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Because of an increased risk for myopathy in Chinese patients taking simvastatin 40 mg coadministered with lipid-modifying dosesgreater than or equal to 1 g/day niacinof niacin-containing productscaution should be used when treating Chinese patients with VYTORIN doses exceeding 10/20 mg/day coadministered with lipid-modifying dosesgreater than or equal to 1 g/day niacinof niacin-containing productsBecause the risk for myopathy is dose-relatedChinese patients should not receive VYTORIN 10/80 mg coadministered with lipid-modifying doses of niacin-containing productsThe cause of the increased risk of myopathy is not knownIt is also unknown if the risk for myopathy with coadministration of simvastatin with lipid-modifying doses of niacin-containing products observed in Chinese patients applies to other Asian patientsSee WARNINGS AND PRECAUTIONS

15McDonagh JWinocour PWalker DJMusculoskeletal manifestations during simvastatin therapyBr J Rheumatol 321993647-8.

The following adverse reactions have been reported in postmarketing experience for VYTORIN or ezetimibe or simvastatinpruritusalopeciaerythema multiformea variety of skin changese.gnodulesdiscolorationdryness of skin/mucous membraneschanges to hair/nailsdizzinessmuscle crampsmyalgiaarthralgiapancreatitisparesthesiaperipheral neuropathyvomitingnauseaanemiaerectile dysfunctioninterstitial lung diseasemyopathy/rhabdomyolysissee WARNINGS AND PRECAUTIONShepatitis/jaundicefatal and non-fatal hepatic failuredepressioncholelithiasischolecystitisthrombocytopeniaelevations in liver transaminaseselevated creatine phosphokinase.

16Itakura HVaughn DHaller DGO’Dwyer PJRhabdomyolysis from cytochrome p-450 interaction of ketoconazole and simvastatin in prostate cancerJ Urol 1692003613.

Hypersensitivity reactionsincluding anaphylaxisangioedemarashand urticaria have been reported.

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your doctor may ask you to take vytorin with other cholesterol lowering agents such as bile acid sequestrants.

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