United States - English - NLM (National Library of Medicine)

merck sharp & dohme corp. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24), simvastatin (unii: agg2fn16ev) (simvastatin - unii:agg2fn16ev) - ezetimibe 10 mg - therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. vytorin® is indicated for the reduction of elevated total cholesterol (total-c), low-density lipoprotein cholesterol (ldl-c), apolipoprotein b (apo b), triglycerides (tg), and non-high-density lipoprotein cholesterol (non-hdl-c), and to increase high-density lipoprotein cholesterol (hdl-c) in patients with primary (heterozygous familial and non-familial) hyperlipidemia or mixed hyperlipidemia. vytorin is indicated for the reduction of elevated total-c and ldl-c in patients with homozygous familial hypercholesterolemia, as an adjunct to other lipid-lowering treatments (e.g., ldl apheresis) or if such treatments are unav

United States - English - NLM (National Library of Medicine)

pd-rx pharmaceuticals, inc. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24), simvastatin (unii: agg2fn16ev) (simvastatin - unii:agg2fn16ev) - ezetimibe 10 mg - therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. vytorin ® is indicated for the reduction of elevated total cholesterol (total-c), low-density lipoprotein cholesterol (ldl-c), apolipoprotein b (apo b), triglycerides (tg), and non-high-density lipoprotein cholesterol (non-hdl-c), and to increase high-density lipoprotein cholesterol (hdl-c) in patients with primary (heterozygous familial and non-familial) hyperlipidemia or mixed hyperlipidemia. vytorin is indicated for the reduction of elevated total-c and ldl-c in patients with homozygous familial hypercholesterolemia, as an adjunct to other lipid-lowering treatments (e.g., ldl apheresis) or if such trea

United States - English - NLM (National Library of Medicine)

