1 March 2006

A combined ezetimibe and simvastatin tablet (Vytorin) described as a ‘new weapon’ against heart disease should be weighed against the patient’s treatment needs and the yet-to-be seen outcomes of the new fixed dose combination.

This is the conclusion of the 1 March edition of NPS RADAR, which also reviews the results of an Australian trial of fenofibrate, another drug used in treatment of dyslipidaemia.

According to NPS RADAR, the combination tablet could be considered for patients already taking ezetimibe and a statin, or those who need their (low-density lipoprotein cholesterol) LDL-C levels lowered and for whom adding ezetimibe is an appropriate choice.

‘There is no need to consider adding ezetimibe for patients who have reached lipid goals and are tolerating statin monotherapy,’ Dr Roush said. ‘An alternative to adding a second drug is to increase the dose of statin monotherapy.’

The effect of ezetimibe with simvastatin tablets is equivalent to the two drugs co-administered separately. The main effect of ezetimibe is to reduce LDL-C levels. It has little effect on high-density lipoprotein cholesterol (HDL-C) or triglyceride levels.

‘The key question for prescribers is whether adding another drug is the best option for the patient. If statin monotherapy isn’t working as expected, prescribers should check patient compliance before changing the script,’ Dr Roush said.

The combination tablets are cheaper for patients (because only one co-payment is required) and may be more convenient (because only one tablet is needed).

Dr Roush said the convenience may help patients take their medicines correctly, where adding ezetimibe is an appropriate choice. He also pointed out that compared to many cholesterol-lowering drugs, ezetimibe is relatively new, and this fixed-dose combination tablet newer still, so neither the full adverse effect profile nor the benefits of treatment are known as yet.

To register for your complimentary NPS RADAR log on to www.npsradar.org.au. The website also includes previous issues of NPS RADAR.

NPS RADAR provides independent information about new medicines and changes to PBS listings important to GPs, pharmacists and other health professionals involved in primary care management of patients. More than 20,000 people have registered to receive NPS RADAR.

ENDS

National Prescribing Service Limited (NPS) is a member-based organisation providing accurate, balanced, evidence-based information and services to health professionals and the community on Quality Use of Medicines (QUM). To achieve this we work in partnership with GPs, pharmacists, specialists, other health professionals, Government, pharmaceutical industry, consumer organisations and the community.