The risk of myopathy, including rhabdomyolysis, is greater in patients on simvastatin 80 mg compared with other statin therapies with similar or greater LDL-C-lowering efficacy and compared with lower doses of simvastatin. Therefore, the mg dose of simvastatin should be used only in patients who have been taking simvastatin 80 mg chronically e. If, however, a patient who is currently tolerating the mg dose of simvastatin needs to be initiated on an interacting drug that is contraindicated or is associated with a dose cap for simvastatin, that patient should be switched to an alternative statin with less potential for the drug-drug interaction.
Patients should be advised of the increased risk of myopathy, including rhabdomyolysis, and to report promptly any unexplained muscle pain, tenderness or weakness. There have been rare reports of immune-mediated necrotizing myopathy IMNM , an autoimmune myopathy, associated with statin use. IMNM is characterized by: All patients starting therapy with simvastatin, or whose dose of simvastatin is being increased, should be advised of the risk of myopathy, including rhabdomyolysis, and told to report promptly any unexplained muscle pain, tenderness or weakness particularly if accompanied by malaise or fever or if muscle signs and symptoms persist after discontinuing simvastatin.
Simvastatin therapy should be discontinued immediately if myopathy is diagnosed or suspected. In most cases, muscle symptoms and CK increases resolved when treatment was promptly discontinued. Periodic CK determinations may be considered in patients starting therapy with simvastatin or whose dose is being increased, but there is no assurance that such monitoring will prevent myopathy. Many of the patients who have developed rhabdomyolysis on therapy with simvastatin have had complicated medical histories, including renal insufficiency usually as a consequence of long-standing diabetes mellitus.
Such patients merit closer monitoring. Simvastatin therapy should be discontinued if markedly elevated CPK levels occur or myopathy is diagnosed or suspected. Simvastatin therapy should also be temporarily withheld in any patient experiencing an acute or serious condition predisposing to the development of renal failure secondary to rhabdomyolysis, e.
Drug Interactions The risk of myopathy and rhabdomyolysis is increased by high levels of statin activity in plasma. Simvastatin is metabolized by the cytochrome P isoform 3A4. Certain drugs which inhibit this metabolic pathway can raise the plasma levels of simvastatin and may increase the risk of myopathy. Combination of these drugs with simvastatin is contraindicated. Dosage is based on your medical condition, response to treatment, age, and other medications you may be taking.
Be sure to tell your doctor and pharmacist about all the products you use including prescription drugs , nonprescription drugs, and herbal products. Chinese patients taking niacin may require lower doses of simvastatin. Ask your doctor for more details. The usual maximum dose for this medication is 40 milligrams a day.
If you have been instructed by your doctor to take more than 40 milligrams, continue on that same dose. However, promptly talk with him or her about the risks and benefits of your higher dose. Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased. Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor instructs you otherwise. Grapefruit can increase the amount of this medication in your bloodstream.
Consult your doctor or pharmacist for more details. Take this medication regularly in order to get the most benefit from it. Remember to take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high cholesterol or triglycerides do not feel sick. It is very important to continue to follow your doctor's advice about diet and exercise.
It may take up to 4 weeks before you get the full benefit of this drug. What conditions does Simvastatin treat? Side Effects Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. A very small number of people taking simvastatin may have mild memory problems or confusion. If these rare effects occur, talk to your doctor.
Rarely, statins may cause or worsen diabetes. Talk to your doctor about the benefits and risks. This drug may rarely cause muscle problems which can rarely lead to very serious conditions called rhabdomyolysis and autoimmune myopathy. Tell your doctor right away if you develop any of these symptoms during treatment and if these symptoms persist after your doctor stops this drug: This medication may rarely cause liver problems.
If you notice any of the following rare but serious side effects, tell your doctor right away: A very serious allergic reaction to this drug is rare. While the absolute incidence of myopathy is low, the prescribing of simvastatin 40 mg is high and amlodipine is a common co-medication.
Additionally many patients at potential risk of muscle symptoms are excluded from clinical trials. Thus the relatively small increased risk imposed by amlodipine could translate into a significant number of additional adverse muscle effects in practice.
These observations are supported by reported cases of adverse muscle reactions. For example, in the FDA report[7], there were 42 reports of rhabdomyolysis with simvastatin 40 mg plus amlodipine, compared with 20 reports with simvastatin 20 mg plus amlodopine. It must be remembered that such ratios are affected by many factors, such as relative prescribing rates.
In agreement with pharmacokinetic data, greater CK elevations were observed in SEARCH [7], 9 with simvastatin 80 mg when administered with diltiazem, compared with simvastatin 80 mg alone. This translated to a significant 3-fold increase in the incidence of myopathy when diltiazem was administered with high-dose simvastatin.
Lowering "bad" cholesterol and triglycerides and raising "good" cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks. This is not a complete list of possible side effects. Alternative prescribing options are available for patients in whom the lower dose of simvastatin is simvastatin considered appropriate. Drug Interactions The risk of myopathy and rhabdomyolysis is increased by high levels of statin activity in plasma. Of the 1, simvastatin treated patients in 4S with normal liver function tests LFTs at baseline, 8 0. If treatment with itraconazole, ketoconazole, posaconazole, voriconazole, erythromycin, 40mg or telithromycin is unavoidable, therapy with simvastatin pill be suspended during the identification of treatment. If you identification other effects not listed above, contact your doctor or pharmacist. How can we improve it? This medication may rarely cause liver problems. If you become pregnant or think you may simvastatin pregnant, tell your doctor right 40mg. Muscle pain All statins can cause muscle pain, but this effect is more likely pill simvastatin use, simvastatin 40mg pill identification.
Drug treatment also significantly increased the incidence 40mg lung adenomas in mid- simvastatin high-dose males and females. No microscopic changes were observed 40mg the identifications of rats from either study. Simvastatin works by blocking an enzyme 40mg helps create captopril 25 price in the body. Consistent with this, the 5-year SEARCH clinical trial9 also demonstrated increases in the incidence of CK elevations with simvastatin 80 mg plus amlodipine which pill not observed with simvastatin 20 mg pill amlodipine. Statins are often prescribed to help lower your cholesterol. The recommended usual starting dose is 10 or 20 mg once a simvastatin in the identification. Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. Simvastatin Pill Images - What does Simvastatin look like, simvastatin 40mg pill identification. It may slow your kidneys. There was no evidence of hypersensitivity. Drug information on Zocor simvastatin includes drug pictures, simvastatin 40mg pill identification, pill effects, drug interactions, directions for use, symptoms of overdose, and what to avoid. Many people using this identification do not have serious side effects.
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