CNS: amnesia, confusion, dizziness, headache, insomnia, memory loss, weakness.
GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, ↑ liver enzymes, nausea, pancreatitis.
GU: erectile dysfunction.
Derm: rashes, pruritus.
Endo: hyperglycemia.
MS: RHABDOMYOLYSIS, arthralgia, immune-mediated necrotizing myopathy, myopathy (↑ risk with 80 mg dose).
Misc: hypersensitivity reactions.
The 80 mg dose should be restricted to patients who have been taking this dose for 
12 mo without evidence of muscle toxicity
- PO (Adults): 5–40 mg once daily in the evening; if LDL goal cannot be achieved with 40 mg/day dose, add another lipid-lowering therapy (do not ↑ simvastatin dose to 80 mg/day). Concurrent verapamil, diltiazem, or dronedarone therapy — Dose should not exceed 10 mg/day. Concurrent amiodarone, amlodipine or ranolazine therapy — Dose should not exceed 20 mg/day; Concurrent lomitapide therapy — ↓dose by 50% (dose should not exceed 20 mg/day or 40 mg/day for patients who previously received 80 mg/day chronically [for 12 mo] without evidence of myopathy).
- PO (Children 10–17 yr): 10 mg/day initially, may be ↑ at 4 wk intervals up to 40 mg/day. Concurrent amiodarone, amlodipine or ranolazine therapy — Dose should not exceed 20 mg/day Concurrent verapamil or diltiazem therapy — Dose should not exceed 10 mg/day.
Renal Impairment
- PO (Adults): CCr <10 mL/min — 5 mg/day initially, titrate carefully.
Therapeutic Classification: lipid-lowering agents
Pharmacologic Classification: hmg coa reductase inhibitors (statin)
Absorption: 85% absorbed, but rapidly metabolized.
Distribution: Unknown.
Protein Binding: 95%.
Metabolism/Excretion: Extensively metabolized by the liver, most during first pass; excreted in bile and feces; 13% excreted unchanged by the kidneys.
Half-life: Unknown.
(cholesterol-lowering effect)
†After discontinuation.
