Tuesday, May 6, 2008

Vytorin: Desperately Seeking Effectiveness?

One of the latest generation of cholesterol-lowering drugs that raised much controversy when a leading medical journal questioned the drugs effectiveness. Is Vytorin any better than older cholesterol-lowering drugs like Lipitor?

By: Vanessa Uy

Ever since that damning editorial by the New England Journal of Medicine came out questioning the effectiveness of Vytorin in reducing plaque build up which might lead to heart attack later. It not only shocked the medical community, but also to thousands of patients who were prescribed by their doctors to take the drug. Others in the medical community also questioned the wisdom of promoting and prescribing Vytorin even though there are older and therefore much cheaper drugs - like Lipitor for example – are still very effective in their cholesterol-lowering role. But before we condemn Vytorin, let’s examine first what’s going for it.

Vytorin is a cholesterol-lowering drug and is composed by a combination of two drugs, namely simvastatin (Zocor) and ezetimibe (Zetia). When Vytorin is prescribed, it is used along with a special diet and an exercise regimen to lower the amount of fatty material in the blood. Namely triglycerides and low density lipoproteins (LDL) sometimes called “bad cholesterol” because it will build up into fatty plaque deposits that increases the body’s risk of heart attacks. The two components Vytorin works in a different way to lower the levels of fat in the blood. Normally, our liver produces most of the cholesterol that we need to maintain a healthy balance. Cholesterol in the right amount is vital in the proper maintenance of our nervous system. One of Vytorin’s components simvastatin works by interrupting the process of the liver’s cholesterol production, the other one ezetimibe, works by reducing the amount of dietary bad cholesterol that can be absorbed by the intestines.

Vytorin should only be prescribed if diet, exercise, and weight loss fail to bring down the patient’s cholesterol levels under control. The doctor may prescribe Vytorin if the patient’s risk factors for coronary heart disease is high and when the patient’s cholesterol level is above 130 mg / dL. The drug is also prescribed to patients whose cholesterol levels are above 190 mg / dL, even if their risk factors for coronary heart disease are low.

A disadvantage of Vytorin is that quite a number of the population shows allergic reactions to the two main components of the drug, namely simvastatin (Zocor) and ezetimibe (Zetia). The precautions of taking the drug are quite numerous. Pregnant and lactating women are not allowed to take Vytorin because it might affect the child’s nervous system development. Patients with impaired liver function should not be allowed to take Vytorin because the drug will further tax their compromised liver. Though Vytorin should not be taken when the patient had recently or will about to drink alcoholic beverages. Even seemingly innocuous drinks - such as grapefruit juice – can have an adverse interaction with the drug. Vytorin can cause breakdown of the muscle tissue that can lead to serious kidney damage and even death from kidney failure.

Any doctor who is familiar with cholesterol-lowering drugs could conclude that the precautions in taking and prescribing Vytorin is somewhat similar to other common cholesterol-lowering medication like Lipitor (atorvastatin calcium). But should the patient suffer through these unfortunate side effects even if current medical research had shown that Vytorin is no more – even less – effective in lowering cholesterol when compared to older drugs like Lipitor? Maybe we should be campaigning for more awareness of healthier diets and lifestyles at the school level, rather than treating the effects of obesity and high cholesterol via a magic pill. This would drastically reduce the burden of our health care infrastructure.

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