lovastatin vs. simvastatin

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

View Heart Disease (Coronary Artery Disease) Slideshow Pictures

lovastatin vs. simvastatin comparison

Both lovastatin (Mevacor, Altoprev) and simvastatin (Zocor) are members of the statin family of cholesterol-lowering drugs. Statins revolutionized the treatment and prevention of a host of cardiovascular diseases including coronary artery disease and other cholesterol-related problems that cause debilitating and fatal heart attacks and strokes.

Lovastatin and simvastatin are chemically similar. The central difference between these two statins is that simvastatin tends to be more effective at lowering the targeted bloodstream cholesterol levels. Doctors may keep lovastatin in reserve for drug combinations or if a patient has an undesirable reaction to a typically more potent statin.

Side effects for each medication are nearly identical. They include:

Both Mevacor and Zocor react badly with the same drugs, including blood thinners like warfarin (Coumadin).

Another difference between lovastatin and simvastatin is that lovastatin works better when you take it with food, whereas if you take simvastatin, it makes no difference when you eat.

What are lovastatin and simvastatin?

Lovastatin and simvastatin are both members of the class of drugs called statins, which also includes:

Statins work to lower cholesterol in the bloodstream, which is in the form of low-density lipoproteins (LDL). LDL is what doctors are talking about when they say "bad cholesterol."

Cholesterol is vital to your body's functions, performing tasks as diverse as providing cell structure, lining nerves, and aiding digestive processes, among many others. A healthy person's body can easily balance cholesterol levels, and healthy liver is capable of making all the body's necessary cholesterol from simpler fat molecules. Foods also contain cholesterol, however. If your diet is poor and/or you have a genetic predisposition, this extra cholesterol courses through your bloodstream in the form of LDL molecules. Over time, these bits of LDL accumulate in arteries, constricting the blood flow. Often, this leads to catastrophic effects such as debilitating or fatal heart attacks and strokes.

Statins like Mevacor and Zocor bind with a cholesterol precursor chemical called hydroxymethylglutaryl-coenzyme A reductase or HMG-CoA (statins are also called HMG-CoA inhibitors). HMG-CoA is one step in the process the liver cells use to manufacture cholesterol from simpler molecules. Statins throw a wrench in the works of the liver's cholesterol-making process by preventing HMG-CoA from turning into cholesterol. This forces the body's cholesterol balancing impulse to kick in, meaning the liver cells absorb more LDL from the blood stream, meaning less of it is floating around to add to plaque deposits.

Lovastatin and simvastatin also raise levels of high-density lipoprotein (HDL), the so-called "good cholesterol." HDL is beneficial because it acts like a scavenger, capturing LDL molecules and taking them to the liver for processing. Researchers don't understand how statins raise bloodstream HDL as well as they understand how the drugs lower bloodstream LDL.

What are the uses for lovastatin and simvastatin?

Lovastatin and simvastatin treat high cholesterol, LDL, and triglycerides and elevate HDL cholesterol. Both lovastatin and simvastatin can help prevent:

Lovastatin and simvastatin reduce the risk of heart attack, stroke, angina and revascularization procedures in adults with multiple risk factors for coronary artery disease. Lovastatin and simvastatin also prevent heart attacks and strokes in patients with type 2 diabetes with multiple risk factors for coronary artery disease.

What are the side effects of lovastatin and simvastatin?

The potential side effects of lovastatin and simvastatin are nearly identical. The most common reactions include headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain and abnormal liver tests. People sometimes have allergic reactions to lovastatin or simvastatin.

The chief worry for people taking Mevacor and Zocor is liver damage. Though statin-induced liver damage is rare, it can be serious. Both medications tend to cause important chemical markers in the liver to rise above normal, which is why doctors prescribing statins to their patients keep a close eye on them through frequent liver tests. If the levels are at three times the upper limit of normal, doctors will cease administering the drugs.

Another rare but serious side effect is the potential breakdown of skeletal muscles, which release the protein myoglobin into the bloodstream. This condition, called rhabdomyolosis, can kill you by destroying your kidneys, which aren't equipped to filter myoglobin.

Lovastatin and simvastatin also can raise blood sugar levels, mimicking conditions seen in patients with diabetes.