organon llc - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24), simvastatin (unii: agg2fn16ev) (simvastatin - unii:agg2fn16ev) - vytorin vytorin® is a combination of simvastatin and ezetimibe indicated: - as an adjunct to diet to reduce elevated low density lipoprotein cholesterol (ldl-c): in adults with primary hyperlipidemia. in adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (hefh). - in adults with primary hyperlipidemia. - in adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (hefh). - as an adjunct to other ldl-c-lowering therapies to reduce elevated ldl-c in adults with homozygous familial hypercholesterolemia (hofh). simvastatin simvastatin, when used as a component of vytorin, is indicated to reduce the risk of total mortality by reducing risk of coronary heart disease death, non-fatal myocardial infarction and stroke, and the need for coronary and non-coronary revascularization procedures in adults with established coronary heart disease, cerebrovascular disease, peripheral vascular disease, and/or diabetes, who are at high risk of coronary heart disease events. vytorin is contraindicated in the following conditions: - concomitant use of strong cyp3a4 inhibitors (select azole anti-fungals, macrolide antibiotics, anti-viral medications, and nefazodone) [see drug interactions (7.1)] . - concomitant use of cyclosporine, danazol, or danazol [see drug interactions (7.1)] . - acute liver failure or decompensated cirrhosis [see warnings and precautions (5.3)] . - hypersensitivity to simvastatin, ezetimibe, or any excipients in vytorin. hypersensitivity reactions, including anaphylaxis, angioedema, and stevens-johnson syndrome, have been reported [see adverse reactions (6.2)] . vytorin risk summary discontinue vytorin when pregnancy is recognized. alternatively, consider the ongoing therapeutic needs of the individual patient. vytorin decreases synthesis of cholesterol and possibly other biologically active substances derived from cholesterol; therefore, vytorin may cause fetal harm when administered to pregnant patients based on the mechanism of action [see clinical pharmacology (12.1)] . in addition, treatment of hyperlipidemia is not generally necessary during pregnancy. atherosclerosis is a chronic process and the discontinuation of lipid-lowering drugs during pregnancy should have little impact on the outcome of long-term therapy of primary hyperlipidemia for most patients. available data from case series and prospective and retrospective observational cohort studies over decades of use with statins in pregnant women have not identified a drug-associated risk of major congenital malformations. published data from prospective and retrospective observational cohort studies with vytorin use in pregnant women are insufficient to determine if there is a drug-associated risk of miscarriage (see data) . in animal reproduction studies, no adverse developmental effects were observed in pregnant rats or rabbits orally administered simvastatin during the period of organogenesis at doses that resulted in 2.5 and 2 times, respectively, the human exposure at the maximum recommended human dosage of 80 mg/day, based on body surface area (mg/m2 ). in animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits orally administered ezetimibe during the period of organogenesis at doses that resulted in up to 10 and 150 times, respectively, the human exposure at the mrhd, based on auc (see data). the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data human data ezetimibe there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. simvastatin a medicaid cohort linkage trial of 1152 statin-exposed pregnant women compared to 886,996 controls did not find a significant teratogenic effect from maternal use of statins in the first trimester of pregnancy, after adjusting for potential confounders – including maternal age, diabetes mellitus, hypertension, obesity, and alcohol and tobacco use – using propensity score-based methods. the relative risk of congenital malformations between the group with statin use and the group with no statin use in the first trimester was 1.07 (95% confidence interval 0.85 to 1.37) after controlling for confounders, particularly pre-existing diabetes mellitus. there were also no statistically significant increases in any of the organ-specific malformations assessed after accounting for confounders. in the majority of pregnancies, statin treatment was initiated prior to pregnancy and was discontinued at some point in the first trimester when pregnancy was identified. trial limitations include reliance on physician coding to define the presence of a malformation, lack of control for certain confounders such as body mass index, use of prescription dispensing as verification for the use of a statin, and lack of information on non-live births. animal data ezetimibe in oral (gavage) embryo-fetal development studies of ezetimibe conducted in rats (gestation days 6-15) and rabbits (gestation days 7-19), there was no evidence of maternal toxicity or embryolethality at any dose tested (250, 500, 1000 mg/kg/day) at exposure equivalent to 10 to 150 times the clinical exposure, based on auc, in rats and rabbits. in rats, increased incidences of common fetal skeletal findings (extra pair of thoracic ribs, unossified cervical vertebral centra, shortened ribs) were observed at 1000 mg/kg/day (~10 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). in rabbits treated with ezetimibe, an increased incidence of extra thoracic ribs was observed at 1000 mg/kg/day (150 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). the animal-to-human exposure multiple for total ezetimibe at the no-observed effect level was 6 times for rat and 134 times for rabbit. fetal exposure to ezetimibe (conjugated and unconjugated) was confirmed in subsequent placental transfer studies conducted using a maternal dose of 1000 mg/kg/day. the fetal maternal plasma exposure ratio (total ezetimibe) was 1.5 for rats on gestation day 20 and 0.03 for rabbits on gestation day 22. the effect of ezetimibe on prenatal and postnatal development and maternal function