Ezetimibe and simvastatin are cholesterol-lowering medicines. They reduce the amount of cholesterol (a type of fat) absorbed by the body and block the production of cholesterol in the body.

The combination of ezetimibe and simvastatin lowers “bad” cholesterol in the blood, (also called LDL, or low-density lipoprotein) and raises “good” cholesterol (also called HDL, or high-density lipoprotein). Lowering your LDL and raising your HDL cholesterol levels may reduce your risk of hardened arteries, which can lead to heart attacks, stroke, and circulation problems.

Ezetimibe and simvastatin may also be used for other purposes not listed in this medication guide.

Ezetimibe and simvastatin is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

It may take up to 2 weeks of using this medicine before your cholesterol levels improve. For best results, keep using the medication as directed. Your cholesterol will need to be measured using blood tests at regular intervals. Do not miss any scheduled visits to your doctor. This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. In rare cases, ezetimibe and simvastatin can cause a condition that results in the breakdown of skeletal muscle tissue. This condition can lead to kidney failure. Call your doctor at once if you have unexplained muscle pain or tenderness, muscle weakness, fever or flu symptoms, and dark colored urine.

How should I take ezetimibe and simvastatin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take ezetimibe and simvastatin once a day with or without food. Try to take it at the same time every day.

It may take up to 2 weeks of using this medicine before your cholesterol levels improve. For best results, keep using the medication as directed. Your cholesterol will need to be measured using blood tests at regular intervals. Do not miss any scheduled visits to your doctor. Store ezetimibe and simvastatin at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

An overdose of ezetimibe and simvastatin is not expected to produce life-threatening symptoms.

What should I avoid while taking ezetimibe and simvastatin?

Avoid eating foods that are high in fat or cholesterol. Ezetimibe and simvastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

If you take another cholesterol-lowering medication such as cholestyramine (Locholest, Prevalite, Questran), colestipol (Colestid), or colesevelam (Welchol), take your ezetimibe and simvastatin dose at least 2 hours before or 4 hours after the other medication(s).

Grapefruit and grapefruit juice may interact with ezetimibe and simvastatin and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Avoid drinking alcohol while taking ezetimibe and simvastatin. Alcohol may increase your risk of liver damage. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Ezetimibe and simvastatin can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Ezetimibe and simvastatin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using ezetimibe and simvastatin and call your doctor at once if you have any of these serious side effects:

• muscle pain, tenderness, or weakness with fever or flu symptoms and dark colored urine;
• decreased urine or rust-colored urine; or
• blurred vision.

Less serious side effects may include:

• stomach pain, nausea, diarrhea;
• cough, sore throat, runny or stuffy nose;
• tiredness;
• headache;
• skin rash or itching;
• joint pain, back pain;
• insomnia.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect ezetimibe and simvastatin?

Many drugs can interact with ezetimibe and simvastatin. Below is just a partial list. Tell your doctor if you are using:

• amiodarone (Cordarone, Pacerone);
• cholestyramine (Questran), colestipol (Colestid), or colesevelam (Welchol);
• cyclosporine (Sandimmune, Neoral);
• danazol (Danocrine);
• digoxin (Lanoxin, Lanoxicaps);
• gemfibrozil (Lopid), fenofibrate (Tricor) or clofibrate (Atromid-S);
• nefazodone (Serzone);
• niacin (Nicolar, Nicobid, Slo-Niacin, others);
• verapamil (Calan, Covera-HS, Isoptin, Verelan).
• warfarin (Coumadin);
• an antibiotic such as clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Ery-Tab, others), itraconazole (Sporanox), ketoconazole (Nizoral), or telithromycin (Ketek); or
• HIV medicines such as amprenavir (Agenerase), atazanavir (Reyataz), efavirenz (Sustiva), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), or tipranavir (Aptivus).

This list is not complete and there may be other drugs not listed that can affect ezetimibe and simvastatin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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