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 or pharmacist.
Important Safety Information
This service operates under German pharmaceutical law (HWG). For risks and side effects, read the package leaflet and consult your doctor or pharmacist. All medications are dispensed from a licensed pharmacy in Germany.