Simvastatin (Zocor) and lovastatin (Mevacor, Altoprev) are both cholesterol-lowering drugs called statins. Cholesterol is naturally produced in your body and is one component of your diet, too. Cholesterol can form layers or plaques that partially block your blood vessels or break off and cause blockages. This can cause a heart attack or a stroke.
Diseases like diabetes, high blood pressure, and heart disease can increase inflammation in your body. That increases your risk of forming plaques. Statins and diet changes can help prevent formation of plaques and may even reduce them.
Statins are generally useful if you:
- have a buildup of cholesterol inside your blood vessels
- have LDL, or bad cholesterol, levels greater than 190 milligrams per deciliter
- have diabetes, are between 40 and 75 years old, and have LDL levels between 70 to 189 milligrams per deciliter
- have LDL levels between 70 to milligrams per deciliter, are between 40 and 75 years old, and have a risk of at least 7.5 percent that cholesterol could build up in your blood vessels
Your doctor’s decision to treat you with statins, including which medication and which dose, depends on several factors, including:
- your age
- the severity of your high cholesterol
- other diseases you may also have
- side effects of the medication
Many insurance companies require you to try generic statins first. Generics cost less and doctors are very familiar with their side effects and interactions. Both simvastatin and lovastatin are generic medications used for low to moderate intensity statin treatment. If your doctor doesn’t see a good result with them, there are other, more powerful drugs they may recommend.
The price for 30 tablets of lovastatin at 40 milligrams per tablet could be as low as $5.00 or up to $20 or more per month. Simvastatin may cost a little more, starting at about $20 for 30 tablets. Check prices before you drop off a prescription to save money.
A typical starting dosage for simvastatin is 10 milligrams taken once per day. The typical starting dose for lovastatin is 20 milligrams taken once per day.
At the maximum doses, these drugs can reduce LDL by about 30 to 50 percent. Simvastatin lowers LDL cholesterol more than lovastatin. It also increases HDL, or the good cholesterol, and reduces triglycerides more than lovastatin.
Lovastatin is used primarily for those who are at risk for a heart attack or stroke but have never had one. Simvastatin is used to prevent heart attacks and strokes, and it’s also used after a heart attack or stroke to help prevent another one.
The side effects from these two drugs are very similar because the drugs work in the same way. Side effects that you could experience include:
- diarrhea or stomach upset, which usually improve within a few days or weeks
- increased blood sugar
- a small risk of developing diabetes
Tiredness seems to be more common in women than in men. A study found that women have a greater risk of fatigue from statins. Simvastatin was one of the drugs in this study.
You may also experience muscle pain while taking either of these medications. The most common reason that people have to stop taking statins is muscle pain. Call your doctor if you develop new muscle pain when you start a statin. This pain may happen gradually and may feel like a pulled muscle or fatigue from exercise. Ignoring this pain can lead to kidney problems or even kidney damage. Simvastatin is more likely to cause muscle pain than lovastatin.
Some people taking statins develop liver disease. The symptoms of liver disease include darkened urine, pain in your side, or yellowing skin or eyes. See your doctor right away if you have any of these symptoms.
If you have kidney disease, your doctor may decide to give you a smaller dose of statins. Tell your doctor about your kidney disease before taking either one of these drugs.
If you have liver disease, your doctor may or may not want to treat you with a statin or you may need a smaller dose. Be sure to tell your doctor about any liver disease before taking either of these drugs.
You shouldn’t take any statins if you’re pregnant or thinking about becoming pregnant. These are pregnancy category X drugs, which should never be used when you’re pregnant. Cholesterol is necessary for the normal development of the fetus.
Both drugs have several drug interactions that can increase your risk of side effects. Since these drugs are very similar, they interact with many of the same drugs.
Some of the drugs that interact with both simvastatin and lovastatin are:
- antibiotics like erythromycin (Ilotycin, Ery-tab, Ery-Ped) and clarithromycin (Biaxin)
- antifungals like itraconazole (Onmel, Sporanox), and ketoconazole
- anti-rejection drugs like cyclosporine (Sandimmune, Neoral, Restasis)
- blood pressure drugs, including verapamil (Verelan), diltiazem (Cardizem), and amlodipine (Norvasc)
- colchicine (Colycrys)
- heart disease drugs like amiodarone (Cordarone, Pacerone)
- HIV drugs, including protease inhibitors and cobicistat (Tybost)
- drugs that lower cholesterol like gemfibrozil (Lopid), niacin (Niaspan, Niacor), and fibrates
- warfarin (Coumadin, Jantoven)
Grapefruit juice also interacts with both simvastatin and lovastatin, and it can increase your risk of side effects. You should avoid drinking large amounts of grapefruit juice while taking either of these medications.
Simvastatin and lovastatin are similar in many ways. If your LDL level is higher than normal and your doctor wants you to start a statin, lovastatin may be a good first choice. It can help lower your cholesterol, and it’s less likely to cause muscle pain.
If your LDL level is higher than normal or if you’ve already had a heart attack or stroke, your doctor may want you to take simvastatin. It can lower your LDL more dramatically than lovastatin.
Tell your doctor about all drugs you currently take before starting any new medication. See your doctor before you stop taking the drug if you currently take simvastatin or lovastatin and you’re having side effects that concern you. Lab tests may help determine if the drug is helping you or if it’s the wrong drug for you. Statins only work if they’re taken in the long term and taken every day.