was evaluated in pregnant rats at doses of 100, 300 or 1000 mg/kg/day (gestation day 6 through lactation day 21). no maternal toxicity or adverse developmental outcomes were observed up to and including the highest dose tested (17 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). multiple-dose studies of ezetimibe given in combination with statins in rats and rabbits during organogenesis resulted in higher ezetimibe and statin exposures. reproductive findings occurred at lower doses in combination therapy compared to monotherapy. simvastatin simvastatin was given to pregnant rats at doses of 6.25, 12.5 and 25 mg/kg/day (0.6 times, 1.3 times, and 2.5 times, respectively, the maximum recommended dosage of 80 mg/day when normalized to body surface area) from gestation days 6-17 and to pregnant rabbits from gestation days 6-18 at doses of 2.5, 5, and 10 mg/kg/day (0.5 times, 1 times, and 2 times, respectively, the maximum recommended dosage of 80 mg/day when normalized to body surface area). for both species, there was no evidence of maternal toxicity, or embryolethality. in rats, mean fetal body weights in the 25 mg/kg/day group were decreased 5.4%. similar fetal body weight effects were not observed in rabbits. simvastatin doses of 6.25, 12.5 and 25 mg/kg/day (0.6 times, 1.3 times, and 2.5 times, respectively, the maximum recommended dosage of 80 mg/day when normalized to body surface area) were given to pregnant rats from gestation day 15 to lactation day 21. slight decreases in maternal body weight gain and pup postnatal day 0 weight were observed in the 25 mg/kg/day dose group. mean body weight gain of pups during lactation was slightly decreased at doses ≥12.5 mg/kg/day. post weaning weight, behavior, reproductive performance and fertility of the offspring were not affected at any dose tested. placental transfer of simvastatin was not evaluated in rats or rabbits. however, it has been shown that other drugs in this class cross the placenta. risk summary there is no information about the presence of ezetimibe or simvastatin in human breast milk, the effects of the drug on the breastfed infant or the effect of the drug on milk production. however, it has been shown that other statins pass into human milk. statins, including vytorin, decrease cholesterol synthesis and possibly the synthesis of other biologically active substances derived from cholesterol and may cause harm to the breast fed infant. because of the potential for serious adverse reactions in a breastfed infant, based on the mechanism of action, advise patients that breastfeeding is not recommended during treatment with vytorin [see use in specific populations (8.2) and clinical pharmacology (12.1)] . data animal data ezetimibe was present in the milk of lactating rats. the pup to maternal plasma ratio for total ezetimibe was 0.5 on lactation day 12. the safety and effectiveness of ezetimibe in combination with a statin as an adjunct to diet to reduce ldl-c have been established in pediatric patients 10 years of age and older with hefh. use of vytorin for this indication is based on a double-blind, placebo-controlled clinical trial in 248 pediatric patients (142 males and 106 postmenarchal females) 10 years of age and older with hefh [see clinical studies (14)] . in this limited controlled trial, there was no significant effect on growth or sexual maturation in the adolescent males or females, or on menstrual cycle length in females. the safety and effectiveness of vytorin have not been established in pediatric patients younger than 10 years of age with hefh, or in pediatric patients with other types of hyperlipidemia. advanced age (≥65 years) is a risk factor for vytorin-associated myopathy and rhabdomyolysis. dose selection for an elderly patient should be cautious, recognizing the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy and the higher risk of myopathy. monitor geriatric patients receiving vytorin for the increased risk of myopathy [see warnings and precautions (5.1)] . of the 10,189 patients who received vytorin in clinical studies, 3242 (32%) were 65 and older (this included 844 (8%) who were 75 and older). no overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients but greater sensitivity of some older individuals cannot be ruled out. renal impairment is a risk factor for myopathy and rhabdomyolysis. monitor all patients with renal impairment for development of myopathy. doses of vytorin exceeding 10/20 mg should be used with caution and close monitoring in patients with moderate to severe renal impairment [see dosage and administration (2.4) and warnings and precautions (5.1)] . in the sharp trial of 9270 patients with moderate to severe renal impairment (6247 non-dialysis patients with median serum creatinine 2.5 mg/dl and median estimated glomerular filtration rate 25.6 ml/min/1.73 m2 , and 3023 dialysis patients), the incidence of serious adverse events, adverse events leading to discontinuation of trial treatment, or adverse events of special interest (musculoskeletal adverse events, liver enzyme abnormalities, incident cancer) was similar between patients ever assigned to vytorin 10/20 mg (n=4650) or placebo (n=4620) during a median follow-up of 4.9 years. vytorin is contraindicated in patients with acute liver failure or decompensated cirrhosis. [see contraindications (4) and warnings and precautions (5.3).] in a clinical trial in which patients at high risk of cvd were treated with simvastatin 40 mg/day (median follow-up 3.9 years), the incidence of myopathy was approximately 0.05% for non-chinese patients (n=7367) compared with 0.24% for chinese patients (n=5468). in this trial the incidence of myopathy for chinese patients on simvastatin 40 mg/day or ezetimibe and simvastatin 10/40 mg/day coadministered with extended-release niacin 2 g/day was 1.24%. chinese patients may be at higher risk for myopathy, monitor these patients appropriately. coadministration of vytorin with lipid-modifying doses of niacin-containing products (≥1 g/day niacin) is not recommended in chinese patients [see warnings and precautions (5.1) and drug interactions (7.1)] .

United States - English - NLM (National Library of Medicine)

pd-rx pharmaceuticals, inc. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24), simvastatin (unii: agg2fn16ev) (simvastatin - unii:agg2fn16ev) - therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. vytorin ® is indicated for the reduction of elevated total cholesterol (total-c), low-density lipoprotein cholesterol (ldl-c), apolipoprotein b (apo b), triglycerides (tg), and non-high-density lipoprotein cholesterol (non-hdl-c), and to increase high-density lipoprotein cholesterol (hdl-c) in patients with primary (heterozygous familial and non-familial) hyperlipidemia or mixed hyperlipidemia. vytorin is indicated for the reduction of elevated total-c and ldl-c in patients with homozygous familial hypercholesterolemia, as an adjunct to other lipid-lowering treatments (e.g., ldl apheresis) or if such trea

United States - English - NLM (National Library of Medicine)

sandoz inc - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe is indicated: when ezetimibe is used in combination with a statin, fenofibrate, or other ldl-c lowering therapies, refer to the prescribing information of these products for information on the safe and effective use. ezetimibe is contraindicated in patients with a known hypersensitivity to ezetimibe or any of the excipients in ezetimibe. hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported [see adverse reactions (6.2)] . when used in combination with a statin, fenofibrate, or other ldl-c lowering therapy, ezetimibe is contraindicated in patients for whom a statin, fenofibrate, or other ldl-c lowering therapy are contraindicated. refer to the prescribing information of these products for a list of their contraindications [see warnings and precautions (5.1)] . risk summary there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. in anim

United States - English - NLM (National Library of Medicine)

aurobindo pharma limited - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe tablets are indicated: - in combination with a statin, or alone when additional low-density lipoprotein cholesterol (ldl-c) lowering therapy is not possible, as an adjunct to diet to reduce elevated ldl-c in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (hefh). - in combination with a statin as an adjunct to diet to reduce elevated ldl-c in pediatric patients 10 years of age and older with hefh. - in combination with fenofibrate as an adjunct to diet to reduce elevated ldl-c in adults with mixed hyperlipidemia. - in combination with a statin, and other ldl-c lowering therapies, to reduce elevated ldl-c levels in adults and in pediatric patients 10 years of age and older with homozygous familial hypercholesterolemia (hofh). - as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels in adults and in pediatric patients 9 years of age and older with homozygous familial sitosterolemia. when ezetimibe tablets are used in combination with a statin, fenofibrate, or other ldl-c lowering therapies, refer to the prescribing information of these products for information on the safe and effective use. ezetimibe tablets are contraindicated in patients with a known hypersensitivity to ezetimibe or any of the excipients in ezetimibe tablets. hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported [see adverse reactions (6.2)] . when used in combination with a statin, fenofibrate, or other ldl-c lowering therapy, ezetimibe tablets are contraindicated in patients for whom a statin, fenofibrate, or other ldl-c lowering therapy are contraindicated. refer to the prescribing information of these products for a list of their contraindications [see warnings and precautions (5.1)] . risk summary there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. in animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits orally administered ezetimibe during the period of organogenesis at doses that resulted in up to 10 and 150 times, respectively, the human exposure at the mrhd, based on auc (see data) . ezetimibe should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. when ezetimibe is administered with a statin, refer to the prescribing information for the statin. the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. in the u.s. