Ezitimibe, Atorvastain

Question: I have eaten Ezetrol 10 mg together with Xarator 20 mg. Using 2 drugs together cause side effects or not and what are they?

Answer: Ezetrol® 10 mg is the trade name of ezitimibe and Xarator® 20 mg is the trade name of atorvastatin. Both of drugs are used to treat high cholesterol. However, the mechanism of action and side effects are different.

-          Ezetimibe inhibits the absorption of cholesterol in the small intestine. Found that adverse events of drug have been a little report. Patients receiving drug, most are able to tolerate medication. Adverse effects that have been reported such as diarrhea (2.5-4%), joint pain (2.6-3%), muscle cramps (3.2%), infection of the respiratory tract (2.9 to 4%).

-          Atorvastatin inhibits the function of the enzyme which acts on the synthesis of cholesterol in the body. Atorvastatin is lipid-lowering drug which is effective in reducing blood cholesterol levels. Side effects of the drug are diarrhea (14.1%), joint pain (11.7%), muscle cramps (8.4%), infection of the respiratory tract (8.3%), pain in the arms and legs (9.3%), increase in liver enzymes (0.2% - 2.3%).

The indications suggest that ezetimibe can be used as monotherapy and has also been approved for use in combination with the statin group. (Atorvastatin is a drug in the statin group.) To control blood cholesterol levels, studies have found that when using two drugs together in reducing the fat will be effective more than increasing a double dose of statin in monotherapy.

Information on adverse effects when using atorvastatin together with ezetmibe did not differ when getting ezetimibe or atorvastatin alone.

Adverse effects on the muscle may increase. (Especially in patients receiving ezetimibe combined with atorvastatin about 8%. But in people who have atorvastatin 6% and ezitimibe 5%)

Adverse effects on liver enzyme (alanine aminotransferase) increase more than usual three times (especially in patients receiving ezetimibe combined with atorvastatin 2%, but in people who have atorvastatin <1% and ezitimibe 0%).

So side effects that may need to be careful when using combined drug, are muscle pain, muscle cramps and adverse effects on the liver (hepatitis or increased liver enzymes).

References:

1. Ballantyne CM, Houri J, Notarbartolo A, Melani L, Lipka LJ, Suresh R et al. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia A prospective, randomized, double-blind trial. Circulation 2003; 107:2409-15.
2. Ezetimibe. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.
3. Atorvastatin. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.
4. Mikhailidis DP. Comparative efficacy of the addition of ezetimibe to statinvsstatin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. Current Medical Research & Opinion 2011; 27(6): 1191-210.