Should I stop taking Vytorin?

Dear Dr. Si,

I recently read that Vytorin® is ineffective. I have been taking it but am considering stopping it. What do you think?- AK, Chicago, IL


Dear AK,

Vytorin® is a combination product for control of lipids that contains the active ingredients from the prescription medicines Zocor® (simvastatin) and Zetia® (ezetimibe). Combining both of those medicines in one tablet makes sense because each drug has a different mechanism of action – Zocor® inhibits the production of cholesterol in the body and Zetia® impairs the absorption of dietary cholesterol.

However, recently, the preliminary results of the ENHANCE trial were published and researchers found that the combination was apparently no more effective than using Zocor® all by itself.

These findings were a surprise because we would expect the combination of two cholesterol lowering medications to work better than a single drug.

The media got hold of the story and probably made it more of a big deal than they should have because the patients studied had an uncommon form of familial hypercholesterolemia that resulted in very high cholesterol levels, and the data is just preliminary so it may take years before we know the real answer.

In my opinion, I would not recommend that Vytorin® be discontinued based on this study because there is no evidence that Vytorin® causes excessive harm and there is plenty of evidence that lowering cholesterol has very favorable outcomes.

Risk Versus Benefit of Drug Therapy

When it comes right down to it, drug therapy is a huge risk-benefit exercise that requires a serious consideration of the potential benefits, balanced by the potential risks of that therapy.It might make sense to use a high risk medicine if the benefit is great enough. For example, if a patient has cancer that could respond to chemotherapy, it might be a reasonable decision to start that therapy, in spite of its potential risks.On the other hand, it might make sense to use a medicine that is only partially effective for a condition, as long as it is associated with minimal adverse effects.A situation that you probably want to avoid is the use of a medicine that offers few benefits, but has a high risk of complications such as adverse reactions or drug interactions.So, whenever your physician wants to start you on a new medicine ask these three basic but most important questions: What is the potential benefit of the medicine? What are the potential risks? AND, are the risks worth the potential benefit?