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Simvastatin (Zocor, Simlup, Simcard, Simvacor) is used to control elevated levels of cholesterol (hypercholesterolemia) and to prevent cardiovascular conditions. The drug is one of the HMG-CoA inhibitors, the group of medications called statins.

Simvastatin inhibits the liver enzyme HMG-CoA reductase which plays a major role in the cholesterol production. The medication increases the level of “bad” cholesterol (LDL) and triglycerides and increase the level of “good”, protective cholesterol (HDL).

Simvastatin is used to decrease cholesterol and triglycerides levels and also for reduction of the mortality risk in patients suffering from diabetes, stroke, cerebrovascular or coronary heart disease. The medication helps to reduce the probability of the heart attack and stroke and the need for revascularization surgery. The dose of the medication may vary from 5 to 80 mg per day and it is usually taken once a day, before bedtime.

Patients using simvastatin are likely to experience headache, nausea and vomiting, stomack pain, diarrhea, and sometimes muscle pain. There is a possibility for some allergic reactions to simvastatin, too.

The drug may damage the liver, being the reason for liver tests before and during the use of simvastatin. Serious liver damage is rare when using this medication, but the liver results three times higher than normal are the reason to cancel simvastatin.

Muscle pain in simvastatin patients must be taken seriously. Any pain or tenderness of the muscle should be reported to the doctor, because of the possibility of a condition called rhabdomyolysis. This is rare but severe disease caused by damaged muscle cells and release of myoglobin to the blood, with potentially fatal result.

Many medication increase muscle toxicity when combined with simvastatin, like erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (Ketek), Cyclosporine (Sandimmune), nefazodone (Serzone), then amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), danazol (Danocrine), Cyclosporine, niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil (Lopid) and fenofibrate (Tricor). HIV medications such as indinavir (Crixivan) and ritonavir (Norvir) and grapefruit juice, taken with simvastatin also affect the muscles.

The use of amiodarone and verapamil limits the dosage of simvastatin to 20mg, and the patients on danazol or Cyclosporine should not take more than 10mg of simvastatin.

Patients treated with warfarin or digoxin should be closely watched for the use of simvastatin may increase their toxic potential.

Simvastatin should be used 2 hours before or 4 hours after the dose of Cholestyramine (Questran, Questran Light).

Pregnant women or breastfeeding moms should not use simvastatin because the drug is lowering cholesterol which fetus/child needs in all stages of development.

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