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data animal data in oral (gavage) embryo-fetal development studies of ezetimibe conducted in rats (gestation days 6-15) and rabbits (gestation days 7-19), there was no evidence of maternal toxicity or embryolethal effects at the doses tested (250, 500, 1,000 mg/kg/day). in rats, increased incidences of common fetal skeletal findings (extra pair of thoracic ribs, unossified cervical vertebral centra, shortened ribs) were observed at 1,000 mg/kg/day (~10 times the human exposure at 10 mg daily based on auc0-24hr   for total ezetimibe). in rabbits treated with ezetimibe, an increased incidence of extra thoracic ribs was observed at 1,000 mg/kg/day (150 times the human exposure at 10 mg daily based on auc0-24hr   for total ezetimibe). the animal-to-human exposure multiple for total ezetimibe at the no-observed effect level was 6 times for rat and 134 times for rabbit. fetal exposure to ezetimibe (conjugated and unconjugated) was confirmed in subsequent placental transfer studies conducted using a maternal dose of 1,000 mg/kg/day. the fetal maternal plasma exposure ratio (total ezetimibe) was 1.5 for rats on gestation day 20 and 0.03 for rabbits on gestation day 22. the effect of ezetimibe on prenatal and postnatal development and maternal function was evaluated in pregnant rats at doses of 100, 300 or 1,000 mg/kg/day from gestation day 6 through lactation day 21. no maternal toxicity or adverse developmental outcomes were observed up to and including the highest dose tested (17 times the human exposure at 10 mg daily based on auc0-24hr   for total ezetimibe). multiple-dose studies of ezetimibe given in combination with statins in rats and rabbits during organogenesis resulted in higher ezetimibe and statin exposures. reproductive findings occurred at lower doses in combination therapy compared to monotherapy. risk summary there is no information about the presence of ezetimibe in human milk. ezetimibe is present in rat milk (see data) . when a drug is present in animal milk, it is likely that the drug will be present in human milk. there is no information about the effects of ezetimibe on the breastfed infant or the effects of ezetimibe on milk production. ezetimibe should not be used in nursing mothers unless the potential benefit justifies the potential risk to the infant. data ezetimibe was present in the milk of lactating rats. the pup to maternal plasma ratio for total ezetimibe was 0.5 on lactation day 12. the safety and effectiveness of ezetimibe in combination with a statin as an adjunct to diet to reduce ldl-c have been established in pediatric patients 10 years of age and older with hefh. use of ezetimibe for this indication is based on a double-blind, placebo-controlled clinical trial in 248 pediatric patients (142 males and 106 postmenarchal females) 10 years of age and older with hefh [see clinical studies (14)] . in this limited controlled trial, there was no significant effect on growth or sexual maturation in the adolescent males or females, or on menstrual cycle length in females. the safety and effectiveness of ezetimibe in combination with a statin, and other ldl-c lowering therapies, to reduce ldl-c have been established in pediatric patients 10 years of age and older with hofh. use of ezetimibe for this indication is based on a 12-week double-blind, placebo-controlled clinical trial followed by an uncontrolled extension period in 7 pediatric patients 11 years of age and older with hofh [see clinical studies (14)] . the safety and effectiveness of ezetimibe as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels have been established in adults and pediatric patients 9 years of age and older with homozygous familial sitosterolemia. use of ezetimibe for this indication is based on an 8-week double-blind, placebo-controlled clinical trial in 4 patients 9 years of age and older with homozygous sitosterolemia with elevated plasma sitosterol levels (>5 mg/dl) [see clinical studies (14)] . the safety and effectiveness of ezetimibe have not been established in pediatric patients younger than 10 years of age with hefh or hofh, in pediatric patients younger than 9 years of age with homozygous familial sitosterolemia, or in pediatric patients with other types of hyperlipidemia. of the 2,396 patients who received ezetimibe in clinical trials, 669 (28%) were 65 years of age and older, and 111 (5%) were 75 years of age and older. of the 11,308 patients who received ezetimibe in combination with a statin in clinical trials, 3587 (32%) were 65 years of age and older, and 924 (8%) were 75 years of age and older [see clinical studies (14)] . no overall differences in safety or effectiveness of ezetimibe have been observed between patients 65 years of age and older and younger patients. no clinically meaningful differences in the pharmacokinetics of ezetimibe were observed in geriatric patients compared to younger adult patients [see clinical pharmacology (12.3)]. no dosage adjustment of ezetimibe is necessary in patients with renal impairment. ezetimibe is not recommended for use in patients with moderate to severe hepatic impairment (child-pugh b or c) due to the unknown effects of the increased exposure to ezetimibe [see clinical pharmacology (12.3)] .

United States - English - NLM (National Library of Medicine)

zydus pharmaceuticals usa inc. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe tablets are indicated: - in combination with a statin, or alone when additional low-density lipoprotein cholesterol (ldl-c) lowering therapy is not possible, as an adjunct to diet to reduce elevated ldl-c in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (hefh). - in combination with a statin as an adjunct to diet to reduce elevated ldl-c in pediatric patients 10 years of age and older with hefh. - in combination with fenofibrate as an adjunct to diet to reduce elevated ldl-c in adults with mixed hyperlipidemia. - in combination with a statin, and other ldl-c lowering therapies, to reduce elevated ldl-c levels in adults and in pediatric patients 10 years of age and older with homozygous familial hypercholesterolemia (hofh). - as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels in adults and in pediatric patients 9 years of age and older with homozygous familial sitosterolemia. when ezetimibe tablets are used in combination with a statin, fenofibrate, or other ldl-c lowering therapies, refer to the prescribing information of these products for information on the safe and effective use. ezetimibe tablets are contraindicated in patients with a known hypersensitivity to ezetimibe or any of the excipients in ezetimibe tablets. hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported [see adverse reactions (6.2)] . when used in combination with a statin, fenofibrate, or other ldl-c lowering therapy, ezetimibe tablets are contraindicated in patients for whom a statin, fenofibrate, or other ldl-c lowering therapy are contraindicated. refer to the prescribing information of these products for a list of their contraindications [see warnings and precautions (5.1)] . risk summary there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. in animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits orally administered ezetimibe during the period of organogenesis at doses that resulted in up to 10 and 150 times, respectively, the human exposure at the mrhd, based on auc (see data) . ezetimibe should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. when ezetimibe is administered with a statin, refer to the prescribing information for the statin. the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. in the u.s. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data animal data in oral (gavage) embryo-fetal development studies of ezetimibe conducted in rats (gestation days 6-15) and rabbits (gestation days 7-19), there was no evidence of maternal toxicity or embryolethal effects at the doses tested (250, 500, 1,000 mg/kg/day). in rats, increased incidences of common fetal skeletal findings (extra pair of thoracic ribs, unossified cervical vertebral centra, shortened ribs) were observed at 1,000 mg/kg/day (~10 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). in rabbits treated with ezetimibe, an increased incidence of extra thoracic ribs was observed at 1,000 mg/kg/day (150 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). the animal-to-human exposure multiple for total ezetimibe at the no-observed effect level was 6 times for rat and 134 times for rabbit. fetal exposure to ezetimibe (conjugated and unconjugated) was confirmed in subsequent placental transfer studies conducted using a maternal dose of 1,000 mg/kg/day. the fetal maternal plasma exposure ratio (total ezetimibe) was 1.5 for rats on gestation day 20 and 0.03 for rabbits on gestation day 22. the effect of ezetimibe on prenatal and postnatal development and maternal function was evaluated in pregnant rats at doses of 100, 300 or 1,000 mg/kg/day from gestation day 6 through lactation day 21. no maternal toxicity or adverse developmental outcomes were observed up to and including the highest dose tested (17 times the human exposure at 10 mg daily based on auc0-24hr for total ezetimibe). multiple-dose studies of ezetimibe given in combination with statins in rats and rabbits during organogenesis resulted in higher ezetimibe and statin exposures. reproductive findings occurred at lower doses in combination therapy compared to monotherapy. risk summary there is no information about the presence of ezetimibe in human milk. ezetimibe is present in rat milk (see data) . when a drug is present in animal milk, it is likely that the drug will be present in human milk. there is no information about the effects of ezetimibe on the breastfed infant or the effects of ezetimibe on milk production. ezetimibe should not be used in nursing mothers unless the potential benefit justifies the potential risk to the infant. data ezetimibe was present in the milk of lactating rats. the pup to maternal plasma ratio for total ezetimibe was 0.5 on lactation day 12. the safety and effectiveness of ezetimibe in combination with a statin as an adjunct to diet to reduce ldl-c have been established in pediatric patients 10 years of age and older with hefh. use of ezetimibe for this indication is based on a double-blind, placebo-controlled clinical trial in 248 pediatric patients (142 males and 106 postmenarchal females) 10 years of age and older with hefh [see clinical studies (14)] . in this limited controlled trial, there was no significant effect on growth or sexual maturation in the adolescent males or females, or on menstrual cycle length in females. the safety and effectiveness of ezetimibe in combination with a statin, and other ldl-c lowering therapies, to reduce ldl-c have been established in pediatric patients 10 years of age and older with hofh. use of ezetimibe for this indication is based on a 12-week double-blind, placebo-controlled clinical trial followed by an uncontrolled extension period in 7 pediatric patients 11 years of age and older with hofh [see clinical studies (14)] . the safety and effectiveness of ezetimibe as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels have been established in adults and pediatric patients 9 years of age and older with homozygous familial sitosterolemia. use of ezetimibe for this indication is based on an 8-week double-blind, placebo-controlled clinical trial in 4 patients 9 years of age and older with homozygous sitosterolemia with elevated plasma sitosterol levels (>5 mg/dl) [see clinical studies (14)] . the safety and effectiveness of ezetimibe have not been established in pediatric patients younger than 10 years of age with hefh or hofh, in pediatric patients younger than 9 years of age with homozygous familial sitosterolemia, or in pediatric patients with other types of hyperlipidemia. of the 2,396 patients who received ezetimibe in clinical trials, 669 (28%) were 65 years of age and older and 111 (5%) were 75 years of age and older. of the 11,308 patients who received ezetimibe in combination with a statin in clinical trials, 3587 (32%) were 65 years of age and older and 924 (8%) were 75 years of age and older [see clinical studies (14)] . no overall differences in safety or effectiveness of ezetimibe have been observed between patients 65 years of age and older and younger patients. no clinically meaningful differences in the pharmacokinetics of ezetimibe were observed in geriatric patients compared to younger adult patients [see clinical pharmacology (12.3)]. no dosage adjustment of ezetimibe is necessary in patients with renal impairment. ezetimibe is not recommended for use in patients with moderate to severe hepatic impairment (child-pugh b or c) due to the unknown effects of the increased exposure to ezetimibe [see clinical pharmacology (12.3)] .

