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Indications

Simvastatin lowers high cholesterol, especially LDL ("bad") cholesterol and triglycerides, and slightly raises HDL ("good") cholesterol. It is used, together with diet and exercise, to reduce the risk of heart attack and stroke in people with heart disease, diabetes, a past stroke or other high risk, and in inherited high cholesterol.

How It Works

Simvastatin is a statin. It blocks an enzyme called HMG-CoA reductase that the liver uses to make cholesterol. The liver then removes more LDL cholesterol from the blood.

Dosage and Administration

Adults: usually 10 to 20 mg once a day in the evening, which the doctor may raise to 40 mg once a day. Higher doses are not started in new patients because of the risk of muscle damage. Lower maximum doses apply with some other medicines (see Interactions). Take it at the same time each evening, with or without food, and keep to a healthy diet. Children with inherited high cholesterol: as prescribed.

Interactions

• Must not be used with Itraconazole, Ketoconazole, Posaconazole, Clarithromycin, Erythromycin, HIV protease inhibitors, Gemfibrozil, Ciclosporin or Danazol, because the risk of serious muscle damage rises sharply.
• Lower doses are needed with Amlodipine, Amiodarone, Diltiazem, Verapamil and Ranolazine.
• Fusidic acid tablets or injection should not be taken at the same time.
• It may increase the effect of Warfarin; INR checks are needed.
• Avoid drinking large amounts of grapefruit juice.

Contraindications

• Active liver disease or unexplained raised liver tests.
• Pregnancy and breastfeeding.
• Use with the strong interacting medicines listed above.
• Allergy to Simvastatin or any ingredient of the product.

Side Effects

Common: headache, stomach pain, constipation, wind, nausea and mild muscle aches. Rarely it can cause liver problems, serious muscle damage or a small rise in blood sugar.

Get urgent medical help if you have unexplained muscle pain, tenderness or weakness (especially with fever, feeling unwell or dark brown urine), yellowing of the skin or eyes, or swelling of the face, lips or throat.

Pregnancy and Lactation

Do not take Simvastatin during pregnancy, as cholesterol is needed for the baby's development. Stop it before trying to conceive and tell your doctor at once if you become pregnant. Do not take it while breastfeeding.

Precautions and Warnings

Your doctor may check liver tests before and during treatment. The risk of muscle problems is higher in people over 65, with kidney problems, an underactive thyroid, heavy alcohol use or a past muscle problem with another statin. People with diabetes or at risk of it should have their blood sugar checked. Tell the doctor before surgery that you take a statin.

Overdose

There is no specific antidote. Seek medical advice if much more than the prescribed dose is taken.

Therapeutic Class

Lipid-lowering medicine (statin, HMG-CoA reductase inhibitor).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.