High Cholesterol
Simvastatin (Zocor)
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Written by Christine Hoogasian, Nurse Practitioner
Information last reviewed 06/21/19
Simvastatin is a medication that is used to lower cholesterol. It is in the class of cholesterol-lowering medications called statins. Cholesterol is a type of fat (lipid) in your blood. Statins are used to reduce the ‘bad’ cholesterol and lipids in your blood and to increase your levels of ‘good’ cholesterol.
Simvastatin, and all statin medications, works by reducing the liver’s ability to process and make more cholesterol. They work by blocking an enzyme in the body called HMG-CoA Reductase. They have also been shown to reduce inflammation in the body and in blood vessels.
Simvastatin is prescribed following a blood test to check your cholesterol levels. The blood test will check the levels of:
High0density lipoprotein (HDL) - ‘good’ cholesterol
Low-density lipoprotein (LDL) - ‘bad’ cholesterol
Triglycerides - another type of fat
Your total cholesterol
If your total cholesterol, LDL or triglyceride levels are too high, you may be prescribed Simvastatin. Usually, the recommended levels of cholesterol in adults are the following:
Less than 200 total cholesterol,
Less than 150 triglycerides,
More than 40 HDL,
Less than 130 LDL.
If you have diabetes and/or a previous heart condition, the recommended cholesterol levels may be even lower.
Having a high cholesterol level is very dangerous because it increases your risk of getting a heart attack, stroke, and/or dying early from heart disease. High cholesterol is a huge public health concern. In the United States, more than 33 % of Americans have a dangerously high level of LDL (‘bad’ cholesterol). Lowering high cholesterol levels by just 10 % can lower your risk of dying early from heart disease by up to 50 %.
Statins like Simvastatin can effectively reduce LDL levels by 30 to over 60 %! Another benefit of Simvastatin is that the higher the dose prescribed, the higher the HDL (‘good’ cholesterol) level can get. This serves as added protection against heart disease.
The active ingredient in Simvastatin and Zocor is simvastatin.
The inactive ingredients in Simvastatin are: ascorbic acid, citric acid, starch, talc, titanium dioxide, hydroxypropyl cellulose, hypromellose, iron oxide, lactose, microcrystalline cellulose, and magnesium stearate, as well as the preservative butylated hydroxyanisole.
Please note: Inactive ingredients can vary across different generic manufacturers.
Get emergency medical help if you notice any of these symptoms: hives/rash, difficulty breathing, swelling of the lips or face, dizziness or falls. These are symptoms of a severe allergic reaction to the medication. While Simvastatin rarely causes a severe allergic reaction in people, it is important to keep a lookout for these symptoms if it is the first time taking this medication.
Simvastatin is a tablet to be taken by mouth, once daily at bedtime. The available doses of Simvastatin are: 5 mg, 10 mg, 20 mg, 40 mg, and 80 mg. It is recommended to take a dose of no more than 40 mg daily, due to the now known increased side effects of myalgia (muscle cramps) associated with the use of the 80 mg dose.
Simvastatin should be taken once a day, and can be taken at the same time each evening. It does not have to be taken with or without food.
If it is the same day, you can still take the missed dose of Simvastatin. However, if more than 12 hours have passed since the missed dose, skip the missed dose and resume dosing at the next scheduled dose. Do not “double-up” to make up for the missed dose.
The most common side effect of Simvastatin is muscle aches/cramps in the arms and/or legs. Many people who get this side effect report that it lessens over time and in some cases, it goes away. There is also a very small risk of elevated liver enzymes (can be found by a simple blood test), that may be associated with statins. Elevated liver enzymes are a possible sign of damage or inflammation in the liver cells, which, if left unchecked, could contribute to liver disease such as cirrhosis.
You should not take Simvastatin if any of the following apply:
You are allergic to Simvastatin,
You have been diagnosed with extremely high liver enzymes,
You have severe liver or kidney disease,
You are pregnant or breastfeeding.
Simvastatin is known to interact with the following substances:
CYP3A4 Inhibitors
Danazol
Cyclosporine
Amiodarone
Dronedarone
Calcium Channel Blockers
Ranolazine
Colchicine
Digoxin
Niacin
Anticoagulants.
Grapefruit/grapefruit juice
You should let the prescribing physician know if you are taking any of these substances and you should avoid consuming these substances whilst taking Simvastatin.
Simvastatin and Atorvastatin work largely in the same way. Simvastatin is slightly shorter acting, thus its effect is not as consistent throughout the day, but has been shown to work similarly and as effective as Atorvastatin. However, Atorvastatin can be prescribed as a “high-intensity” Statin for people at high risk of heart attack or stroke, or for people who have already had heart attacks or strokes. Simvastatin is a “moderate-intensity” Statin used for people at lower risk.
If you are taking Simvastatin, your doctor or health care provider will initially check your fasting cholesterol level (with a blood test) before you start taking Simvastatin. Your provider will check your cholesterol levels again in 4-6 weeks to be sure the cholesterol is better. Following this, you should get your cholesterol levels checked once a year routinely.
Your provider will also be checking another blood test to measure your liver enzymes before starting Simvastatin and then again after being on it 4-6 weeks. The reason for this test is to be sure the liver enzymes are not elevated.
Simvastatin has a half-life of 2 to 5 hours. This means it can stay in your body for up to 10 hours.
One of the more common adverse effects of Simvastatin (and all of the statin class medications) includes myopathy, or muscle problems. If you have had muscle pains or weakness before while on a Statin, you should let your doctor know, as a Statin medication might not be right for you. If you notice muscle pain while on Simvastatin, your doctor can check your blood levels for a lab marker called “CPK,” or Creatine Phosphokinase to see if your muscle pain could be an adverse effect of Simvastatin. In most cases you should stop taking the medication if this occurs, and either have a lower dose or switch to a different cholesterol medication. In rare cases, muscle damage is severe or long-lasting, but in the majority of cases is mild and resolves.
Simvastatin is used to treat high cholesterol. It does not have a significant effect on blood pressure. Lowering cholesterol is one way of reducing cardiovascular disease risk, as is lowering blood pressure.
There have been some reports by the FDA of abnormal liver enzymes on laboratory testing, but when Simvastatin was stopped, levels returned to normal. Some reports of liver failure associated with Simvastatin are very rare. Liver enzyme tests should be obtained before starting Simvastatin. Simvastatin should be avoided in heavy alcohol consumers or people with known active liver disease.
More recently, the FDA has reported some increases in Hemoglobin A1c, the marker of diabetes control, and increases in fasting blood sugar in some patients on Simvastatin, however, the benefit of lowering cholesterol is felt to far outweigh this small risk.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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