Primary Disease Name: Cholesterol
Primary Drug Name: Zetia
Chemical Drug Name: Ezetimibe
Zetia Information - What is Zetia?
ZETIA is a prescription drug used for lowering cholesterol. ZETIA
(ezetimibe) is in a class of lipid-lowering compounds that selectively
inhibits the intestinal absorption of cholesterol and related phytosterols.
ZETIA, administered alone is indicated as adjunctive therapy to
diet for the reduction of elevated total-C, LDL-C, and Apo B in
patients with primary (heterozygous familial and non-familial) hypercholesterolemia.
ZETIA, in combination with an HMG-CoA reductase inhibitor, is indicated
as adjunctive therapy to diet for the reduction of elevated total-C,
LDL-C, and Apo B in patients with primary (heterozygous familial
and non-familial) hypercholesterolemia. Concurrent administration
of ZETIA with a specific HMG-CoA reductase inhibitor should be in
accordance with the product labeling for that HMG-CoA reductase
inhibitor.
The combination of ZETIA and Lipitor (atorvastatin) or Zocor (simvastatin),
is indicated for the reduction of elevated total-C and LDL-C levels
in patients with homozygous familial hypercholesterolemia (HoFH),
as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis)
or if such treatments are unavailable.
ZETIA is also indicated as adjunctive therapy to diet for the reduction
of elevated sitosterol and campesterol levels in patients with homozygous
familial sitosterolemia.
Therapy with lipid-altering agents should be a component of multiple
risk-factor intervention in individuals at increased risk for atherosclerotic
vascular disease due to hypercholesterolemia. Lipid-altering agents
should be used in addition to an appropriate diet (including restriction
of saturated fat and cholesterol) and when the response to diet
and other non-pharmacological measures has been inadequate.
Prior to initiating therapy with ZETIA, secondary causes for dyslipidemia
(i.e., diabetes, hypothyroidism, obstructive liver disease, chronic
renal failure, and drugs that increase LDL-C and decrease HDL-C
[progestins, anabolic steroids, and corticosteroids]), should be
excluded or, if appropriate, treated. A lipid profile should be
performed to measure total-C, LDL-C, HDL-C and TG. For TG levels
>400 mg/dL (>4.5 mmol/L), LDL-C concentrations should be determined
by ultracentrifugation.
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Zetia Canada - Is Zetia from Canada Safe?
Canadian Interenet Pharmacies with the CIPA
seal are a part of the Canadian International Pharmacy Association
Canada and only ship drugs that are of the highest quality, and
as safe as in the United States.
CIPA Certified Canadian Pharmacies dispense only Health Canada approved
prescription drugs such as Zetia from Canada.
Health Canada is the equivalent to the US FDA and has standards
that match those of the FDA.
Prescription drugs from a Cipa Certified Canadian pharmacies are
just as good as those purchased in the United States and the generic
drugs, commonly purchased from online Canadian pharmacies, are of
the highest standard in the world. When purchasing your prescriptions
from an online Canadian Pharmacy you will notice that generic versions
of many popular brand names drugs are readily available.
Zetia from Canada and other Prescription drugs from Canada
points to note:
- All Drugs are approved by Health Canada
- Health Canada is Canada's equivilent to the FDA
- Canadian Generics are of the highest quality in the world
- Prescrition medications from Canada really are of the highest
quality in the world
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Zetia Side Effects
Zetia Side Effects: If you are prescribed ZETIA
(EZETIMIBE), be sure to alert your doctor as soon as possible if
you have any unexplained side effects. ZETIA is generally very well-tolerated.
Zetia side effects include stomach upset and nausea. DO NOT USE
ZETIA IF YOU ARE PREGNANT.
Other Possible Zetia Side Effects:
Zetia Contraindications when used with a statin: Active
liver disease; unexplained persistent elevations of serum transaminases.
Statins are contraindicated in pregnant and nursing women; refer
to the statin label for details.
When ZETIA was coadministered with a statin, consecutive elevations
in serum transaminases (>3 × ULN) were slightly higher
(1.3%) than those of statins alone (0.4%). Liver function tests
should be performed when ZETIA is added to statin therapy and according
to statin recommendations.
