acids by breaking down cholesterol, which lowers your cholesterol levels.

Vytorin side effects

Vytorin can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Vytorin. These lists don’t include all possible side effects.

For more information about the possible side effects of Vytorin, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Vytorin, you can do so through MedWatch.

Mild side effects

Mild side effects of Vytorin can include:*

• headache
• upper respiratory infections, such as sinusitis or the common cold
• diarrhea
• muscle pain or weakness†
• back or joint pain
• pain in your arms or legs
• feeling weak or lacking energy
• insomnia (trouble sleeping)
• nausea
• dizziness
• rash or itchiness
• alopecia (hair loss)†
• memory loss†
• depression†

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Vytorin. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Vytorin’s prescribing information.

† For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Vytorin aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Myopathy (muscle damage) and rhabdomyolysis (muscle breakdown that can lead to kidney failure). Symptoms of these conditions can include:
  • severe muscle pain or weakness
  • fever
  • extreme fatigue (lack of energy)
  • dark or tea-colored urine
  • dizziness
  • confusion
  • nausea and vomiting
• Immune-mediated necrotizing myopathy or myositis (an overactive immune system response that leads to muscle cell death). Symptoms of these conditions can include:
  • muscle weakness
  • extreme fatigue (lack of energy)
  • trouble climbing stairs or standing up from a chair
  • trouble lifting your arms over your head
  • weight loss
  • trouble breathing or swallowing
• Liver problems, such as increased liver enzymes or liver failure.*
• Allergic reaction.*

* For more information about these side effects, see “Side effect details” below.

Side effects in children

Vytorin is approved for use in children ages 10 years and older. Side effects of Vytorin in children ages 10 years and older are similar to those seen in adults, as described above and below.

Side effect details

You may wonder how often certain side effects occur with Vytorin. Below are details about certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Vytorin.

Allergic reactions weren’t reported during clinical studies of Vytorin. However, allergic reactions have been reported since the drug was released onto the market. It’s not known how often this side effect may occur in people taking Vytorin.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have an allergic reaction to Vytorin, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Muscle pain

Some people may have muscle pain while taking Vytorin.

In some clinical studies, people took either Vytorin or a placebo for approximately 7 months. (A placebo is a treatment with no active drug.) In these studies, muscle pain occurred in:

• 3.6% of people who took Vytorin
• 2.4% of people who took a placebo

Muscle pain and muscle weakness can be a symptom of myopathy (muscle damage). Myopathy is a known side effect of all statin drugs, including simvastatin (one of the active drugs in Vytorin).

Your risk for muscle pain or myopathy while taking Vytorin is highest during your first year of taking the drug. But after the first year, your risk for these side effects gets lower as you continue taking the drug. For example, in a long-term clinical study, myopathy occurred in:

• 0.2% of people who took Vytorin for approximately 5 years
• 0.1% of people who took a placebo for approximately 5 years

Higher doses of Vytorin, particularly Vytorin 10 mg/80 mg,* are more likely to cause muscle damage than are lower doses. And some groups of people have a higher risk for muscle damage while taking Vytorin. For more information, see the “Vytorin precautions” section below.

Additionally, your risk for muscle problems increases if you’re taking certain other medications with Vytorin. See the “Vytorin interactions” section below to learn more about this.

Note: Muscle pain and weakness may also be signs of a serious side effect of Vytorin called immune-mediated necrotizing myopathy. This is an overactive immune system response that causes muscle cell death. Immune-mediated necrotizing myopathy is a rare side effect of statin drugs, including simvastatin (one of the active drugs in Vytorin). For a list of other possible symptoms of this side effect, see the “Serious side effects” list above.

* Vytorin dosages are given as milligrams (mg) of ezetimibe/mg of simvastatin.

When to call your doctor

Call your doctor right away if you have any unusual muscle pain, tenderness, or weakness while taking Vytorin.

It’s especially important to call your doctor right away if you have muscle problems along with other symptoms. Muscle problems with other symptoms, such as fever, can sometimes be a sign of a more serious side effect called rhabdomyolysis. (To learn more about rhabdomyolysis, see the “Serious side effects” list above.)

If you have muscle problems while taking Vytorin, your doctor may recommend a creatinine phosphokinase (CPK) blood test. CPK is an enzyme (a type of protein) that helps with muscle function. Having high levels of CPK can be a sign of muscle damage. If you have high CPK or other symptoms of muscle damage, your doctor will usually recommend that you stop taking Vytorin.

Muscle pain and weakness usually gets better after you stop taking Vytorin. But tell your doctor if you continue to have these symptoms after you stop taking Vytorin.

Increased liver enzymes

Having increased liver enzymes is a possible side effect of Vytorin. And this can be a sign of liver damage.

Liver enzymes are proteins that help your liver function. Vytorin can sometimes cause liver damage. And if cells in your liver are damaged, liver enzymes can leak into your bloodstream. This shows up as increased liver enzymes in blood tests called liver function tests. Most of the time, increased liver enzymes don’t cause any symptoms.

In clinical studies, increased liver enzymes occurred in 1.7% to 1.8% of people who took Vytorin for up to a year. It’s not known how often this side effect may have occurred in people who took a placebo in these studies. (A placebo is a treatment with no active drug.)

In a long-term clinical study, increased liver enzymes occurred in:

• 0.7% of people who took Vytorin for approximately 5 years
• 0.6% of people who took a placebo for approximately 5 years

As you continue to take Vytorin, your liver enzymes tend to return to normal levels. However, sometimes increased liver enzymes can be a sign of more serious damage to your liver.

Before you start taking Vytorin, your doctor will order liver function tests to check your liver enzyme levels. You may also have liver function tests during your Vytorin treatment.

When to call your doctor

Call your doctor right away if you have any symptoms of liver damage while taking Vytorin. These symptoms may include:

• pain in your upper abdomen (belly)
• nausea and vomiting
• yellowing of your skin or the whites of your eyes
• unusually dark-colored urine
• unusually pale-colored stools
• loss of appetite

If you have any of these symptoms, your doctor will order liver function tests to check your liver enzymes. If the tests show a problem with your liver, your doctor will usually recommend that you stop taking Vytorin.

Alopecia

Some people may have alopecia (hair loss or thinning) while taking Vytorin. But it isn’t known how often this side effect may occur with Vytorin.

Alopecia wasn’t reported in clinical studies of Vytorin. However, alopecia has been reported in some people who’ve taken Vytorin since the drug was approved and released onto the market. Alopecia has also been reported in people taking simvastatin and ezetimibe since these drugs were released. (Simvastatin and ezetimibe are the active drugs in Vytorin). But it’s not known exactly how many people had alopecia while taking these drugs.

If you’re concerned about hair loss or thinning with Vytorin, talk with your doctor.

Memory loss

Memory loss may occur while taking Vytorin. However, it’s not known how often this side effect may occur with the drug.

Memory loss wasn’t reported in clinical studies of Vytorin. But simvastatin, one of the active drugs in Vytorin, is a statin. And problems with memory have been reported as a side effect of simvastatin as well as other statin drugs.

Memory problems that occur when taking statins tend to be mild and may include:

• forgetfulness
• trouble remembering
• confusion

In some cases, memory problems have developed within a few days after starting a statin drug. In other cases, memory problems have developed after people have been taking a statin drug for years. Most memory problems get better within a few weeks after stopping statin treatment.

If you have memory problems while taking Vytorin, talk with your doctor. They may recommend switching to a different treatment.

Depression

Some people may have depression while taking Vytorin. It’s not known how often this side effect may occur with the drug, however.

Depression wasn’t reported in clinical studies of Vytorin. But it has been reported in some people who’ve taken Vytorin since the drug was approved and released onto the market. Depression has also been reported in people taking simvastatin and ezetimibe since these drugs were released. (Simvastatin and ezetimibe are the active drugs in Vytorin.) It’s not known exactly how many people have developed depression while taking these drugs, though.

Symptoms of depression may include:

• feeling sad, gloomy, or hopeless for long periods of time
• feeling irritable or anxious
• lack of energy
• changes in sleep patterns
• changes in appetite

If you’re concerned about depression while you’re taking Vytorin, talk with your doctor. And if you have symptoms of depression while taking Vytorin, tell your doctor right away.

Vytorin dosage

The Vytorin dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Vytorin to treat
• how well your kidneys work
• other medical conditions you may have
• other medications you may be taking

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Vytorin comes as a tablet that’s taken by mouth. The active drugs in Vytorin are ezetimibe and simvastatin.

Vytorin tablets are available in four strengths, which are given in milligrams (mg):

• 10 mg/10 mg (10 mg of ezetimibe/10 mg of simvastatin)
• 10 mg/20 mg (10 mg of ezetimibe/20 mg of simvastatin)
• 10 mg/40 mg (10 mg of ezetimibe/40 mg of simvastatin)
• 10 mg/80 mg (10 mg of ezetimibe/80 mg of simvastatin)

Dosage for high cholesterol

Vytorin is approved to treat certain types of high cholesterol when used with a low-cholesterol diet. (For more information on the specific conditions Vytorin can treat, see the “Vytorin uses” section above.)

For these uses, the recommended dosage of Vytorin is either 10 mg/10 mg, 10 mg/20 mg, or 10/40 mg, once a day. It’s taken in the evening.

Dosage for homozygous familial high cholesterol

Vytorin is approved to treat high cholesterol caused by homozygous familial hypercholesterolemia (HoFH). For this use, Vytorin is prescribed with a low-cholesterol diet, and is typically added on to other cholesterol-lowering treatments. (For more information see the “Vytorin uses” section above.)

For treating HoFH, the recommended dosage of Vytorin is 10 mg/40 mg, once a day. It’s taken in the evening.

Dosage in children

The recommended dosages of Vytorin for children ages 10 years and over are the same as for adults. These dosages are described above.

What if I miss a dose?

If you miss a dose of Vytorin, skip that dose and take your next dose as usual the following evening. Do not take a double dose to make up for a missed dose. “Doubling up” on doses could increase your risk for side effects from Vytorin.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

If you miss a dose of Vytorin and you aren’t sure whether to skip it or take it when you remember, contact your doctor.

Will I need to take this drug long term?

Vytorin is meant to be taken as a long-term treatment. If you and your doctor determine that Vytorin is safe and effective for you, you’ll likely take it long term.

However, if you’re taking Vytorin 10 mg/80 mg,* the length of your treatment may depend on whether you have certain side effects. This is because compared with lower doses, Vytorin 10 mg/80 mg* is more likely to cause muscle problems (such as muscle pain and weakness).

For this reason, you can only continue to take Vytorin 10 mg/80 mg* if you’ve taken this dosage for at least 12 months and you haven’t had muscle problems.

To learn more about side effects that can affect your muscles while you’re taking Vytorin, see the “Vytorin side effects” section above. And if you have questions about how long you’ll take Vytorin or what to expect during treatment, talk with your doctor.

* Vytorin dosages are given as mg of ezetimibe/mg of simvastatin.

Alternatives to Vytorin

Other drugs are available that can treat certain forms of high cholesterol. Some may be a better fit for you than others. If you’re interested in finding an alternative to Vytorin, talk with your doctor. They can tell you about other medications that may work well for you.

Examples of other drugs that may be used for high cholesterol include:

• statins, such as:
  • atorvastatin (Lipitor)
  • fluvastatin (Lescol XL)
  • lovastatin
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)
• fibrates, such as:
  • fenofibrate (Antara, Lipofen, Tricor, and more)
  • fenofibric acid (Trilipix)
  • gemfibrozil (Lopid)
• bile acid sequestrants, such as:
  • cholestyramine (Prevalite, Questran)
  • colesevelam (Welchol)
  • colestipol (Colestid)
• PCSK9 inhibitors, such as:
  • alirocumab (Praluent)
  • evolocumab (Repatha)
• ezetimibe (Zetia)
• niacin (Niacor, Niaspan)
• lomitapide (Juxtapid), which is used specifically to treat homozygous familial hypercholesterolemia (HoFH)

Vytorin vs. Lipitor

You may wonder how Vytorin compares with other medications that are prescribed for similar uses. Here we look at how Vytorin and Lipitor are alike and different.

Ingredients

Vytorin contains two active drugs: ezetimibe and simvastatin. On the other hand, Lipitor contains one active drug: atorvastatin.

Simvastatin and atorvastatin both belong to a class of drugs called statins. (A class of drugs is a group of medications that work in a similar way.) Statins work to lower cholesterol by stopping your liver from making cholesterol.

Ezetimibe belongs to a different class of drugs, called cholesterol absorption inhibitors. These types of drugs work to lower cholesterol by preventing your small intestine from absorbing cholesterol.

Uses

Both Vytorin and Lipitor are approved for use with a low-cholesterol diet to treat the following forms of high cholesterol in adults:

• primary hyperlipidemia
• mixed hyperlipidemia
• homozygous familial hypercholesterolemia (HoFH)

For these uses, Vytorin is also approved for use in children ages 10 years and older. For more information about these forms of high cholesterol, see the “Vytorin uses” section above.

Additionally, Lipitor is approved for use with a low-cholesterol diet to:

• reduce the risk of heart attack, stroke, angina (chest pain), and heart surgery in adults who either have heart disease or have risk factors for heart disease
• treat high levels of triglycerides in adults
• treat primary dysbetalipoproteinemia (a genetic cholesterol condition) in adults
• treat HoFH in children ages 10 to 17 years

Drug forms and administration

Both Vytorin and Lipitor come as a tablet that’s taken by mouth. Each drug is taken once a day.

