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Zocor
simvastatin
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg, 40 mg
Special Note
- [restricted 80 mg dose]
- Info: max simvastatin dose 40 mg/day; as of 6/8/2011, any patient previously on 80 mg/day without muscle toxicity x12mo may remain on this dose; do not incr. dose to 80 mg/day in any other patients; switch to alternative tx if LDL-C goal not met on 40 mg/day
primary hyperlipidemia
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
heterozygous familial hypercholesterolemia
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
homozygous familial hypercholesterolemia, adjunct tx
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
hypertriglyceridemia
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
primary dysbetalipoproteinemia
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
cardiovascular event risk reduction
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
atherosclerotic cardiovascular disease
- [10-40 mg PO qpm]
- Max: 40 mg/day; Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Treatment Selector decision tool
renal dosing
- [adjust dose amount]
- CrCl 15-29: start 5 mg qpm; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- acute hepatic failure or decompensated cirrhosis: contraindicated
Peds Dosing .
- Dosage forms: TAB: 10 mg, 20 mg, 40 mg
Special Note
- [restricted 80 mg dose]
- Info: max simvastatin dose 40 mg/day; as of 6/8/2011, any patient previously on 80 mg/day without muscle toxicity x12mo may remain on this dose; do not incr. dose to 80 mg/day in any other patients; switch to alternative tx if LDL-C goal not met on 40 mg/day
heterozygous familial hypercholesterolemia
- [10 yo and older]
- Dose: 10-40 mg PO qpm; Max: 40 mg/day; Info: may adjust dose q4wk
homozygous familial hypercholesterolemia, adjunct tx (off-label)
- [10 yo and older]
- Dose: 20-40 mg PO qpm; Max: 40 mg/day; Info: may adjust dose q4wk
renal dosing
- [adjust dose amount]
- CrCl 15-29: start 5 mg qpm; CrCl <15: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- acute hepatic failure or decompensated cirrhosis: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy (except high-risk patients)
- myopathy
- hepatic failure, acute
- cirrhosis, decompensated
- avoid: breastfeeding (high-risk patients)
- caution: alcohol abuse
- caution: patients 65 yo and older
- caution: Chinese patients (incr. risk of myopathy)
- caution: patients of childbearing potential
- caution: renal impairment
- caution: hepatic disease history
- caution: diabetes mellitus
- caution: hypothyroidism, uncontrolled
- caution: high-dose use
- caution: immune-mediated necrotizing myopathy history
Drug Interactions .
Overview
simvastatin
statin
- CYP2C8 substrate
- CYP3A4 substrate
- BCRP substrate
- OATP1B1 substrate
- OATP1B3 substrate
- OATP2B1 substrate
- P-gp substrate
- P-gp inhibitor, weak
- binds to polyvalent cations
- rhabdomyolysis
Contraindicated
- adagrasib
- atazanavir
- ceritinib
- chloramphenicol
- clarithromycin
- cobicistat
- cyclosporine
- danazol
- darunavir
- erythromycin
- fosamprenavir
- gemfibrozil
- idelalisib
- itraconazole
- ketoconazole
- levoketoconazole
- lonafarnib
- lopinavir/ritonavir
- mifepristone
- nefazodone
- nelfinavir
- posaconazole
- ribociclib
- ritonavir
- tipranavir
- tucatinib
- voriconazole
Avoid/Use Alternative
- alprazolam
- amiodarone
- amlodipine
- apalutamide
- aprepitant
- asciminib
- atorvastatin
- avacopan
- belumosudil
- berberine
- berotralstat
- bicalutamide
- bosentan
- butalbital
- capivasertib
- carbamazepine
- cenobamate
- chlorzoxazone
- cilostazol
- cimetidine
- ciprofloxacin
- clofazimine
- clotrimazole oropharyngeal
- colchicine
- conivaptan
- cranberry
- crizotinib
- dabrafenib
- daridorexant
- diltiazem
- diosmin
- dronedarone
- duvelisib
- efavirenz
- elbasvir
- elinzanetant
- encorafenib
- entrectinib
- enzalutamide
- ethinyl estradiol (contraceptive)
- etravirine
- everolimus
- fedratinib
- fenofibrate
- fenofibric acid
- fexinidazole
- finerenone
- flibanserin
- fluconazole
- fluvastatin
- fluvoxamine
- fosaprepitant
- fosphenytoin
- fostamatinib
- gepotidacin
- givinostat
- givosiran
- glecaprevir
- goldenseal
- grapefruit
- grazoprevir
- imatinib
- isavuconazonium
- isoniazid
- istradefylline
- ivacaftor
- ivosidenib
- kratom
- lapatinib
- larotrectinib
- lazertinib
- lefamulin
- lenacapavir
- letermovir
- lorlatinib
- lovastatin
- lumacaftor/ivacaftor
- lurasidone
- maribavir