Because of the unknown effects of ZETIA in patients with moderate
or severe hepatic insufficiency, ZETIA is not recommended in these
patients.
In clinical trials, there was no excess of myopathy or rhabdomyolysis
associated with ZETIA compared with statin or placebo alone. However,
myopathy and rhabdomyolysis are known adverse reactions to statins
and other lipid-lowering drugs.
The safety and effectiveness of ZETIA with fibrates have not been
established; therefore, coadministration with fibrates is not recommended
until use in patients is studied.
Coadministration of cholestyramine, gemfibrozil, and cyclosporine
affected the bioavailability of ZETIA. Because of significantly
increased blood levels of ZETIA in 1 patient on multiple medications
including cyclosporine, patients who take both ZETIA and cyclosporine
should be carefully monitored.
The effects of ZETIA, either alone or in addition to a statin, on
the risk of cardiovascular morbidity and mortality have not been
established.
In clinical trials, most frequent side effects, regardless of cause
and at an incidence greater than placebo, for ZETIA alone vs placebo
included: back pain (4.1% vs 3.9%) and arthralgia (3.8% vs 3.4%);
for ZETIA + statin vs statin or placebo alone: back pain (4.3% vs
3.7% vs 3.5%) and abdominal pain (3.5% vs 3.1% vs 2.3%).
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Zetia Cholesterol Medication Mechanism of Action
Clinical studies have demonstrated that elevated levels of total
cholesterol (total-C), low density lipoprotein cholesterol (LDL-C)
and apolipoprotein B (Apo B), the major protein constituent of LDL,
promote human atherosclerosis. In addition, decreased levels of
high density lipoprotein cholesterol (HDL-C) are associated with
the development of atherosclerosis. Epidemiologic studies have established
that cardiovascular morbidity and mortality vary directly with the
level of total-C and LDL-C and inversely with the level of HDL-C.
Like LDL, cholesterol-enriched triglyceride-rich lipoproteins, including
very-low-density lipoproteins (VLDL), intermediate-density lipoproteins
(IDL), and remnants, can also promote atherosclerosis. The independent
effect of raising HDL-C or lowering triglycerides (TG) on the risk
of coronary and cardiovascular morbidity and mortality has not been
determined.
ZETIA reduces total-C, LDL-C, Apo B, and TG, and increases HDL-C
in patients with hypercholesterolemia. Administration of ZETIA with
an HMG-CoA reductase inhibitor is effective in improving serum total-C,
LDL-C, Apo B, TG, and HDL-C beyond either treatment alone. The effects
of ezetimibe given either alone or in addition to an HMG-CoA reductase
inhibitor on cardiovascular morbidity and mortality have not been
established.
Zetia (Ezetimibe) reduces blood cholesterol by inhibiting the absorption
of cholesterol by the small intestine. In a 2-week clinical study
in 18 hypercholesterolemic patients, ZETIA inhibited intestinal
cholesterol absorption by 54%, compared with placebo. ZETIA had
no clinically meaningful effect on the plasma concentrations of
the fat-soluble vitamins A, D, and E (in a study of 113 patients),
and did not impair adrenocortical steroid hormone production (in
a study of 118 patients).
The cholesterol content of the liver is derived predominantly from
three sources. The liver can synthesize cholesterol, take up cholesterol
from the blood from circulating lipoproteins, or take up cholesterol
absorbed by the small intestine. Intestinal cholesterol is derived
primarily from cholesterol secreted in the bile and from dietary
cholesterol.
Zetia (Ezetimibe) has a mechanism of action that differs from those
of other classes of cholesterol-reducing compounds (HMG-CoA reductase
inhibitors, bile acid sequestrants [resins], fibric acid derivatives,
and plant stanols).
Zetia (Ezetimibe) does not inhibit cholesterol synthesis in the
liver, or increase bile acid excretion. Instead, ezetimibe localizes
and appears to act at the brush border of the small intestine and
inhibits the absorption of cholesterol, leading to a decrease in
the delivery of intestinal cholesterol to the liver. This causes
a reduction of hepatic cholesterol stores and an increase in clearance
of cholesterol from the blood; this distinct mechanism is complementary
to that of HMG-CoA reductase inhibitors.
