Simvastatin(sim va stah’ tin)
Apo-Simvastatin (CAN), CO Simvastatin (CAN), Gen-Simvastatin (CAN), Novo-Simvastatin (CAN), PMS-Simvastatin (CAN), ratio-Simvastatin (CAN), Zocor
PREGNANCY CATEGORY X
Drug Classes
Antihyperlipidemic
HMG-CoA reductase inhibitor
Therapeutic Actions
Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.
Indications
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Adjunct to diet in the treatment of hyperlipidemia
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To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, MI, and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholesterolemia
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Treatment of adolescents 10–17 yr with heterozygous familial hypercholesterolemia
Contraindications and Cautions
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Contraindicated with allergy to simvastatin, fungal by-products; active liver disease or unexplained, persistent elevations of serum transaminases; concurrent use of HIV protease inhibitors, erythromycin, clarithromycin, telithromycin, nefazodone, qemfibrozil, cyclosporine, danazol; pregnancy, lactation.
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Use cautiously with impaired hepatic and renal function, cataracts, Asian-Americans (increased risk of myopathy).
Available Forms
Tablets—5, 10, 20, 40, 80 mg
Dosages
Adults
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Prevention of coronary events: 10–20 mg PO once daily in the evening. Patients at high risk: Start at 40 mg/day.
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Familial hypercholesterolemia: 40 mg/day PO in the evening.
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Combination therapy: Do not combine with other statins; if used with fibrates or niacin, do not exceed 10 mg/day; regular dose if combined with bile acid sequestrants. Give at least 4 hr before simvastatin. Combined with cyclosporine, start with 5 mg/day; do not exceed 10 mg/day. If used with diltiazem or verapamil, dose should not exceed 10 mg/day. If used with amiodarone, amlodipine, ranolazine, dose should not exceed 20 mg/day.
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