- mavacamten
- mavorixafor
- mitapivat
- mitotane
- modafinil
- nafcillin
- neratinib
- netupitant
- niacin (vitamin B3)
- nicardipine
- nilotinib
- nirogacestat
- osilodrostat
- pacritinib
- palbociclib
- pazopanib
- pentobarbital
- peppermint
- pexidartinib
- phenobarbital
- phenytoin
- pibrentasvir
- pirtobrutinib
- pitavastatin
- pravastatin
- primaquine
- primidone
- quercetin
- ranolazine
- red yeast rice
- relugolix
- remdesivir
- repotrectinib
- resveratrol
- rifabutin
- rifampin
- rifapentine
- rilzabrutinib
- ritlecitinib
- rosuvastatin
- rucaparib
- selpercatinib
- sevabertinib
- simvastatin
- sotorasib
- spironolactone
- St. John's wort
- stiripentol
- ticagrelor
- tolvaptan
- treosulfan
- trofinetide
- verapamil
- viloxazine
- vonoprazan
- xanomeline
- ziftomenib
- zileuton
Monitor/Modify Tx
- abiraterone acetate
- acalabrutinib
- azithromycin
- bempedoic acid
- bisoprolol
- brigatinib
- cannabidiol
- capmatinib
- carvedilol
- ceftobiprole
- danicopan
- daptomycin
- darolutamide
- digoxin
- elacestrant
- elafibranor
- elexacaftor/tezacaftor/ivacaftor
- eltrombopag
- eluxadoline
- enasidenib
- febuxostat
- fostemsavir
- gilteritinib
- ibrutinib
- imlunestrant
- irbesartan
- lanthanum
- ledipasvir
- leflunomide
- leniolisib
- lomitapide
- midostaurin
- momelotinib
- orforglipron
- oteseconazole
- pretomanid
- propafenone
- quinidine (antiarrhythmic)
- raltegravir
- regorafenib
- resmetirom
- rolapitant
- selumetinib
- sparsentan
- sunvozertinib
- tafamidis
- tedizolid
- tepotinib
- teriflunomide
- turmeric
- vadadustat
- vanzacaftor/tezacaftor/deutivacaftor
- velpatasvir
- vemurafenib
- vimseltinib
- voclosporin
- voxilaprevir
- warfarin
- zongertinib
Caution Advised
- armodafinil
- artemether/lumefantrine
- belzutifan
- bexarotene
- clobazam
- danshen
- deferasirox
- dexamethasone
- dicloxacillin
- echinacea
- elagolix
- eslicarbazepine acetate
- felbamate
- garlic
- ginkgo
- ginseng, Asian
- glycerol phenylbutyrate
- griseofulvin
- maralixibat
- meropenem
- mobocertinib
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- oxcarbazepine
- perampanel
- pioglitazone
- prednisone
- rufinamide
- sarilumab
- suzetrigine
- tazemetostat
- tecovirimat
- telotristat ethyl
- tocilizumab
- topiramate
- tovorafenib
- vaborbactam
- vamorolone
- vinblastine
- vorasidenib
- zanubrutinib
Adverse Reactions .
Serious Reactions
- myopathy
- immune-mediated necrotizing myopathy
- tendon rupture
- rhabdomyolysis
- acute renal failure
- hepatotoxicity
- pancreatitis
- hypersensitivity reaction
- anaphylaxis
- photosensitivity
- erythema multiforme
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- thrombocytopenia
- leukopenia
- hemolytic anemia
- diabetes mellitus
- interstitial lung disease
- myasthenia gravis
Common Reactions
- URI
- headache
- abdominal pain
- constipation
- nausea
- gastritis
- vertigo
- eczema
- diabetes mellitus
- insomnia
- myalgia
- CK elevated
- ALT or AST elevated
- UTI
- edema
- cognitive impairment
- lichen planus
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; LFTs at baseline, then as clinically indicated; CK at baseline if myopathy risk, then as clinically indicated; glucose if diabetes risk
Look/Sound-Alike Drug Names
Zocor confused with: Cozaar; Lipitor; Proscar; Yocon; Zantac; Zestril; Zetia; Ziac; Zofran; Zoloft
simvastatin confused with: atorvastatin; lovastatin; pravastatin; SandoSTATIN; simethicone; Singulair; valsartan
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy in non-high risk patients, otherwise weigh risk/benefit in high risk patients; possible risk of teratogenicity based on limited or conflicting human data; no known risk of teratogenicity based on animal data at up to 3x recommended human dose; possible risk of delayed fetal development based on drug's mechanism of action
Lactation
Clinical Summary
avoid breastfeeding in high risk patients, otherwise weigh risk/benefit in non-high risk patients; no human data available to assess risk of infant harm, though possible risk of drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for simvastatin: liver; CYP450: 2C8, 3A4 (primary) substrate
Excretion: for simvastatin: feces 60%, urine 13%; Half-life: 2-5h
Subclass: Dyslipidemia: HMG-CoA Reductase Inhibitors (Statins)
Mechanism of Action
for simvastatin: prodrug converted to beta-hydroxyacid metabolites, which inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis
Formulary .
No Formulary Selected
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