After oral administration, ezetimibe is absorbed and extensively
conjugated to a pharmacologically active phenolic glucuronide (ezetimibe-glucuronide).
After a single 10-mg dose of ZETIA (Ezetimibe) to fasted adults,
mean ezetimibe peak plasma concentrations (Cmax) of 3.4 to 5.5 ng/mL
were attained within 4 to 12 hours (Tmax). Ezetimibe-glucuronide
mean Cmax values of 45 to 71 ng/mL were achieved between 1 and 2
hours (Tmax). There was no substantial deviation from dose proportionality
between 5 and 20 mg. The absolute bioavailability of ezetimibe cannot
be determined, as the compound is virtually insoluble in aqueous
media suitable for injection. Ezetimibe has variable bioavailability;
the coefficient of variation, based on inter-subject variability,
was 35 to 60% for AUC values.
Food administration (high fat or non-fat meals) had no effect on
the extent of absorption of ezetimibe when administered as ZETIA
10-mg tablets. The Cmax value of ezetimibe was increased by 38%
with consumption of high fat meals. ZETIA can be administered with
or without food.
Ezetimibe and ezetimibe-glucuronide are highly bound (>90%)to
human plasma proteins.
Ezetimibe is primarily metabolized in the small intestine and liver
via glucuronide conjugation (a phase II reaction) with subsequent
biliary and renal excretion. Minimal oxidative metabolism (a phase
I reaction) has been observed in all species evaluated.
In humans, ezetimibe is rapidly metabolized to ezetimibe-glucuronide.
Ezetimibe and ezetimibe-glucuronide are the major drug-derived compounds
detected in plasma, constituting approximately 10 to 20% and 80
to 90% of the total drug in plasma, respectively. Both ezetimibe
and ezetimibe-glucuronide are slowly eliminated from plasma with
a half-life of approximately 22 hours for both ezetimibe and ezetimibe-glucuronide.
Plasma concentration-time profiles exhibit multiple peaks, suggesting
enterohepatic recycling.
Ezetimibe was the major component in feces and accounted for 69%
of the administered dose, while ezetimibe-glucuronide was the major
component in urine and accounted for 9% of the administered dose.
In a multiple dose study with ezetimibe given 10 mg once daily for
10 days, plasma concentrations for total ezetimibe were about 2-fold
higher in older (³65 years) healthy subjects compared to younger
subjects.
In a multiple dose study with ezetimibe given 10 mg once daily for
7 days, the absorption and metabolism of ezetimibe were similar
in adolescents (10 to 18 years) and adults. Based on total ezetimibe,
there are no pharmacokinetic differences between adolescents and
adults. Pharmacokinetic data in the pediatric population <10
years of age are not available.
In a multiple dose study with ezetimibe given 10 mg once daily for
10 days, plasma concentrations for total ezetimibe were slightly
higher (<20%) in women than in men.
Based on a meta-analysis of multiple-dose pharmacokinetic studies,
there were no pharmacokinetic differences between Blacks and Caucasians.
There were too few patients in other racial or ethnic groups to
permit further pharmacokinetic comparisons.
After a single 10-mg dose of ezetimibe, the mean area under the
curve (AUC) for total ezetimibe was increased approximately 1.7-fold
in patients with mild hepatic insufficiency (Child-Pugh score 5
to 6), compared to healthy subjects. The mean AUC values for total
ezetimibe and ezetimibe were increased approximately 3-4 fold and
5-6 fold, respectively, in patients with moderate (Child-Pugh score
7 to 9) or severe hepatic impairment (Child-Pugh score 10 to 15).
In a 14-day, multiple-dose study (10 mg daily) in patients with
moderate hepatic insufficiency, the mean AUC values for total ezetimibe
and ezetimibe were increased approximately 4-fold on Day 1 and Day
14 compared to healthy subjects. Due to the unknown effects of the
increased exposure to ezetimibe in patients with moderate or severe
hepatic insufficiency, ZETIA is not recommended in these patients.