Side effects and risks

Vytorin and Lipitor both contain a statin drug. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with either Vytorin or Lipitor, as well as mild side effects that both drugs may share.

• Can occur with Vytorin:
  • headache
  • feeling weak or lacking energy
  • dizziness
• Can occur with Lipitor:
  • urinary tract infection (UTI)
  • indigestion
  • sore throat
• Can occur with both Vytorin and Lipitor:
  • nausea
  • upper respiratory infections, such as sinusitis or the common cold
  • diarrhea
  • muscle pain or weakness
  • joint pain
  • pain in your arms or legs
  • insomnia (trouble sleeping)

Serious side effects

This list contains examples of serious side effects that can occur with both Vytorin and Lipitor (when taken individually):

• myopathy (muscle damage) and rhabdomyolysis (muscle breakdown that can lead to kidney failure)
• immune-mediated necrotizing myopathy or myositis (an overactive immune system response that causes muscle cell death)
• liver problems, such as increased liver enzymes or liver failure
• allergic reaction

Effectiveness

Vytorin and Lipitor have some different FDA-approved uses, but they’re both used to lower high cholesterol.

The use of Vytorin and Lipitor in treating primary hyperlipidemia has been directly compared in clinical studies. In these studies, Vytorin was more effective than Lipitor in lowering cholesterol.

For example, in one 6-week study, the following results were seen:

These results varied depending on the dosages that people took. In general, the higher their dosage, the more people’s cholesterol was reduced.

(For more details about what total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides are, see the “Vytorin uses” section above.)

Costs

Vytorin and Lipitor generally cost about the same. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Vytorin and Lipitor are both brand-name drugs. In addition, Lipitor is available as the generic drug atorvastatin. And Vytorin’s active drugs (ezetimibe and simvastatin) are available in generic form, both separately and as a combination. (For details, see the “Vytorin generic” section above.)

A generic drug is an exact copy of an active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Vytorin cost

As with all medications, the cost of Vytorin can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Vytorin, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Vytorin, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Vytorin, or if you need help understanding your insurance coverage, help is available.

Merck, the manufacturer of Vytorin, offers a program called Merck Helps, which may provide ways to lower the cost of Vytorin. For more information and to find out if you’re eligible for support, call 800-727-5400 or visit the program website.

Generic version

Vytorin is a brand-name drug that contains two active drugs: ezetimibe and simvastatin. This active drug combination is also available as a generic medication. (Additionally, both of Vytorin’s active drugs are available separately in generic and brand-name forms. For details, see the “Vytorin generic” section above.)

A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

If you’re interested in using a generic form of Vytorin, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition. You’ll also need to check your insurance plan, as it may only cover one or the other.

Vytorin and alcohol

Vytorin hasn’t been shown to interact with alcohol. However, drinking alcohol while you’re taking Vytorin could increase your risk for liver damage with Vytorin. This is because regularly drinking large amounts of alcohol can damage your liver, and Vytorin can also cause liver damage.

Drinking large amounts of alcohol also increases your risk for high cholesterol, which Vytorin is used to treat.

If you drink alcohol, talk with your doctor about how much may be safe for you to drink while you’re taking Vytorin.

Vytorin interactions

Vytorin can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For example, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Vytorin and other medications

Below are examples of medications that can interact with Vytorin. This section doesn’t contain all drugs that may interact with Vytorin.

Before taking Vytorin, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Vytorin and certain antimicrobials

Antimicrobials are medications that treat infections. Certain antimicrobial drugs shouldn’t be taken with Vytorin. This is because these drugs can cause Vytorin to build up in your body. And this buildup can increase your risk for side effects from Vytorin. These side effects may include myopathy (muscle pain or weakness) or rhabdomyolysis (muscle breakdown that can lead to kidney failure).

Examples of antimicrobial drugs that shouldn’t be taken with Vytorin include:

• certain antibiotics, such as:
  • clarithromycin
  • erythromycin (Eryc, Ery-Tab, Erythrocin, and more)
  • telithromycin (Ketek)
  • daptomycin (Cubicin)
• certain antifungals, such as:
  • ketoconazole (Nizoral)
  • itraconazole (Sporanox)
  • posaconazole (Noxafil)
  • voriconazole (Vfend)
• certain antivirals for HIV treatment, such as:
  • atazanavir (Reyataz)
  • cobicistat (Tybost)
  • ritonavir (Norvir)
  • indinavir (Crixivan)
  • nelfinavir (Viracept)
  • saquinavir (Invirase)

If you take any of these antimicrobial drugs, talk with your doctor before starting Vytorin. They may recommend that you stop taking Vytorin temporarily.