How should lovastatin and simvastatin be taken (dosage)?

lovastatin

  • The dose range for Mevacor is 10-80 mg daily given preferably in the evening when it may be most effective.
  • The usual starting dose is 20 mg once daily, and the maximum dose is 80 mg daily.
  • Blood cholesterol determinations are performed at regular intervals during treatment so that adjustments in dosage can be made.

simvastatin

  • The recommended dose range of Zocor 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.

Which drugs interact with lovastatin and simvastatin?

A large number of drugs can compromise your body's ability to get rid of lovastatin and simvastatin. Higher concentrations of these drugs in the body can increase the chances of dangerous side effects. Examples of drugs that decrease elimination of lovastatin and simvastatin include:

Don't binge on grapefruit juice if you take either lovastatin or simvastatin. More than a liter a day will increase muscle toxicity.

Amiodarone (Cordarone), verapamil (Calan, Verelan, Isoptin), diltiazem (Cardizem), and some others will also increase the risk of muscle toxicity for statins. You may be able to still take lovastatin or simvastatin if you are on these other drugs, but the doctor will have to adjust your statin dose accordingly.

Lovastatin may increase the effect of warfarin (Coumadin), a blood thinner; warfarin toxicity is a danger for people taking that drug plus lovastatin or simvastatin, so doctors keep watch for that possibility.

This is not a complete list of medications that interact with lovastatin and simvastatin, so make sure to tell your doctor about all the other medications you're taking if they prescribe you either of these drugs.

Are lovastatin and simvastatin safe to take during pregnancy or while breastfeeding?

Under no circumstances should you take statins while pregnant or nursing. Cholesterol is crucial for the proper formation of the developing fetus and for a growing infant. You shouldn't take statins even if you think you might become pregnant. Statins are also passed on in breast milk, so don't take them if you're nursing, either.

REFERENCES:

"Which Statin is Right for My Patient?"
Darrell Hulisz, PharmD
Medscape.com

FDA Prescribing Information

"A Comparison of Simvastatin and Atorvastatin up to Maximal Recommended Doses in Large Multicenter Randomized Clinical Trial"
D. Roger Illingworth et. al
Current Medical Research and Opinion, 2001

"The 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductases"
Jon A Friesen and Victor W Rodwell
Genome Biology, 2004

"Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5"
National Center for Biotechnology information

"Low-density lipoprotein receptor--its structure, function, and mutations"
JC Defesche
Seminars in Vascular Medicine, 2004

"Statin inhibition of HMG-CoA reductase: a 3-dimensional view."
E. Istvan
Atherosclerosis Supplements, 2003

"Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database"
Philip J. Barter et. al
Journal of Lipid Research

"Good vs. Bad Cholesterol"
The American Heart Association

Summary

Lovastatin (Mevacor) and simvastatin (Zocor) are both members of the cholesterol-lowering class of drugs called statins. Statins work by causing the liver to absorb cholesterol in the form of LDL from the bloodstream so it does not add to plaque deposits, which are implicated in heart attacks and strokes. Lovastatin tends to be less potent than simvastatin. Doctors often keep lovastatin in reserve for use in drug combinations or if people have adverse reactions to a stronger statin like simvastatin.

Treatment & Diagnosis

Medications & Supplements

Subscribe to MedicineNet's Heart Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

FDA Logo

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.

Reviewed on 3/9/2017
References
REFERENCES:

"Which Statin is Right for My Patient?"
Darrell Hulisz, PharmD
Medscape.com

FDA Prescribing Information

"A Comparison of Simvastatin and Atorvastatin up to Maximal Recommended Doses in Large Multicenter Randomized Clinical Trial"
D. Roger Illingworth et. al
Current Medical Research and Opinion, 2001

"The 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductases"
Jon A Friesen and Victor W Rodwell
Genome Biology, 2004

"Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5"
National Center for Biotechnology information

"Low-density lipoprotein receptor--its structure, function, and mutations"
JC Defesche
Seminars in Vascular Medicine, 2004

"Statin inhibition of HMG-CoA reductase: a 3-dimensional view."
E. Istvan
Atherosclerosis Supplements, 2003

"Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database"
Philip J. Barter et. al
Journal of Lipid Research

"Good vs. Bad Cholesterol"
The American Heart Association

Health Solutions From Our Sponsors