- Tablets: 5, 10, 20, 40, and 80 mg.
- Orally disintegrating tablets: 10, 20, 40, and 80 mg.
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),
- boceprevir (Victrelis),
- telaprevir (incivek),
- voriconazole (Vfend),
- posaconazole (Noxafil), and
- HIV protease inhibitors such as:
They should not be combined with simvastatin.
Large quantities of grape fruit juice (>1 quart daily) also will increase blood levels of simvastatin and should be avoided.
The following drugs should not be used with simvastatin:
- Amiodarone (Cordarone),
- verapamil (Calan Verelan, Isoptin),
- amlodipine (Norvasc),
- danazol (Danocrine),
- ranolazine (Ranexa),
- niacin (Niacor, Niaspan, Slo-Niacin),
- gemfibrozil (Lopid) and
- fenofibrate (Tricor).
Patients taking amiodarone, amlodipine, or ranolazine should not exceed 20 mg, and patients taking verapamil or diltiazem should not exceed 10 mg of of simvastatin daily. Patients taking gemfibrozil or danazol should not take simvastatin.
Chinese patients taking ≥1 g/day of niacin in combination with simvastatin 40 mg have an increased risk of muscle-related side effects. Therefore, these patients should not receive simvastatin 80 mg combined with niacin in doses ≥1 g/day. Simvastatin doses greater than 20 mg daily should be administered cautiously when combined with niacin ≥1 g/day.
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