Additionally, if you need treatment with any type of antimicrobial drug while you’re taking Vytorin, always check with your doctor first. You’ll typically start Vytorin again after you’ve completed the course of the antimicrobial drug.

Vytorin and nefazodone

Nefazodone is an antidepressant medication. Nefazodone and Vytorin shouldn’t be taken at the same time. Taking these drugs together can cause Vytorin to build up in your body. And this buildup can increase your risk for side effects from Vytorin. These side effects may include myopathy (muscle pain or weakness) or rhabdomyolysis (muscle breakdown that can lead to kidney failure).

If you take nefazodone, talk with your doctor before starting Vytorin. Your doctor can determine the best medications to treat your conditions.

Vytorin and cyclosporine or danazol

Vytorin shouldn’t be taken with the drugs cyclosporine or danazol.

Cyclosporine (Neoral, Gengraf, Sandimmune) is a drug that reduces the activity of your immune system. It may be given after an organ transplant, or to treat severe rheumatoid arthritis or psoriasis. And Danazol is a drug that’s used to treat endometriosis.

Taking Vytorin with either of these drugs can cause Vytorin to build up in your body.

This buildup can make you more likely to have side effects from Vytorin. These side effects may include myopathy (muscle pain or weakness) or rhabdomyolysis (muscle breakdown that can lead to kidney failure).

If you take cyclosporine or danazol, talk with your doctor before starting Vytorin. Your doctor can determine the best choice of medications to treat your conditions.

Vytorin and certain other cholesterol-lowering medications

Taking Vytorin with certain other cholesterol-lowering medications can increase your risk for side effects that affect your muscles. These side effects may include myopathy (muscle pain or weakness) or rhabdomyolysis (muscle breakdown that can lead to kidney failure).

Examples of these cholesterol-lowering medications include:

• fibrates, such as:
  • gemfibrozil (Lopid)*
  • fenofibrate (Trilipix, Antara, Lipofen, and more)
• niacin
• lomitapide
• bile acid sequestrants†

If you any of these types of medications, talk with your doctor. Your doctor may prescribe a lower dosage of Vytorin than usual for you to decrease your risk for muscle side effects. Or they may recommend a medication other than Vytorin to lower your cholesterol.

* Gemfibrozil (Lopid) shouldn’t be taken with Vytorin. This combination of drugs greatly increases your risk for muscle problems.

† Bile acid sequestrants are discussed below.

Vytorin and bile acid sequestrants

Bile acid sequestrants are drugs that help lower cholesterol by regulating the amount of bile acid* in your digestive system. In addition to increasing your risk for muscle side effects, bile acid sequestrants can cause your body to absorb less Vytorin than usual.

Examples of bile acid sequestrants that can reduce absorption of Vytorin include:

• cholestyramine (Prevalite)
• colestipol (Colestid)

If taken at the same time of day as Vytorin, these drugs can prevent Vytorin from being absorbed into your body as well as usual. This can make Vytorin less effective in lowering your cholesterol.

In some cases, your doctor may prescribe both a bile acid sequestrant and Vytorin. These drugs should be taken at different times of day, as recommended by your doctor. Taking them at different times reduces the risk of the drugs interacting. (For details about when to take Vytorin, see the “How to take Vytorin” section below.)

* Bile acid is made from cholesterol and helps the body digest fats. Bile acid sequestrant drugs work by removing bile acids from the body. This causes your body to make more bile acids by breaking down cholesterol, which lowers your cholesterol levels.

Vytorin and colchicine

Colchicine (Mitigare, Gloperba, Colcrys) is a drug used to treat gout. Taking Vytorin with colchicine can increase your risk for side effects from Vytorin. These side effects include myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that can lead to kidney failure).

If you take colchicine, talk with your doctor before taking Vytorin. They may prescribe a lower dosage of Vytorin than usual. Or they may recommend a medication other than Vytorin to lower your cholesterol.

Vytorin and certain heart or blood pressure medications

Taking Vytorin with certain drugs that affect your heart or blood pressure can increase your risk for side effects of Vytorin. These side effects include myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that can lead to kidney failure).

Examples of heart or blood pressure medications that can interact with Vytorin include:

• amiodarone (Pacerone)
• dronedarone (Multaq)
• ranolazine (Ranexa)
• diltiazem (Cardizem, Cartia XT)
• verapamil (Calan SR, Verelan)
• amlodipine (Norvasc)

If you take any of these medications, talk with your doctor before taking Vytorin. Your doctor may prescribe a lower dose of Vytorin than usual. Or they may recommend a medication other than Vytorin to lower your cholesterol. And if you take any other medications for your heart or blood pressure, check with your doctor about whether Vytorin is safe for you to take.

