Adult Dosing
Hypercholesterolemia or prevention of cardiovascular events
- Starting dose: 10-20 mg PO qpm; start with 40 mg PO qpm in patient with high risk for CHD event
- Dosage range: 5-40 mg PO; Max: 40 mg/day
Patients with Homozygous Familial Hypercholesterolemia
Coadministration with Other Drugs
- Amiodarone, Verapamil, or Diltiazem
- Do not exceed 10 mg/day PO
- Amlodipine or Ranolazine
- Do not exceed 20 mg/day PO
- Chinese Patients taking
1 g/day of Niacin - 20 mg/day PO, use with caution dose >20 mg/day
Note:
- Use of 80 mg of simvastatin should be restricted due to increased risk of myopathy, including rhabdomyolysis, particularly during the first year of treatment
Hyper-IgD Syndrome (HIDS) [Non-FDA Approved]
Pediatric Dosing
Patients with heterozygous Familial Hypercholesterolemia (10-17 yrs)
- Starting dose: 10 mg PO qpm
- Dose range: 10-40 mg/day; Max: 40 mg/day
[Outline]
- Myopathy manifested as muscle pain, tenderness or weakness with creatine kinase (CK) above ten times the upper limit of normal (ULN) and sometime as rhabdomyolysis with or without acute renal failure has been reported with use of simvastatin
- Advanced age (>65 years),female gender, uncontrolled hypothyroidism, and renal impairment are the predisposing factor for myopathy
- High levels of statin activity in plasma increases the risk of myopathy
- Before starting with simvastatin therapy, inform the patient about the risk of myopathy and rhabdomyolysis and report any unexplained muscle pain, tenderness or weakness. Discontinue the drug immediately if myopathy is diagnosed or suspected
- The risk of myopathy, including rhabdomyolysis is higher in patients taking 80 mg of simvastatin as compared to lower dose and other statin therapies with similar or greater LDL-C-lowering efficacy. Hence 80 mg dose should only be used in patients who have been taking simvastatin 80 mg for 12 months without any evidence of muscle toxicity
- Increase in serum transaminases levels (>3 x ULN) has been observed with simvastatin therapy. Perform liver function tests before the initiation of treatment, before titration of dose to 80 mg/day, 3 months after titration and periodically thereafter. If AST or ALT levels >3 x ULN, withdraw the therapy. Use cautiously in patients with past history of liver disease or who consume substantial quantities of alcohol
- Immune-mediated necrotizing myopathy (IMNM) characterized by proximal muscle weakness and elevated serum creatine kinase has been reported with statin use, and may persist despite discontinuation of statin treatment
- Monitor lipid levels after 4 weeks of therapy and periodically thereafter. Monitor CPK levels periodically
- Strong CYP3A4 inhibitors (itraconazole, ketoconazole, posaconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone, or large quantities of grapefruit juice) should not be used concomitantly, as they may increase plasma levels of simvastatin resulting in increased risk of myopathy
Cautions: Use cautiously in
- Renal impairment
- History of liver diseases
- Alcohol use
- Geriatric population
- Grapefruit juice
Pregnancy Category:X
Breastfeeding: Limited published data exist to define the safety of breastfeeding; due to potential for serious adverse reactions and disruption of infant lipid metabolism, breastfeeding is not recommended. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 March 2011). Small amount of another drug in this class is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants manufacturer recommends either discontinue nursing or discontinue drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Zocor 20 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $173.99
90 mg = $498.97 - Simvastatin 40 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
30 mg = $27.99
90 mg = $75.97 - Zocor 80 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $178.99
90 mg = $533.96 - Simvastatin 10 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
30 mg = $19.99
90 mg = $49.97 - Simvastatin 20 MG TABS [Bottle] (DR.REDDY'S LABORATORIES)
INC. mg = $30
mg = $90 - Simvastatin 80 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
30 mg = $35.99
90 mg = $95.97 - Simvastatin 5 MG TABS [Bottle] (TEVA PHARMACEUTICALS USA)
30 mg = $17.99
90 mg = $42.98 - Zocor 10 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $100.99
90 mg = $288.97 - Zocor 5 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $77.3
90 mg = $206.49 - Zocor 40 MG TABS [Bottle] (MERCK SHARP & DOHME)
90 mg = $465.99
180 mg = $924.64
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
