[Drug of the month. Ezetimibe/simvastatin tablet (Inegy)]

Inegy, recently launched by Merck Sharp & Dohme and Schering Plough, is a fixed combination of simvastatin, which inhibits hepatic cholesterol synthesis, and ezetimibe, which selectively inhibits the intestinal absorption of cholesterol and phytosterols. The two mechanisms of action are complementary and result in a synergistic cholesterol-lowering effect. Three formulations of Inegy are commercialized and reimbursed in Belgium, ezetimibe 10 mg/simvastatin 20 mg, ezetimibe 10 mg/simvastatin 40 mg and ezetimibe 10 mg/ simvastatin 80 mg. By blocking both synthesis and absorption of cholesterol, the fixed combination exerts a cholesterol-lowering effect as important as, or even greater than, that observed with the highest dosage of simvastatin and other statins, with a good tolerance profile. Inegy is indicated, as adjuvant treatment to diet, in patients with primary hypercholesterolaemia (homozygote or heterozygote familial form and non-familial polygenic form) not well controlled with a statin alone. Ongoing trials aim at proving the efficacy of such a fixed combination in reducing cardiovascular morbidity and mortality.