Supervisor : Prof. Dr.Hekma

Coordinator : Ph.Fatmah Bakhder

Umm Al-Qura University Faculty of pharmacology

department

HYPER LIPIDEMIA

INEGY

OBJECTIVES• Trade and generic names• Mechanism of action• Clinical use• Side effects• Drug interactions• Life style

Therapeutic class :Lipid-Lowering AgentsPharmacological class :HMG-CoA Reductase Inhibitors

INEGY

• Trade name :Inegy• generic name:Simvastatin & Ezetimibe

Uses of Inegy:The main effects that produce from this drug are:• lower levels of total cholesterol,

(LDL cholesterol) and triglycerides in the blood.

• Raises levels of (HDL cholesterol).

• Hypercholesterolaemia

So. It can use if patient has:• Homozygous Familial

Hypercholesterolaemia (HoFH)

• patients not appropriately controlled with a statin alone

• patients treated with a statin and ezetimibe

M.O.A

• Side effectHeadache.FatigueConstipationAbdominal painIndigestionDiarrheaNausea ,vomiting.Hot flushes.Myopathy and Rhabdomyolysis. Myoglobinuria and acute renal failure .Photosensitivity, purpura, and alopecia.

• Drug - drug interaction

Mainly for Simvastatin Warfarin AspirinNiacin Fibrate ErythromycinVerapamil

Drug interaction classificationMajor Highly clinically significant. Avoid

combinations; the risk of the interaction outweighs the benefit.

Moderate

Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.

Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Simvastatin ↔ WarfarinIt acts by affecting

hepatic/intestinal enzyme CYP3A4 metabolism that lead to:• Reversible Rhabdomyolysis .• Acute renal failure

Simvastatin&ezetimibe

↔ cholestyramine• cholestyramine decreases levels of ezetimibe and simvastatin by inhibition of GI absorption. 

Simvastatin ↔ NiacinEither increases toxcity of

the other by pharmacodynamic synergism that increase risk of :  • (Rhabdomyolysis ) for

Both

simvastatin ↔ fibrateE.g. Gemfibrozil.

Either increases effects of the other by pharmacodynamic synergism lead to :• Liver damaged .• Severe myopathy and

Rhabdomyolysis – renal failure secondary to

Myoglobinuria and may result in death.

• increased risk of musculoskeletal toxicity.

simvastatin ↔ verapamilSimvastatin ↔ erythromycin

• Verapamil

•   hypertension

•  angina pectoris

•  cardiac arrhythmia

• erythromycin

• Anti-biotic– infecti

ons

simvastatin ↔ verapamil

Simvastatin ↔ erythromycinThey will increase the level or effect of

simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism that lead to :• myopathy and Rhabdomyolysis – renal failure secondary to

Myoglobinuria and may result in death.

• increased risk of musculoskeletal toxicity.

simvastatin level• Bosentan – (pulmonary artery hypertension)

• Carbamazepine – (seizure disorders and

neuropathic pain.)• Efavirenz – (human immunodeficiency virus

(HIV) infection. )• Rifampicin – (tuberculosis )

LIFE STYLE

DONE BYAfraa 3esaAnan fataniAnmah KinsarahGhofran RawasLamiaa alsalmyLujain AndargiriMaram KafyahNazmeyah alkyyalRazan basalmanWaad alhajjaje

REFERENCETextbooks: Anand Ramachandran, Pharmacology recall , 2nd edition, 2007.

Medical Website :SharePractice. Featured Dx: Hyperlipidemia. 04/02/2014. http://sharepractice.com/blog/featured-dx-hyperlipidemia/ (Accessed 30 Mar 2014). University of Maryland medical center. 06/04/2012. Familial combined Hyperlipidemia. May 31, 2013. http://umm.edu/Health/Medical/Ency/Articles/Familial-combined-hyperlipidemia (Accessed 30 Mar 2014). 

SIU School of Medicine. Hyperlipidemia. http://www.siumed.edu/surgery/vascular/hyperlipidemia.html (Accessed 30 Mar 2014). Medscape. When Do Triglycerides Matter? 2014. http://www.medscape.org/viewarticle/457696_7 (Accessed 30 Mar 2014).  Anupama Kizhakkeveettil, Parla S. Jayagopal and Kevin Rose. June 30, 2011. Hypercholesterolemia and Ayurvedic Medicine: A Case Report. http://www.tihcij.com/Articles/Hypercholesterolemia-and-Ayurvedic-Medicine-A-Case-Report.aspx?id=0000282 (Accessed 30 Mar 2014).