United States - English - NLM (National Library of Medicine)

glenmark pharmaceuticals inc., usa - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe tablets are indicated: when ezetimibe tablet is used in combination with a statin, fenofibrate, or other ldl-c lowering therapies, refer to the prescribing information of these products for information on the safe and effective use. risk summary there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. in animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits orally administered ezetimibe during the period of organogenesis at doses that resulted in up to 10 and 150 times, respectively, the human exposure at the mrhd, based on auc (see data) . ezetimibe should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. when ezetimibe is administered with a statin, refer to the prescribing information for the statin. the estimated background risk of major birth defects and miscarriage for the indic

United States - English - NLM (National Library of Medicine)

actavis pharma, inc. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe tablets are indicated: - in combination with a statin, or alone when additional low-density lipoprotein cholesterol (ldl-c) lowering therapy is not possible, as an adjunct to diet to reduce elevated ldl-c in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (hefh). - in combination with a statin as an adjunct to diet to reduce elevated ldl-c in pediatric patients 10 years of age and older with hefh. - in combination with fenofibrate as an adjunct to diet to reduce elevated ldl-c in adults with mixed hyperlipidemia. - in combination with a statin, and other ldl-c lowering therapies, to reduce elevated ldl-c levels in adults and in pediatric patients 10 years of age and older with homozygous familial hypercholesterolemia (hofh). - as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels in adults and in pediatric patients 9 years of age and older with homozygous familial sitosterolemia. when ezetimibe tablets are used in combinat

United States - English - NLM (National Library of Medicine)

