simvastatin, Zocor (cont.)

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Medical and Pharmacy Editor:

Large quantities of grape fruit juice (>1 quart daily) also will increase blood levels of simvastatin and should be avoided.

Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), diltiazem, amlodipine (Norvasc), danazol (Danocrine), ranolazine (Ranexa), 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, 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.

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.

Cholestyramine (Questran) decreases the absorption of ezetimibe (Zetia); Therefore, simvastatin should be taken 2 hours before or at least 4 hours after cholestyramine.

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.

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.



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