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Simvastatin (Zocor, Simlup, Simcard, Simvacor)is used to control elevated levelsof cholesterol (hypercholesterolemia) and to prevent cardiovascularconditions. The drug is one of the HMG-CoA inhibitors, the group of medicationscalled statins.

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

Simvastatin is used to decrease cholesterol and triglycerideslevels and also for reduction of the mortality risk in patients suffering fromdiabetes, stroke, cerebrovascular or coronary heart disease. The medicationhelps to reduce the probability of the heart attack and stroke and the needfor revascularization surgery. The dose of the medication may vary from 5 to 80mg 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 isa possibility for some allergic reactions to simvastatin, too.

The drug may damage the liver, being the reason for livertests before and during the use of simvastatin. Serious liver damage is rarewhen using this medication, but the liver results three times higher than normalare 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, becauseof the possibility of a condition called rhabdomyolysis. This is rare but severedisease caused by damaged muscle cells and release of myoglobin to the blood,with potentially fatal result.

Many medication increase muscle toxicity when combined withsimvastatin, 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 suchas indinavir (Crixivan) and ritonavir (Norvir) and grapefruit juice, taken withsimvastatin also affect the muscles.

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

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

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

Pregnant women or breastfeeding moms should not usesimvastatin because the drug is lowering cholesterol which fetus/child needsin all stages of development.

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