Vytorin and digoxin

Digoxin (Lanoxin) is a drug used to treat heart failure and atrial fibrillation. Taking Vytorin with digoxin can increase the level of digoxin in your body. This can increase your risk for side effects from digoxin.

If you take Vytorin with digoxin, you’ll have blood tests to check your digoxin level. If your digoxin level becomes too high, your doctor may lower your digoxin dosage.

Vytorin and certain blood thinners

Taking Vytorin with certain blood thinners can make the blood thinners more effective than usual. And this can increase your risk for bleeding and bruising.

These blood-thinning drugs are called coumarin anticoagulants. Warfarin (Jantoven) is an example of a coumarin anticoagulant.

If you take Vytorin with this type of blood thinner, your doctor may recommend that you have additional blood tests while you’re taking both drugs. These tests measure how long it takes your blood to clot. This length of time is called your International Normalized Ratio (INR). Based on your INR results, your doctor may adjust the dosage of your blood thinner.

Vytorin and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Vytorin. However, you should still check with your doctor or pharmacist before using any of these products while taking Vytorin.

Vytorin and foods

You shouldn’t eat grapefruit* or drink grapefruit juice while you’re taking Vytorin. This is because grapefruit can cause Vytorin to build up in your body. And this buildup can increase your risk for side effects of Vytorin. These side effects include myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that can lead to kidney failure).

There aren’t any other foods that have been specifically reported to interact with Vytorin.

* In addition to grapefruit, some other citrus fruits may have a similar effect on Vytorin. For details and a list of these fruits, see this article.

How Vytorin works

Vytorin is FDA-approved to treat certain types of high cholesterol in adults and certain children when used with a low-cholesterol diet. (For more information on the specific conditions Vytorin can treat, see the “Vytorin uses” section above.)

What is high cholesterol?

If you have high cholesterol, this means you have more cholesterol in your blood than you need. Cholesterol is a type of fat. Your body uses it to make cell membranes, certain hormones, and vitamin D.

Cholesterol is made by your liver, and it’s found in various foods. These foods include certain meats, eggs, and dairy products.

High cholesterol can develop if you have certain genetic conditions. It can also develop due to certain lifestyle habits. For example, if you eat a lot of high-cholesterol foods, smoke, or don’t get enough exercise, you may be more likely to have high cholesterol.

Having high cholesterol increases your risk for a heart attack or stroke.

What does Vytorin do?

Vytorin works to lower your cholesterol. It also works to lower your level of triglycerides, which are another type of fat. (High cholesterol and triglycerides are symptoms of mixed hyperlipidemia, which Vytorin is approved to treat. For more information about triglycerides and the types of cholesterol that Vytorin affects, see the “Vytorin uses” section above.)

Vytorin contains two active drugs: ezetimibe and simvastatin. These drugs work together in different ways to lower your cholesterol.

• Ezetimibe belongs to a drug class called cholesterol absorption inhibitors. (A drug class is a group of medications that work in a similar way.) Drugs in this class work to prevent your small intestine from absorbing cholesterol.
• Simvastatin belongs to a drug class called statins. Statins work to prevent your liver from making cholesterol.

How long does it take to work?

Vytorin typically lowers cholesterol levels within 2 weeks of starting treatment. However, it should be taken long term in order for the drug to keep your cholesterol at a healthy level over time.

It’s unlikely that you’ll notice the drug working. But you’ll have a blood cholesterol test (also called a lipid panel or lipid profile) to check that Vytorin is working to lower your cholesterol. If Vytorin doesn’t lower your cholesterol enough at first, your doctor may increase your dosage.

Vytorin withdrawal and dependence

Vytorin doesn’t cause drug dependence or withdrawal. (With dependence, your body needs the drug in order for you to feel normal. And with withdrawal, you have unpleasant symptoms when you stop taking a drug that your body has become dependent upon.)

Vytorin needs to be taken long term in order for the drug to keep your cholesterol at a healthy level. But this continued use isn’t the same as drug dependence.

So if your doctor recommends that you stop taking Vytorin, there’s no need to taper (slowly reduce) your dosage. However, make sure to take Vytorin as recommended by your doctor.

Common questions about Vytorin

Here are answers to some frequently asked questions about Vytorin.

Will Vytorin make me lose or gain weight?

No, Vytorin isn’t known to affect body weight. Taking it won’t help you to lose weight. And weight gain wasn’t reported in clinical studies of Vytorin.

