Drug Interactions between TriCor and Zetia

MONITOR: Concomitant use of ezetimibe may potentiate the risk of cholelithiasis associated with fenofibrate and other fibrates. Fibrates can increase cholesterol excretion into the bile and cause cholelithiasis. In dogs, administration of ezetimibe for one month increased the concentration of cholesterol in gallbladder bile by 2- to 4-fold, although administration for one year did not result in gallstone formation or any other adverse hepatobiliary effects. In a study of 32 healthy hypercholesterolemic adult subjects, coadministration with fenofibrate (200 mg once daily) increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of total ezetimibe by approximately 64% and 48%, respectively. These increases are not considered clinically relevant. Ezetimibe (10 mg once daily) did not significantly affect the pharmacokinetics of fenofibrate.

MANAGEMENT: Caution is advised during coadministration of ezetimibe and fenofibrate. If cholelithiasis is suspected, gallbladder studies are indicated and alternative lipid-lowering therapy should be considered. Some authorities consider concomitant use of ezetimibe and fenofibrate to be contraindicated in patients with pre-existing gallbladder disease (AU).

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