simvastatin, Zocor (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC AVAILABLE: Yes
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 vascular 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 recommended dose range of simvastatin is 10 mg to 40 mg, and it is administered once daily in the evening with or without food. Therapy usually is initiated with 10 or 20 mg daily, but individuals who have a high risk of heart disease can be started on 40 mg daily.
Simvastatin 80 mg is restricted to patients who have been taking simvastatin 80 mg chronically (for example, for 12 months or more) without evidence of muscle toxicity because the 80 mg dose is associated with increased risk of muscle toxicity, including rhabdomyolysis. Patients who are currently tolerating the 80 mg dose of simvastatin who need to start an interacting drug that should not be taken with simvastatin or is associated with a dose cap for simvastatin should be switched to an alternative statin or statin-based regimen with less potential for the drug-drug interaction.
Patients that require more than the 40 mg dose should be switched to an alternative drug.
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 indinavir (Crixivan) and ritonavir (Norvir). They should not be combined with simvastatin.
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