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atorvastatin and ezetimibe (Oral route)

a-tor-va-STAT-in KAL-see-um, e-ZET-i-mibe

Commonly used brand name(s)

In the U.S.

  • Liptruzet

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antihyperlipidemic

Pharmacologic Class: Atorvastatin

Uses For atorvastatin and ezetimibe

Ezetimibe and atorvastatin combination is used together with a proper diet to treat high cholesterol and triglyceride (fats) levels in the blood. atorvastatin and ezetimibe may help prevent medical problems (eg, heart attack, stroke) caused by clogged blood vessels. It is also used to treat a condition called homozygous familial hypercholesterolemia (HoFH).

Ezetimibe is a cholesterol absorption inhibitor and atorvastatin is an HMG-CoA reductase inhibitor, or statin. These medicines will reduce the absorption of cholesterol from foods and the production of cholesterol in your body.

atorvastatin and ezetimibe was available only with your doctor's prescription.

The atorvastatin/ezetimibe combination (Liptruzet(R)) was withdrawn from the United States market on June 2, 2015.

Before Using atorvastatin and ezetimibe

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For atorvastatin and ezetimibe, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to atorvastatin and ezetimibe or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of atorvastatin and ezetimibe combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of atorvastatin and ezetimibe combination in the elderly. However, elderly patients are more likely to have muscle weakness, which may require caution in patients receiving atorvastatin and ezetimibe.

Pregnancy

Pregnancy Category Explanation
All Trimesters X Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking atorvastatin and ezetimibe, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using atorvastatin and ezetimibe with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Posaconazole

Using atorvastatin and ezetimibe with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Atazanavir
  • Bezafibrate
  • Carbamazepine
  • Ceritinib
  • Ciprofibrate
  • Clarithromycin
  • Clofibrate
  • Cobicistat
  • Colchicine
  • Conivaptan
  • Crizotinib
  • Cyclosporine
  • Dabrafenib
  • Daclatasvir
  • Dalfopristin
  • Danazol
  • Daptomycin
  • Darunavir
  • Diltiazem
  • Domperidone
  • Eliglustat
  • Erlotinib
  • Erythromycin
  • Eslicarbazepine Acetate
  • Fenofibrate
  • Fenofibric Acid
  • Fentanyl
  • Fluconazole
  • Fosamprenavir
  • Fusidic Acid
  • Gemfibrozil
  • Idelalisib
  • Indinavir
  • Isavuconazonium Sulfate
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Mibefradil
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Niacin
  • Nilotinib
  • Paritaprevir
  • Piperaquine
  • Primidone
  • Quinupristin
  • Saquinavir
  • Siltuximab
  • Simeprevir
  • Telaprevir
  • Telithromycin
  • Teriflunomide
  • Tipranavir
  • Troleandomycin
  • Verapamil

Using atorvastatin and ezetimibe with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amiodarone
  • Amprenavir
  • Azithromycin
  • Bexarotene
  • Black Cohosh
  • Boceprevir
  • Bosentan
  • Cholestyramine
  • Clopidogrel
  • Colestipol
  • Cyclosporine
  • Digoxin
  • Efavirenz
  • Eltrombopag
  • Etravirine
  • Fenofibrate
  • Fosphenytoin
  • Interferon Beta
  • Oat Bran
  • Pectin
  • Phenytoin
  • Pioglitazone
  • Quinine
  • Rifampin
  • St John's Wort
  • Voriconazole

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using atorvastatin and ezetimibe with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use atorvastatin and ezetimibe, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of atorvastatin and ezetimibe. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse or
  • Diabetes or
  • Hypothyroidism (underactive thyroid) or
  • Kidney disease or
  • Liver disease, history of or
  • Stroke, recent or
  • Transient ischemic attack, within the last 6 months—Use with caution. May cause side effects to become worse.
  • Hypotension (low blood pressure) or
  • Infection, acute and severe or
  • Kidney disease (severe), history of or
  • Major surgery or
  • Metabolic, endocrine, and electrolyte disorders or
  • Seizures, uncontrolled or
  • Trauma—Patients with these conditions may be at risk for muscle or kidney problems.
  • Liver disease, active or
  • Liver enzymes, elevated—Should not be used in patients with these conditions.