After a single 10-mg dose of ezetimibe in patients with severe renal
disease (n=8; mean CrCl £ 30 mL/min/1.73 m2), the mean AUC
values for total ezetimibe, ezetimibe-glucuronide, and ezetimibe
were increased approximately 1.5-fold, compared to healthy subjects
(n=9).
Zetia had no significant effect on a series of
probe drugs (caffeine, dextromethorphan, tolbutamide, and IV midazolam)
known to be metabolized by cytochrome P450 (1A2, 2D6, 2C8/9 and
3A4) in a "cocktail" study of twelve healthy adult males.
This indicates that ezetimibe is neither an inhibitor nor an inducer
of these cytochrome P450 isozymes, and it is unlikely that ezetimibe
will affect the metabolism of drugs that are metabolized by these
enzymes;
Warfarin: Concomitant administration of ezetimibe
(10 mg once daily) had no significant effect on bioavailability
of warfarin and prothrombin time in a study of twelve healthy adult
males.
Digoxin: Concomitant administration of ezetimibe
(10 mg once daily) had no significant effect on the bioavailability
of digoxin and the ECG parameters (HR, PR, QT, and QTc intervals)
in a study of twelve healthy adult males.
Gemfibrozil: In a study of twelve healthy adult males, concomitant
administration of gemfibrozil (600 mg twice daily) significantly
increased the oral bioavailability of total ezetimibe by a factor
of 1.7. Ezetimibe (10 mg once daily) did not significantly affect
the bioavailability of gemfibrozil.
Oral Contraceptives: Co-administration of ezetimibe (10 mg once
daily) with oral contraceptives had no significant effect on the
bioavailability of ethinyl estradiol or levonorgestrel in a study
of eighteen healthy adult females.
Cimetidine: Multiple doses of cimetidine (400 mg twice daily) had
no significant effect on the oral bioavailability of ezetimibe and
total ezetimibe in a study of twelve healthy adults.
Antacids: In a study of twelve healthy adults,
a single dose of antacid (SupraloxTM 20 mL) administration had no
significant effect on the oral bioavailability of total ezetimibe,
ezetimibe-glucuronide, or ezetimibe based on AUC values. The Cmax
value of total ezetimibe was decreased by 30%.
Glipizide: In a study of twelve healthy adult males,
steady-state levels of ezetimibe (10 mg once daily) had no significant
effect on the pharmacokinetics and pharmacodynamics of glipizide.
A single dose of glipizide (10 mg) had no significant effect on
the exposure to total ezetimibe or ezetimibe.
HMG-CoA reductase inhibitors: In studies of healthy
hypercholesterolemic (LDL-C ³130 mg/dl) adult subjects, concomitant
administration of ezetimibe (10 mg once daily) had no significant
effect on the bioavailability of either lovastatin, simvastatin,
pravastatin, atorvastatin, or fluvastatin. No significant effect
on the bioavailability of total ezetimibe and ezetimibe was demonstrated
by either lovastatin (20 mg once daily), pravastatin (20 mg once
daily), atorvastatin (10 mg once daily), or fluvastatin (20 mg once
daily).
Fenofibrate: In a study of thirty-two healthy hypercholesterolemic
(LDL-C ³130 mg/dl) adult subjects, concomitant fenofibrate
(200 mg once daily) administration increased the mean Cmax and AUC
values of total ezetimibe approximately 64% and 48%, respectively.
Pharmacokinetics of fenofibrate were not significantly affected
by ezetimibe (10 mg once daily).
Cholestyramine: In a study of forty healthy hypercholesterolemic
(LDL-C ³130 mg/dl) adult subjects, concomitant cholestyramine
(4 g twice daily) administration decreased the mean AUC values of
total ezetimibe and ezetimibe approximately 55% and 80%, respectively.
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Why is LDL Cholesterol "Bad"?