ohm laboratories inc. - ezetimibe (unii: eor26lqq24) (ezetimibe - unii:eor26lqq24) - ezetimibe 10 mg - ezetimibe tablets are indicated: - in combination with a statin, or alone when additional low-density lipoprotein cholesterol (ldl-c) lowering therapy is not possible, as an adjunct to diet to reduce elevated ldl-c in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (hefh). - in combination with a statin as an adjunct to diet to reduce elevated ldl-c in pediatric patients 10 years of age and older with hefh. - in combination with fenofibrate as an adjunct to diet to reduce elevated ldl-c in adults with mixed hyperlipidemia. - in combination with a statin, and other ldl-c lowering therapies, to reduce elevated ldl-c levels in adults and in pediatric patients 10 years of age and older with homozygous familial hypercholesterolemia (hofh). - as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels in adults and in pediatric patients 9 years of age and older with homozygous familial sitosterolemia. when ezetimibe tablets are used in combination with a statin, fenofibrate, or other ldl-c lowering therapies, refer to the prescribing information of these products for information on the safe and effective use. ezetimibe tablets are contraindicated in patients with a known hypersensitivity to ezetimibe or any of the excipients in ezetimibe tablets. hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported [ see adverse reactions (6.2)]. when used in combination with a statin, fenofibrate, or other ldl-c lowering therapy, ezetimibe tablets are contraindicated in patients for whom a statin, fenofibrate, or other ldlc lowering therapy are contraindicated. refer to the prescribing information of these products for a list of their contraindications [see warnings and precautions (5.1)] risk summary there are insufficient data on ezetimibe use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. in animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits orally administered ezetimibe during the period of organogenesis at doses that resulted in up to 10 and 150 times, respectively, the human exposure at the mrhd, based on auc (see data) . ezetimibe tablets should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. when ezetimibe tablets are administered with a statin, refer to the prescribing information for the statin. the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. in the u.s. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data animal data in oral (gavage) embryo-fetal development studies of ezetimibe conducted in rats (gestation days 6-15) and rabbits (gestation days 7-19), there was no evidence of maternal toxicity or embryolethal effects at the doses tested (250, 500, 1,000 mg/kg/day). in rats, increased incidences of common fetal skeletal findings (extra pair of thoracic ribs, unossified cervical vertebral centra, shortened ribs) were observed at 1,000 mg/kg/day (~10 times the human exposure at 10 mg daily based on auc 0-24hr for total ezetimibe). in rabbits treated with ezetimibe, an increased incidence of extra thoracic ribs was observed at 1,000 mg/kg/day (150 times the human exposure at 10 mg daily based on auc 0-24hr for total ezetimibe). the animal-to-human exposure multiple for total ezetimibe at the no-observed effect level was 6 times for rat and 134 times for rabbit. fetal exposure to ezetimibe (conjugated and unconjugated) was confirmed in subsequent placental transfer studies conducted using a maternal dose of 1,000 mg/kg/day. the fetal maternal plasma exposure ratio (total ezetimibe) was 1.5 for rats on gestation day 20 and 0.03 for rabbits on gestation day 22. the effect of ezetimibe on prenatal and postnatal development and maternal function was evaluated in pregnant rats at doses of 100, 300 or 1,000 mg/kg/day from gestation day 6 through lactation day 21. no maternal toxicity or adverse developmental outcomes were observed up to and including the highest dose tested (17 times the human exposure at 10 mg daily based on auc 0-24hr for total ezetimibe). multiple-dose studies of ezetimibe given in combination with statins in rats and rabbits during organogenesis resulted in higher ezetimibe and statin exposures. reproductive findings occurred at lower doses in combination therapy compared to monotherapy. risk summary there is no information about the presence of ezetimibe in human milk. ezetimibe is present in rat milk (see data) . when a drug is present in animal milk, it is likely that the drug will be present in human milk. there is no information about the effects of ezetimibe on the breastfed infant or the effects of ezetimibe on milk production. ezetimibe tablets should not be used in nursing mothers unless the potential benefit justifies the potential risk to the infant. data ezetimibe was present in the milk of lactating rats. the pup to maternal plasma ratio for total ezetimibe was 0.5 on lactation day 12. the safety and effectiveness of ezetimibe tablets in combination with a statin as an adjunct to diet to reduce ldl-c have been established in pediatric patients 10 years of age and older with hefh. use of ezetimibe tablets for this indication is based on a double-blind, placebo-controlled clinical trial in 248 pediatric patients (142 males and 106 postmenarchal females) 10 years of age and older with hefh [ see clinical studies (14)] . in this limited controlled trial, there was no significant effect on growth or sexual maturation in the adolescent males or females, or on menstrual cycle length in females. the safety and effectiveness of ezetimibe tablets in combination with a statin, and other ldl-c lowering therapies, to reduce ldl-c have been established in pediatric patients 10 years of age and older with hofh. use of ezetimibe tablets for this indication is based on a 12-week double-blind, placebo-controlled clinical trial followed by an uncontrolled extension period in 7 pediatric patients 11 years of age and older with hofh [ see clinical studies (14)] . the safety and effectiveness of ezetimibe tablets as an adjunct to diet for the reduction of elevated sitosterol and campesterol levels have been established in adults and pediatric patients 9 years of age and older with homozygous familial sitosterolemia. use of ezetimibe tablets for this indication is based on an 8-week double-blind, placebo-controlled clinical trial in 4 patients 9 years of age and older with homozygous sitosterolemia with elevated plasma sitosterol levels (>5 mg/dl) [ see clinical studies (14)] . the safety and effectiveness of ezetimibe tablets have not been established in pediatric patients younger than 10 years of age with hefh or hofh, in pediatric patients younger than 9 years of age with homozygous familial sitosterolemia, or in pediatric patients with other types of hyperlipidemia. of the 2,396 patients who received ezetimibe tablets in clinical trials, 669 (28%) were 65 years of age and older, and 111 (5%) were 75 years of age and older. of the 11,308 patients who received ezetimibe tablets in combination with a statin in clinical trials, 3587 (32%) were 65 years of age and older, and 924 (8%) were 75 years of age and older [ see clinical studies (14)] . no overall differences in safety or effectiveness of ezetimibe tablets have been observed between patients 65 years of age and older and younger patients. no clinically meaningful differences in the pharmacokinetics of ezetimibe were observed in geriatric patients compared to younger adult patients [ see clinical pharmacology (12.3)]. no dosage adjustment of ezetimibe tablets is necessary in patients with renal impairment. ezetimibe tablets are not recommended for use in patients with moderate to severe hepatic impairment (child-pugh b or c) due to the unknown effects of the increased exposure to ezetimibe [ see clinical pharmacology (12.3)].