Proper Use of atorvastatin and ezetimibe

Take atorvastatin and ezetimibe only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

atorvastatin and ezetimibe comes with a patient information insert. Read and follow these instructions carefully. Ask your doctor if you have any questions.

In addition to atorvastatin and ezetimibe, your doctor may change your diet to one that is low in fat, sugar, and cholesterol. Carefully follow your doctor's orders about any special diet.

Swallow the tablet whole. Do not crush, break, chew, or dissolve it. You may take atorvastatin and ezetimibe with or without food.

If you are taking certain medicines to lower cholesterol (eg, cholestyramine, colesevelam, colestipol, Questran®, Welchol®), take Liptruzet® 2 hours before or 4 hours after taking these medicines.

Do not drink more than 1.2 liters of grapefruit juice per day.

Do not drink large amounts of alcohol with atorvastatin and ezetimibe. This could cause unwanted effects on the liver.

Dosing

The dose of atorvastatin and ezetimibe will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of atorvastatin and ezetimibe. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For high cholesterol and triglycerides:
      • Adults—At first, one tablet per day. Your doctor may increase your dose as needed. However, the dose is usually not more than 10 mg of ezetimibe and 80 mg of atorvastatin.
      • Children—Use and dose must be determined by your doctor.
    • For homozygous familial hypercholesterolemia (HoFH):
      • Adults—One tablet per day. Each tablet contains 10 mg of ezetimibe and 40 mg of atorvastatin or 10 mg of ezetimibe and 80 mg of atorvastatin.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of atorvastatin and ezetimibe, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep your medicine in the blister pack until you are ready to use it. After opening the blister pack, store it in a dry place and protect from moisture and light. Once a tablet is removed, slide the blister card back into its folded card.

Precautions While Using atorvastatin and ezetimibe

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

Using atorvastatin and ezetimibe while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have unusual tiredness or a fever. These could be symptoms of serious muscle problems, such as myopathy or immune-mediated necrotizing myopathy (IMNM).

Check with your doctor right away if you have dark-colored urine, fever, muscle cramps or spasms, muscle pain or stiffness, or unusual tiredness or weakness. These could be symptoms of a serious muscle problem called rhabdomyolysis, which can cause kidney problems.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Make sure any doctor or dentist who treats you knows that you are using atorvastatin and ezetimibe. You may need to stop using atorvastatin and ezetimibe if you have a major surgery, a major injury, or you develop other serious health problems.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

atorvastatin and ezetimibe Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
  • Abdominal or stomach pain
  • confusion
  • difficult breathing
  • difficulty with moving
  • irregular heartbeat
  • muscle, joint, or bone pain
  • muscle stiffness
  • muscle weakness
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • weakness or heaviness of the legs
Incidence not known
  • Black, tarry stools
  • blistering, peeling, or loosening of the skin
  • blood in the urine or stools
  • chills
  • dark-colored urine
  • diarrhea
  • fever
  • gaseous abdominal or stomach pain
  • general tiredness and weakness
  • hives, welts, or skin rash
  • itching
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • severe nausea or vomiting
  • sores, ulcers, or white spots in the mouth or on the lips
  • swelling of the eyes, face, or inside of the nose
  • unsteadiness or awkwardness
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellow eyes and skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Cough
  • dizziness
  • feeling of warmth
  • pain or tenderness around the eyes and cheekbones
  • redness of the face, neck, arms, and occasionally, upper chest
  • stuffy or runny nose
  • sudden sweating
  • tightness in the chest
Incidence not known
  • Being forgetful
  • bloating burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chills
  • constipation
  • discouragement
  • fast heartbeat
  • feeling sad or empty
  • irritability
  • lack of appetite
  • loss of interest or pleasure
  • loss of memory
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • tiredness
  • trouble concentrating
  • trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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