When too much LDL cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke. The levels of HDL cholesterol and LDL cholesterol in the blood are measured to evaluate the risk of having a heart attack. LDL cholesterol of less than 100 mg/dL (or total cholesterol levels of 4.7 millimoles per litre (mmol/L) is the optimal level. Less than 130 mg/dL (total cholesterol of 5.2 millimoles per litre (mmol/L) is near optimal for most people. A high LDL level (more than 160 mg/dL (6mmol/L) or 130 mg/dL (>5.2m/mol) or above if you have two or more risk factors for cardiovascular disease) reflects an increased risk of heart disease. That's why LDL cholesterol is often called "bad" cholesterol. Prescription drugs such as Lipitor (atorvastatin), Zetia (Ezetimibe), Pravachol (pravastatin), and Lescol (fluvastatin) have been shown to interfere in the synthesis of LDL by blocking an enzyme that helps produce cholesterol in the body.
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Diet and Benefits of Zetia
Dietary intake of cholesterol includes the contribution of animal
fats found in red meat, cheese, cream and whole cream milk and from
cooking oils. Oils that possess a high concentration of saturated
fats such as palmitic oils (palm & cottonseed oils), stearic
oils (lards & dairy fats), myristic and lauric oils (coconut
and palm kernel oils & dairy fats) are known to contribute more
towards the development of heart disease as compared to the lower
saturated fat based oils such as those containing oleic acids (olive,
safflower & sunflower oils) and lioleic acids (Seed oils; grape
seed oil & walnut oil). Health care professionals discourage
the use of cooking oils that possess higher levels of saturated
fats (as these assist oxidation of LDL and foam cell formation).
In addition, animal fats are rich in saturated fatty acids that
promote the accumulation of cholesterol. Rich animal fats have an
inverse effect on the production of LDL receptors in the liver,
so the individual with a diet that is high in animal fat is increasing
the risk of developing atherosclerosis. Drugs such as the statins
(Lipitor, Zetia, Lescol, Crestor, Pravachol, and Advicor) can help
to reduce the process of atherosclerosis by reducing LDL cholesterol.
LDL cholesterol is known as "the bad cholesterol." Excess
LDL builds up on your arteries (called a fatty streak) and may lead
to heart disease. The higher the level of LDL cholesterol, the higher
the risk for developing heart disease. Lowering elevated LDL cholesterol
can reduce the risk of heart attacks. ZETIA can help to reduce LDL
cholesterol.
High-density lipoprotein, or HDL cholesterol, has earned the nickname
"the good cholesterol." That's because it is believed
to remove cholesterol from the blood. High levels of HDL in your
blood may help to reduce your risk of heart disease. A low level
can increase your risk of heart disease. ZETIA can help to increase
HDL cholesterol.
Triglycerides are another type of fat in your bloodstream. Persons
with a high blood-triglyceride level have an increased risk of heart
disease. ZETIA helps to reduce triglyceride levels.
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Why is HDL Cholesterol "Good"?
About one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as the "good" cholesterol because a high level of it seems to protect against heart attack. (Low HDL cholesterol levels [less than 40 mg/dL] increase the risk for heart disease.) Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe that HDL removes excess cholesterol from plaque in arteries, thus slowing the buildup.
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Zetia Dose and Supply
The patient should be placed on a standard cholesterol-lowering
diet before receiving ZETIA and should continue on this diet during
treatment with ZETIA. The recommended dose of ZETIA is 10 mg once
daily. ZETIA can be administered with or without food. ZETIA may
be administered with an HMG-CoA reductase inhibitor (e.g. Zocor,
Lipitor, Pravachol, Lescol, Mevacor, or Advicor) for incremental
effect. For convenience, the daily dose of ZETIA may be taken at
the same time as the HMG-CoA reductase inhibitor, according to the
dosing recommendations for the HMG-CoA reductase inhibitor. ZETIA,
10 mg, are white to off-white, capsule-shaped tablets debossed with
"414" on one side.
No cases of overdosage with ZETIA have been reported. Administration
of ezetimibe, 50 mg/day, to 15 subjects for up to 14 days was generally
well tolerated. In the event of an overdose, symptomatic and supportive
measures should be employed.
