HMG-CoA reductase inhibitor + cholesterol absorption inhibitor
Simvastatin with ezetimibe
Brand names: Inegy
Adult dose
Dose: 10/10mg, 10/20mg, 10/40mg or 10/80mg PO ON (note simvastatin 80mg only continued if used >12 months without myopathy)
Route: PO
Frequency: ON
Dose adjustments
Renal
Use cautiously if eGFR <30
Clinical pearls
- Hypercholesterolaemia when monotherapy inadequate
- Atorvastatin/rosuvastatin preferred 1st-line per NICE NG181
Contraindications
- Active liver disease
- Pregnancy/breastfeeding
- Concurrent strong CYP3A4 inhibitors / fibrates / amiodarone (with simva 40-80mg)
Side effects
- Myalgia
- Rhabdomyolysis
- Transaminitis
- GI upset
- Headache
Interactions
- Strong CYP3A4 inhibitors (limit simva to 20mg or avoid)
- Amiodarone/diltiazem/verapamil (limit simva)
- Fibrates
- Ciclosporin
Monitoring
- LFTs
- CK if symptomatic
- Lipids
Reference: BNF; NICE NG181; MHRA; https://bnf.nice.org.uk/drugs/simvastatin-with-ezetimibe/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Framingham Risk Score · Cardiovascular Risk
- Reynolds Risk Score for Women · Cardiovascular Risk
- SCORE2 — 10-Year CVD Risk (Age 40–69) · Cardiovascular Risk
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- UK Prospective Diabetes Study (UKPDS) Risk Engine · Prognosis
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines