Vytorin Dosage/Direction for Use

The patient should be placed on a standard cholesterol-lowering diet before receiving Vytorin and should continue on this diet during treatment with Vytorin. The dosage should be individualized according to the baseline LDL-C level, the recommended goal of therapy and the patient's response. Vytorin should be taken as a single daily dose in the evening, with or without food.
The dosage range is 10/10 mg/day through 10/40 mg/day. The recommended usual starting dose is 10/20 mg/day. Initiation of therapy with 10/10 mg/day may be considered for patients requiring less aggressive LDL-C reductions. Patients who require a larger reduction in LDL-C (>55%) may be started at 10/40 mg/day. After initiation or titration of Vytorin, lipid levels may be analyzed after ≥2 weeks and dosage adjusted, if needed.
Patients with Homozygous Familial Hypercholesterolemia: Recommended Dose: 10/40 mg/day in the evening. Vytorin should be used as an adjunct to other lipid-lowering treatments (eg, LDL apheresis) in these patients or if such treatments are unavailable.
Hepatic Impairment: No dosage adjustment is required in patients with mild hepatic insufficiency (Child-Pugh score 5 or 6). Treatment with Vytorin is not recommended in patients with moderate (Child-Pugh score 7-9) or severe (Child-Pugh score >9) liver dysfunction (see Special Populations in Pharmacology under Actions and Precautions).
Renal Impairment: No dosage adjustment is required for patients with moderate renal insufficiency. If treatment in patients with severe renal insufficiency (creatinine clearance ≤30 mL/min) is deemed necessary, dosages >10/10 mg/day should be implemented cautiously (see Special Populations in Pharmacology under Actions).
Co-administration with Other Medicines: Dosing of Vytorin should occur either ≥2 hrs before or ≥4 hrs after administration of a bile acid sequestrant.
In patients taking cyclosporine, danazol or niacin ≥1 g/day concomitantly with Vytorin, the dose of Vytorin should not exceed 10/10 mg/day (see Precautions and Interactions).
In patients taking amiodarone or verapamil concomitantly with Vytorin, the dose of Vytorin should not exceed 10/20 mg/day (see Precautions and Interactions).
Elderly: No dosage adjustment is required for elderly patients (see Special Populations in Pharmacology under Actions).
Children: Treatment with Vytorin is not recommended.