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Zetia Storage
ZETIA should be stored away from direct sunlight and kept in a
tightly closed container (vial) in order to prevent moisture from
affecting the tablet stability. Store Zetia at 25°C (77°F);
excursions permitted to 15-30°C (59-86°F).
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How To Take Zetia
How to take Zetia simvastatin?
- Take Zetia (ezetimibe) exactly as directed by your doctor. If
you do not understand these instructions, ask your pharmacist, nurse,
or doctor to explain them to you.
- Take each dose with a full glass of water.
- Take Zetia (ezetimibe) once a day with or without food.
It may be easier to remember to take the medication if you take
it at the same time every day.
- Zetia (ezetimibe) should be taken 2 hours before or 4 hours
after a bile acid sequestrant such as cholestyramine (Locholest,
Prevalite, Questran), colestipol (Colestid), or colesevelam (Welchol).
- Eat a low-fat, low-cholesterol diet. To see beneficial effects
from Zetia (ezetimibe) avoid fatty, high-cholesterol foods.
- Your doctor may want to monitor cholesterol levels, liver
function, or other factors with blood tests before starting and
during treatment with Zetia (ezetimibe). Depending on the results
of these tests, your doctor can determine how much monitoring you
will require.
- Do not stop taking Zetia (ezetimibe) unless directed to
do so by your doctor. It may be weeks or months before beneficial
effects are seen from this medication.
- Store Zetia (ezetimibe) at room temperature away from moisture
and heat.
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What Other Drugs will affect Zetia?
Before taking Zetia (ezetimibe), tell your doctor if you are taking:
- Another medicine to lower cholesterol such as gemfibrozil (Lopid),
fenofibrate (Tricor), clofibrate (Atromid-S), atorvastatin (Lipitor),
fluvastatin (Lescol), lovastatin (Altocor, Mevacor), pravastatin
(Pravachol), or simvastatin (Zocor)cyclosporine (Sandimmune, Neoral, Gengraf).
- You may not be able to take Zetia (ezetimibe), or you may
require a dosage adjustment or special monitoring during treatment
if you are taking any of the medications listed above.
- Zetia (ezetimibe) should be taken 2 hours before or 4 hours after
a bile acid sequestrant such as cholestyramine (Locholest, Prevalite,
Questran), colestipol (Colestid), or colesevelam (Welchol).
- Drugs other than those listed here may also interact with cholestyramine.
Talk to your doctor and pharmacist before taking any prescription
or over-the-counter medicines, including herbal products.
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Additional Zetia Information
The task of preventing heart attacks is a lot easier when you know
who is most at risk. We also know that certain biochemical markers
during laboratory tests have shown to be useful to identify who
may be at high risk for a recurrent heart attack or initial heart
attack. C-reactive protein, is an inflammatory marker that's been
available for many years. But in a more sensitive form, we now realize
that this marker can identify people at high risk for death and
myocardial infarction when they have acute coronary syndromes. There's
also utility for C-reactive protein in identifying people at risk
for the first heart attack or the first stroke. So it expands our
ability to identify high-risk individuals. In addition to C-reactive
protein, we can look at the different sizes of the LDL particles.
We now know that a small LDL particle increases the risk of the
first heart attack and also increases the risk of narrowing of the
arteries in people with known disease, and these small particles
are much more susceptible to chemical change that influences their
inflammatory potential. ZETIA can play an important in controlling
LDL and HDl cholesterol.
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Antidepressant
Medication and Information - Lexapro
Side Effects - Paxil
Side Effects - Paxil
CR Side Effects - Zoloft
Side Effects - Arthritis
Medication and Information - Arcoxia
Side Effects- Celebrex
Side Effects - Mobic
Side Effects - Asthma
Medication and Information - Advair
Side Effects - Cholesterol
Medication and Information - Advicor
Side Effects - Crestor
Side Effects -
Lescol Side Effects - Lipitor
Side Effects - Pravachol
Side Effects - Zetia
Side Effects - Zocor
Side Effects - Epilepsy
Medication and Information - Neurontin
Side Effects - Osteoporosis
Medication and Information - Actonel
Side Effects - Fosamax
Side Effects
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