Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: simvastatin
BRAND NAME: Zocor
DRUG CLASS AND MECHANISM: Simvastatin is a cholesterol-lowering drug.
It belongs to a class of drugs called HMG-CoA reductase inhibitors, commonly
called "statins." Other statins include lovastatin (Mevacor), atorvastatin
(Lipitor), fluvastatin (Lescol), and rosuvastatin (Crestor). Statins reduce
cholesterol by inhibiting an enzyme in the liver (HMG-CoA reductase) that is
necessary for the production of cholesterol. In the blood, statins lower total
and LDL ("bad") cholesterol as well as
triglycerides. LDL cholesterol is
believed to be an important cause of coronary artery disease. Lowering LDL
cholesterol levels slows and may even reverse
coronary artery disease. Statins
also increase HDL ("good") cholesterol. Raising HDL cholesterol levels, like
lowering LDL cholesterol may slow coronary artery disease. The FDA approved
simvastatin in December 1991.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
- Tablets: 5, 10, 20, 40, and 80 mg.
- Oral disintegrating tablets: 10, 20, 40, and 80 mg.
STORAGE:
- Tablets should be stored between 5-30 C (41-86 F).
- Oral
disintegrating tablets should be stored between 20-25 C (68-77 F).
PRESCRIBED FOR: Simvastatin is used for reducing total cholesterol,
LDL cholesterol, and triglycerides, and for increasing HDL cholesterol. In
patients with coronary heart disease, diabetes,
peripheral vessel disease, or
history of stroke or other cerebrovascular disease,
simvastatin is prescribed
for reducing the risk of mortality by reducing death from coronary heart
disease, reducing nonfatal myocardial infarction (heart attack) and stroke, and
reducing the need for coronary and noncoronary revascularization procedures.
DOSING: The dose range for is 5-80 mg/day given preferably in the
evening. The usual staring dose is 20-40 mg once daily. Dose adjustments are
made at weekly intervals.
DRUG INTERACTIONS: Decreased elimination of simvastatin could increase
the levels of simvastatin in the body and increase the risk of muscle toxicity
from simvastatin. Examples of drugs that decrease elimination of simvastatin
include erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox),
clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune),
nefazodone (Serzone), and HIV protease inhibitors such as indinavir (Crixivan)
and ritonavir (Norvir). Large quantities of grape fruit juice (>1 quart daily)
also will increase blood levels of simvastatin.
Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin),
danazol (Danocrine),
cyclosporine, niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil (Lopid) and
fenofibrate (Tricor) also may increase the risk of muscle toxicity when combined
with simvastatin. Patients taking amiodarone or verapamil should not take more
than 20 mg of simvastatin. Patients taking danazol or cyclosporine should not
take more than 10 mg of simvastatin.
Simvastatin increases the effect of warfarin (Coumadin) and the blood
concentration of digoxin (Lanoxin). Patients taking simvastatin and warfarin or
digoxin should be monitored carefully for toxic effects of warfarin and digoxin.
Cholestyramine (Questran,
Questran Light) decreases the absorption of simvastatin. Therefore,
simvastatin should only be taken 2 hours before or at least 4 hours after
cholestyramine administration.
PREGNANCY: Pregnant women should not use simvastatin because the
developing fetus requires cholesterol for development, and simvastatin reduces
the production of cholesterol. Simvastatin should only be administered to women
of child bearing age if they are not likely to become
pregnant.
NURSING MOTHERS: Because of the risk of adverse effects to the
developing infant, simvastatin should not be administered to
nursing mothers.
SIDE EFFECTS: The most common side effects of simvastatin are
headache, nausea,
vomiting, diarrhea, abdominal pain, muscle pain, and abnormal
liver tests. Hypersensitivity reactions have also been reported. The most
serious potential side effects are liver damage and muscle inflammation or
breakdown.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Statins - Read about statins, cholesterol lowering medications like Levacor, Zocor, Pravachol, Lipitor, Crestor, and more. Side effects, drug interactions, and patient information is also provided.
- Liver Blood Tests - Learn about liver blood tests used to detect liver damage disease such as fatty liver, cirrhosis, hepatitis, Tylenol liver damage, and more. This includes measuring the aminotransferases enzymes (AST and ALT levels)
- Stroke - Learn about strokes symtoms like sudden numbness or weakness in the face, arms, or legs, confusion, vision problems, problems with walking or coordination, or severe headache.
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