Health Canada, the Canadian equivalent of the FDA, recently issued a public advisory about postmarketing reports of myalgia, rhabdomyolysis, hepatitis, pancreatitis and thrombocytopenia associated with use of ezetimibe (Zetia in the US; Ezetrol in Canada). Ezetimibe is often added to a statin to increase LDL cholesterol lowering (Drugs for Lipids, Treat Guidel Med Lett 2005; 3:15). The advisory did not specify whether these patients were also taking a statin, but according to the Canadian manufacturer Merck Frosst/Schering (Merck/Schering-Plough in the US), some of the patients who developed rhabdomyolysis were taking ezetimibe without a statin. In the US, ezetimibe is also available in a combination with simvastatin (Vytorin - Med Lett Drugs Ther 2004; 46:73). Recently, a few patients already taking a statin developed myalgia when ezetimibe was added (R Fux et al, Ann Intern Med 2004; 140:671). The possibility that adding ezetimibe to a statin could increase the risk of rhabdomyolysis should be kept in mind.

The FDA recently approved three new drugs for treatment of hyperlipidemia. Ezetimibe (ez et' i mibe; Zetia) is the first in a new class of drugs that inhibit intestinal absorption of cholesterol. Extended-release lovastatin (Altocor) is a new formulation of lovastatin (Mevacor, and others). Extended-release niacin plus (immediate-release) lovastatin (Advicor) is the first fixed-dose combination of lipid-lowering drugs.