While you’re taking Vytorin, make sure to follow the low-cholesterol diet and exercise plan recommended by your healthcare provider. If you have concerns or questions about your weight, talk with your doctor. They can help you manage a weight that’s healthy for you.

Can I take Vytorin if I have diabetes?

Yes, usually you can. However, if you have diabetes, talk with your doctor about whether you may need to monitor your blood sugar more often while you take Vytorin.

It’s possible that Vytorin could increase blood sugar levels in some people. Simvastatin, which is one of Vytorin’s active drugs, is a statin. (Statins are a type of cholesterol-lowering drug.) And statin drugs have caused increased blood sugar levels in some people.

Having diabetes increases your risk for heart disease, such as heart attack and stroke. But lowering your cholesterol can help lower this risk. In fact, simvastatin alone is sometimes given to people with diabetes to help prevent heart attack and stroke.

It isn’t known if Vytorin helps lower the risk of heart attack and stroke more than simvastatin alone. And Vytorin isn’t approved for this use. However, Vytorin can lower your cholesterol, which can in turn lower your risk for heart disease.

Make sure to talk with your doctor before starting Vytorin treatment if you have diabetes.

Will I need to have lab tests done while I’m taking Vytorin?

Yes, you will have lab tests while you’re taking Vytorin.

Before you start taking Vytorin, you’ll have a liver function test. This test checks your levels of liver enzymes. (Liver enzymes are proteins that help your liver function.)

You’ll have a liver function test because increased liver enzymes can be a side effect of Vytorin. You may also have liver function tests while you’re taking Vytorin. You may have these tests if you develop signs of liver damage. (For symptoms and more information about liver problems with Vytorin, see the “Vytorin side effects” section above.)

Your doctor may also order a blood cholesterol test (also called a lipid panel or lipid profile) at certain times during your Vytorin treatment. This test measures the levels of cholesterol in your blood. It shows how well Vytorin is working to lower your cholesterol levels.

If you have questions about lab tests that you may have while you’re taking Vytorin, talk with your doctor.

Can older people take Vytorin?

Yes, in general, Vytorin is safe for older people to take. Clinical studies have shown that Vytorin’s safety and effectiveness in older adults was similar to that in younger people.

However, people ages 65 years and older have a higher risk for muscle side effects with Vytorin, compared with younger people. These problems are myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that can lead to kidney failure). For details about possible muscle side effects, see the “Vytorin side effects” section above.

Due to this higher risk, if you’re age 65 or older, your doctor may take extra precautions before prescribing Vytorin for you. This may include ordering additional blood tests. But if you have other risk factors for muscle problems, your doctor may recommend a medication other than Vytorin to lower your cholesterol.

To learn more about risk factors for muscle problems, see the “Vytorin precautions” section below. And if you have questions about taking Vytorin given your age, talk with your doctor.

If I’m of Asian descent, can I take Vytorin?

Yes, you typically can. However, in clinical studies, people of Chinese descent had a higher risk for muscle side effects while taking either simvastatin alone or both ezetimibe and simvastatin. These side effects were myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that leads to kidney failure).

For this reason, if you’re of Chinese descent, your doctor may take extra precautions before prescribing Vytorin for you. This may include ordering additional blood tests. But if you have other risk factors for muscle problems, your doctor may recommend a medication other than Vytorin to lower your cholesterol.

To learn more about risk factors for muscle problems, see the “Vytorin precautions” section below. And if you have questions about taking Vytorin given your ethnicity, talk with your doctor.

Can I take Vytorin if I have liver or kidney disease?

You might not be able to, depending on your condition.

If you have known liver disease or blood tests that may indicate possible liver problems, you shouldn’t take Vytorin. This is because Vytorin can sometimes cause liver damage. Ask your doctor what other medications are better options for you.

If you’ve had liver disease in the past, you may have a higher than usual risk for liver damage with Vytorin. Talk with your doctor about whether Vytorin is right for you.

If you have kidney disease, you can usually take Vytorin. Vytorin is partly removed from your body by your kidneys. If you have chronic (long-term) kidney disease, Vytorin could build up in your body. This may increase your risk for certain side effects. Specifically, you’re more likely to have myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that may lead to kidney failure). For this reason, your doctor may take extra precautions, such as ordering blood tests, before prescribing Vytorin for you.

If you have long-term kidney disease and your kidneys don’t work well, you’ll likely be prescribed a low dosage of Vytorin. But your doctor may recommend a different cholesterol-lowering drug for you if you have other risk factors for muscle problems. To learn more about these risk factors, see the “Vytorin precautions” section below.

How to take Vytorin

You should take Vytorin according to your doctor’s or healthcare provider’s instructions.

