What is Inegy® (Ezetimib/Simvastatin)?
Inegy® is a combination preparation of Ezetimib (10 mg) and Simvastatin (different strengths). It combines two different mechanisms of action: Simvastatin inhibits cholesterol production in the liver, while Ezetimib blocks cholesterol absorption in the intestine.
This dual effect allows a stronger LDL lowering than Simvastatin alone – typically 15–20 % additional LDL reduction due to the Ezetimib component. The IMPROVE-IT study showed for the first time that the addition of Ezetimib to a statin further reduces cardiovascular risk.
Inegy® is used in patients where a statin alone is not sufficient or if a strong LDL lowering is to be achieved without high statin doses.
Active Ingredients & Mechanism of Action
Active ingredient: Ezetimib / Simvastatin
Inegy® uses two complementary mechanisms of action:
**1. Simvastatin (HMG-CoA reductase inhibitor):* *
- inhibits cholesterol synthesis in the liver
- High regulation of LDL receptors
- LDL cholesterol is increasingly absorbed from the blood
2. Ezetimib (cholesterol resorption inhibitor):
- Blocks the NPC1L1 transporter in the small intestine
- Inhibits the intake of cholesterol from food and gall
- The liver compensates with further LDL receptor high regulation
- Synergistic effect with statins
Combined action:
- LDL reduction: 45–60 % (more than Simvastatin alone)
- Triglycerides: 15–25 % reduction
- HDL cholesterol: 8–12 % increase
Clinical benefits: The IMPROVE-IT study showed that Ezetimib/Simvastatin significantly lowers cardiovascular events after acute coronary syndrome than Simvastatin alone.
Who is it suitable for?
Inegy® is suitable for:
- Patients in which a statin alone does not reach the LDL target
- Primary hypercholesterolemia
- Homozygote family hypercholesterinemia (as additional therapy)
- Homozygote sitosterolemia (phytosterolemia)
Especially recommended at:
- High-risk patients who do not reach the LDL target alone with Statin
- If high statin cans are badly tolerated (muscle problems)
- After acute coronary syndrome (IMPROVE-IT)
- Familiary hypercholesterolemia
Not suitable:
- Pregnancy and breastfeeding
- Active liver disease
- Simultaneous intake of strong CYP3A4 inhibitors (simvastatin proportion)
- Incompatibility to Ezetimib or Simvastatin
Available Dosages
Available starches:
- 10/10 mg
- 10/20 mg (standard dose)
- 10/40 mg (higher reduction)
- 10/80 mg (only continued, no new adjustment – see Simvastatin)
Recommended dosage:
- Start: 10/20 mg once a day
- Maximum standard dose: 10/40 mg once a day
LDL (approx.):
- 10/10 mg: approx. 45 %
- 10/20 mg: approx. 50 %
- 10/40 mg: approx. 55 %
Dosis adjustment:
- Kidney insufficiency (light to moderate): No adjustment
- Heavy kidney failure: caution, > 10/20 mg not recommended
- Liver failure: contraindicated with active disease
How to Take
Intake:
- Take ABENDS once a day (Simvastatin share)
- Independent meals
- Swallow tablet with water
Important notes:
- Evening intake is important due to the short half-life of Simvastatin
- No grapefruit juice in large quantities (simvastatin interaction)
- First laboratory control after 4–12 weeks
- Regular monitoring: liver values, lipid profile, CK
- In case of muscle pain or weakness: inform doctor immediately
For forgotten dose: Repeat when it's the same night. Otherwise next evening at regular time.
Solic acid binder: With simultaneous intake of Colestyramine: Inegy® take at least 2 hours before or 4 hours thereafter.
Contraindications
**Inegy® must not be accepted at:* *
- Active liver disease or unexplained transaminase increase
- Pregnancy and breastfeeding
- hypersensitivity to Ezetimib or Simvastatin
- Simultaneous administration of: Itraconazole, ketoconazole, HIV-protease inhibitors, erythromycin, Clarithromycin, Gemfibrozil, Ciclosporin, Danazole
Preview at:
- Hypothyroidism
- Kidney failure
- Muscle diseases
- High alcohol consumption
- Asian descent
- Simultaneous intake of fenofibrate
- At the same time taking Amiodaron, Verapamil, Diltiazem (Simvastatin max. 20 mg
pregnant: Strikt contraindicated. Safe prevention required.
Possible Side Effects
Family (1–10 %):
- Headaches
- Myalgia (muscle pain)
- Gastrointestinal complaints (bulk pain, diarrhea, bloating)
- Increased liver enzymes
- fatigue
** Occasionally (0.1-1 %):* *
- Squeeze
- Skin rash
- Itching
- Increased CK values
- Increased blood sugar levels
Selten, but seriously:
- Myopathy, Rhabdomyolysis (simvastatin-related)
- Hepatitis
- Gallensteine (Ezetimib condition, rare)
- Pancreatitis
- Angioedema
Note to Ezetimib: Ezetimib has a favorable side effect profile. Most side effects stem from the Simvastatin share. In rare cases, Ezetimib alone can cause muscle pain.
Interactions
**The interactions mainly concern the Simvastatin share:* *
Contracted:
- Strong CYP3A4 inhibitors (Itraconazole, ketoconazole, HIV protease inhibitor, erythromycin, clarthromycin)
- Gemfibrozil
- Ciclosporin
- Danazole
Simvastatin content:
- Verapamil, Diltiazem: Max. Inegy® 10/20 mg
- Amlodipin: Max. Inegy® 10/40 mg
Ezetimib specific:
- Colestyramine: Reduces Ezetimib Recording → maintain time interval
- Fibraten (except fenofibrate): Beware of gallstone risk
- Ciclosporin: Increased Ezetimib Mirror
Grapefruit juice: Avoid large quantities (CYP3A4 inhibition → increased simvastatin levels).
Frequently Asked Questions
Similar Medications
Is Inegy® (Ezetimib/Simvastatin) right for you?
A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.
Important Notice
This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor. Read the package leaflet before use.