Fixed-dose combination: statin plus intestinal cholesterol absorption inhibitor
ATC code: C10BA02 (Simvastatin and ezetimibe)
Simvastatin inhibits HMG-CoA reductase after hepatic activation (prodrug); ezetimibe blocks the intestinal NPC1L1 protein. Combined -C reduction of 40-55%. Historical pair – the IMPROVE-IT trial (NEJM 2015) showed a 6.4% MACE reduction over 7 years in post-ACS patients, which is why ezetimibe entered the guidelines.
Second line
Primary hypercholesterolemia and mixed dyslipidemia when -C goal is not met on the maximum tolerated simvastatin dose. Per 2019 and SEA 2023 – second-line. Dose: 10/10, 10/20, 10/40 mg once daily in the evening. 80 mg simvastatin is not recommended due to rhabdomyolysis ( Safety Communication 2011). If 10/40 fails, switch to atorvastatin + ezetimibe or rosuvastatin + ezetimibe.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated. Effective contraception in women of reproductive age; stop 1-2 months before conception.
Contraindicated. Defer therapy until breastfeeding ends.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Simvastatin + Ezetimibe is evaluated for the following indications with varying evidence strength: Dyslipidemia (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Simvastatin + Ezetimibe (≥ 1 in 100): Myalgia, GI upset, Transaminase elevation, Headache. See the Safety section for uncommon and serious reactions.
FDA category X. Contraindicated. Effective contraception in women of reproductive age; stop 1-2 months before conception.
Contraindicated. Defer therapy until breastfeeding ends.
Simvastatin + Ezetimibe is contraindicated in: Hypersensitivity; Active liver disease; Pregnancy and breastfeeding; Concomitant strong CYP3A4 inhibitors (macrolides, azoles), gemfibrozil, cyclosporine, danazol. Full list in the Safety section.