When to take

Vytorin should be taken once every day. The best time to take it is in the evening. The body produces most of its cholesterol at night, so Vytorin can work better to lower your cholesterol when you take it in the evening.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Note: In some cases, your doctor may prescribe a type of drug called a bile acid sequestrant for you to take with Vytorin. If you’re taking these drugs together, make sure to take them at different times of day. Specifically, Vytorin should be taken at least 2 hours before, or at least 4 hours after, taking a bile acid sequestrant.

If you’re taking a bile acid sequestrant with Vytorin, talk with your doctor about what times of day to take each drug.

Taking Vytorin with food

Vytorin can be taken either with or without food.

Can Vytorin be crushed, split, or chewed?

The manufacturer of Vytorin hasn’t stated whether the tablets can be crushed, split, or chewed. If you have trouble swallowing tablets, talk with your doctor or pharmacist.

Vytorin and pregnancy

Vytorin isn’t safe to take during pregnancy. This is because your cholesterol level normally increases during pregnancy, as cholesterol is needed to help a fetus grow. Vytorin lowers your cholesterol level, so the drug could cause fetal harm or birth defects if used during pregnancy.

If you’re pregnant or planning to become pregnant, talk with your doctor about other treatment options for your condition. And if you become pregnant while taking Vytorin, stop taking the drug right away and call your doctor.

Vytorin and birth control

Vytorin isn’t safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re taking Vytorin.

For more information about taking Vytorin during pregnancy, see the “Vytorin and pregnancy” section above.

Vytorin and breastfeeding

Vytorin shouldn’t be taken while breastfeeding. It’s not known if Vytorin passes into breast milk. If Vytorin does pass into breast milk, it could cause serious side effects in a child who’s breastfeeding.

If you’re currently breastfeeding or planning to breastfeed, talk with your doctor about your treatment options and the best way to feed your child.

Vytorin precautions

Before taking Vytorin, talk with your doctor about your health history. Vytorin may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Allergic reaction. If you’ve ever had an allergic reaction to Vytorin or any of its ingredients, you shouldn’t take Vytorin. And you shouldn’t take Vytorin if you’ve ever had an allergic reaction to simvastatin (Zocor) or ezetimibe (Zetia). Ask your doctor what medications other than Vytorin might be better options for you.
• Liver disease. Vytorincan sometimes cause liver damage. If you have known liver disease, or blood test results that may indicate liver problems, you shouldn’t take Vytorin. You also shouldn’t take Vytorin if you have increased levels of liver enzymes called transaminases, and your doctor doesn’t know the cause. If you have active liver disease or increased liver enzymes, talk with your doctor about medications other than Vytorin. Also, if you’ve had liver disease in the past, you may have a higher risk for liver damage with Vytorin. Talk with your doctor about whether Vytorin is right for you.
• Excessive alcohol consumption. Drinking large amounts of alcohol can damage your liver. Vytorin can also cause liver damage. If you regularly drink large amounts of alcohol, either currently or in the past, you could have an increased risk for liver damage with Vytorin. Talk with your doctor about whether Vytorin is right for you.
• Kidney disease. Vytorin is partly removed from your body by your kidneys. If you have chronic (long-term) kidney disease, Vytorin could build up in your body. This buildup could increase your risk for certain side effects from Vytorin. Specifically, you’re more likely to have myopathy (muscle pain or weakness) and rhabdomyolysis (muscle breakdown that may lead to kidney failure). For this reason, your doctor may prescribe a lower dosage of Vytorin than usual if you have kidney disease.
• Risk factors for developing muscle side effects. Taking Vytorin can sometimes cause muscle side effects, such as muscle pain and weakness. Certain factors can increase your risk for these side effects. Talk with your doctor about whether Vytorin is right for you, and whether you’ll need a lower than usual dosage, if you:
  • were born female
  • are 65 years or older
  • are of Chinese descent
  • have kidney problems
  • have an underactive thyroid gland that’s not well controlled with medication
• Pregnancy. Vytorin isn’t safe to take during pregnancy. For more information, see the “Vytorin and pregnancy” section above.
• Breastfeeding. Vytorin isn’t safe to take while breastfeeding. For more information, see the “Vytorin and breastfeeding” section above.

Note: For more information about the potential negative effects of Vytorin, see the “Vytorin side effects” section above.

Vytorin overdose

Do not use more Vytorin than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

What to do in case you take too much Vytorin

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Vytorin expiration, storage, and disposal

When you get Vytorin from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Vytorin tablets should be stored at a room temperature of 68°F to 77°F (20°C to 25°C). The tablets should be kept in a tightly sealed container, away from light. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Vytorin and you have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.