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What You Should Know about Simvastatin
Simvastatin, also known as Zocor, is a statin drug that doctors prescribe to lower cholesterol. It was first approved by the FDA in 1991 and went generic in 2006. Although there are more potent non-generic statin drugs—some with less potential for side effects—cost concerns have driven many patients and insurance companies to request simvastatin specifically.
Along with other statins, simvastatin is known to reduce the risks for heart attacks and strokes. People on statins are also less likely to need stents in their heart arteries or bypass surgeries. Without a doubt, statins, including simvastatin, save lives. Although most people will not experience side effects, all statins can cause muscle aches and liver abnormalities. These problems will generally go away within a few days to weeks after the drug is stopped. Life-threatening side effects are rare, but higher doses of statins—and especially of simvastatin—seem to increase the likelihood of these problems.
In the past, an LDL cholesterol below 100 mg/dL was considered a success. Now that we know that people at high risk for heart disease do better when their LDLs are under 70, higher doses of statins are needed. To be fair, cholesterol can often be improved dramatically with a heart healthy Mediterranean diet, weight loss, and exercise, but the truth is that many people are not willing to make serious lifestyle changes. For these reasons, doctors are now prescribing higher doses of statins for their patients.
On June 8, 2011, the FDA released a recommendation that prescriptions for the highest dose of simvastatin (80 mg) be limited, due to the risk of serious muscle damage, or rhabdomyolysis. This advice was based on the outcome of a new study that compared 20 mg doses of simvastatin with 80 mg doses, and does not apply to other statins. It is important to know that Vytorin, a drug combining simvastatin with Zetia (a non-statin cholesterol drug), also includes an 80 mg dose. Simcor is another combination pill that includes a prescription form of niacin along with simvastatin.
The FDA now advises physicians against starting patients on the 80 mg dose of simvastatin. However, since the risk is greatest in the first year, they do not advise necessarily changing the drug in those who have been on the 80 mg dose without any problems for more than 12 months.
You should avoid drinking large amounts (over one quart) of grapefruit juice if you take simvastatin, since it can raise drug levels. Simvastatin is well known to interact with a number of antibiotics, antiviral, and antifungal drugs, so check with your physician or pharmacist before filling those prescriptions. There are also some important limitations that involve commonly-used drugs, including:
- Do not exceed 10 mg simvastatin daily with amiodarone, verapamil, diltiazem, gemfibrozil, cyclosporine, or danazol.
- Do not exceed 20 mg simvastatin daily with amlodipine or ranolazine.
It is important that you check with your doctor before stopping any medications. All in all, the lifesaving benefits of most statins far exceed the potential risks.
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