What is Simvastatin
Simvastatin is an oral antilipemic agent which inhibits HMG-CoA reductase. Simvastatin is the methylated form of lovastatin.
Both simvastatin and lovastatin are prodrugs that require hydrolysis for activation. Simvastatin is used in the treatment of primary hypercholesterolemia and is effective in reducing total and LDL-cholesterol as well as plasma triglycerides and apolipoprotein B.
Simvastatin has a high affinity for HMG-CoA reductase. At therapeutic doses of 5 to 80 mg once daily, simvastatin reduces mean LDL concentrations by approximately 26—47%.
Simvastatin was approved by the FDA in December 1991. As a result of the Scandinavian Simvastatin Survival Study, on July 5, 1995, the FDA approved simvastatin for use, in combination with diet, to prevent myocardial infarction in patients with hypercholesterolemia and preexisting coronary artery disease.
In April 2003, the FDA approved simvastatin 40 mg as a starting dose for a broad population of patients at high risk for coronary events, including patients with existing coronary heart disease, diabetes, peripheral vessel disease, or patients with a history of stroke or other cerebrovascular disease
Brand Name
- FloLipid
- Zocor
Indications & Dosage
- atherosclerosis
- cerebral vasospasm prophylaxis
- hypercholesterolemia
- hyperlipoproteinemia
- hypertriglyceridemia
- myocardial infarction prophylaxis
- stroke prophylaxis
For the treatment of hypercholesterolemia, including hyperlipidemia, hyperlipoproteinemia, or hypertriglyceridemia, as an adjunct to dietary control; and for reduction in cardiovascular mortality, including myocardial infarction prophylaxis and stroke prophylaxis
Side Effects
- abdominal pain
- alopecia
- amnesia
- anaphylactoid reactions
- angioedema
- arthralgia
- asthenia
- atrial fibrillation
- chills
- cholestasis
- cirrhosis
- Co-Enzyme Q-10 deficiency
- confusion
- constipation
- depression
- diabetes mellitus
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dyspnea
- edema
- elevated hepatic enzymes
- eosinophilia
- erythema multiforme
- fatigue
- fever
- flatulence
- flushing
- gastritis
- headache
- hemolytic anemia
- hepatic failure
- hepatic necrosis
- hepatitis
- hyperbilirubinemia
- hyperglycemia
- immune-mediated necrotizing myopathy
- impotence (erectile dysfunction)
- infection
- insomnia
- interstitial lung disease
- jaundice
- leukopenia
- lupus-like symptoms
- malaise
- memory impairment
- muscle cramps
- musculoskeletal pain
- myalgia
- myasthenia
- myoglobinuria
- myopathy
- nausea
- pancreatitis
- paresthesias
- peripheral neuropathy
- photosensitivity
- pruritus
- purpura
- rash
- rhabdomyolysis
- sinusitis
- Stevens-Johnson syndrome
- thrombocytopenia
- toxic epidermal necrolysis
- urticaria
- vasculitis
- vertigo
- vomiting
Monitoring Parameters
- creatine phosphokinase (CPK)
- LFTs
- serum cholesterol profile
Contraindications
- alcoholism
- Asian patients
- breast-feeding
- children
- cholestasis
- contraception requirements
- diabetes mellitus
- electrolyte imbalance
- endocrine disease
- females
- geriatric
- hepatic disease
- hepatic encephalopathy
- hepatitis
- hypotension
- hypothyroidism
- infants
- infection
- jaundice
- myopathy
- organ transplant
- pregnancy
- renal disease
- renal failure
- renal impairment
- rhabdomyolysis
- seizure disorder
- surgery
- trauma
Interactions
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amiodarone
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Aprepitant, Fosaprepitant
- Atazanavir
- Atazanavir; Cobicistat
- Barbiturates
- Bempedoic Acid
- Bempedoic Acid; Ezetimibe
- Boceprevir
- Bortezomib
- Bosentan
- Carbamazepine
- Ceritinib
- Chlorzoxazone
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Cobicistat
- Colchicine
- Colchicine; Probenecid
- Conivaptan
- Crizotinib
- Cyclosporine
- Dabigatran
- Dabrafenib
- Daclatasvir
- Danazol
- Daptomycin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deferasirox
- Delavirdine
- Digoxin
- Diltiazem
- Dronedarone
- Duvelisib
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Eltrombopag
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Encorafenib
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Etravirine
- Everolimus
- Fedratinib
- Fenofibrate
- Fenofibric Acid
- Flibanserin
- Fluconazole
- Fluvoxamine
- Fosamprenavir
- Fostamatinib
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- grapefruit juice
- Hydantoins
- Hydrochlorothiazide, HCTZ; Propranolol
- Idelalisib
- Imatinib
- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivacaftor
- Ivosidenib
- Ketoconazole
- Lanthanum Carbonate
- Lefamulin
- Leflunomide
- Letermovir
- Lomitapide
- Lopinavir; Ritonavir
- Lovastatin; Niacin
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Metformin; Repaglinide
- Mifepristone
- Mitotane
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicardipine
- Obeticholic Acid
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Oxcarbazepine
- Pazopanib
- Perindopril; Amlodipine
- Pexidartinib
- Posaconazole
- Propranolol
- Protease inhibitors
- Quinine
- Raltegravir
- Ranolazine
- Red Yeast Rice
- Repaglinide
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Riluzole
- Ritonavir
- Saquinavir
- Sarilumab
- Siltuximab
- Simeprevir
- Sirolimus
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- St. John’s Wort, Hypericum perforatum
- Tacrolimus
- Telaprevir
- Telbivudine
- Telithromycin
- Teriflunomide
- Tesamorelin
- Tezacaftor; Ivacaftor
- Ticagrelor
- Tipranavir
- Tocilizumab
- Tolvaptan
- Trandolapril; Verapamil
- Tucatinib
- Verapamil
- Voriconazole
- Warfarin
- Zafirlukast
- Zileuton
