Simvastatin (Zocor)

What is Simvastatin?

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.

How does Simvastatin work?

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. 

When would Simvastatin be prescribed?

Simvastatin is prescribed following a blood test to check your cholesterol levels. The blood test will check the levels of:

• High density 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.

Why is high cholesterol dangerous?

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 %.

How effective is Simvastatin?

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. 

Active ingredients

The active ingredient in Simvastatin and Zocor is simvastatin.  

Inactive ingredients

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. 

What dose of Simvastatin should you take?

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. 

How to take Simvastatin

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. 

What should I do if I miss a dose of Simvastatin?

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. 

Simvastatin side effects

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 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. 

Contraindications

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.

Drug interactions

Simvastatin is known to interact with the following substances:

• CYP3A4 Inhibitors

• Danazol

• Cyclosporine

• Amiodarone

• Dronedarone

• Calcium Channel Blockers

• Ranolazine

• Colchicine

• Dixogin

• 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.

How is Simvastatin different from Atorvastatin?

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.