COMMON BRAND NAME(S):
Zocor, Simvastatin

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Uses: (1) Used by patients with elevated cholesterol to reduce death from heart disease and decrease the number of nonfatal heart attacks; (2) treats high total blood cholesterol levels (in people with types lIa and IIb hypercholesterolemia)-used in conjunction with a cholesterol-lowering diet (it should not be used until an adequate trial of non-drug methods for lowering cholesterol has proved to be ineffective); (3) stops progression and decreases number of deaths of patients with coronary artery disease as well as the need for bypass surgery and angioplasty; (4) decreases risk of strokes; (5) treats isolated hypertriglyceridemia and type three hyperlipoproteinemia; (6) increases HDL-C in people with primary hypercholesterolemia and mixed dyslipidemia.

Other (unlabeled) generally accepted uses: (1) Used in combination with estrogen (in one study of women averaging 57 years old) lowered LDL, increased HDL and reduced undesirable blood-clotting factors and inflammation; (2) may help reduce lipid disorders that occur in kidney problems (nephrotic syndrome); (3) combination therapy in preventing gallstones; (4) may have a role after heart transplants to decrease death and lower LDL-C levels; (5) a small study of 32 patients with multiple sclerosis (MS) is under way looking at the benefits of high dose simvastatin in easing MS symptoms; (5) may help preserve bone health; (6) could have a role in Alzheimer's patients helping prevent it or preserve function.

How This Drug Works: Blocks the liver enzyme starting production of cholesterol. Reduces low-density lipoproteins (LDL), the fraction of cholesterol thought to increase risk of coronary heart disease. Also increase highdensity lipoproteins (HDL), the cholesterol fraction that reduces the risk of heart disease. There is a growing body of evidence that "statins" also have beneficial changes on what is in the blood, blood flow, and even the blood vessel walls themselves (some of this may account for benefits in decreasing Alzheimer's risk). Specific compounds or effects of platelet derived growth factor (PDGF), undesirable blood clotting via thrombinantithrombin III, thrombomodulin, and other chemicals may be beneficially lowered or effects mitigated by statins.

Available Dosage Forms and Strengths

Tablets - 5 mg, 10 mg, 20 mg, 40 mg, 80 mg

Recommended Dosage Ranges (Actual dose and schedule must be determined
for each patient individually.)

Infants and Children: Under 2 years of age-do not use this drug.
2 to 20 years of Age: dose not established for children or adolescents.
20 to 60 Years of Age: Initially 20 mg daily, taken at bedtime. Dose is increased as needed to reach desired goals (such as decreased LDL-C percent). The drug is then increased as needed and tolerated by increments of 5 to 10 mg at intervals of 4 weeks. The total daily dose should not exceed 80 mg. For patients who require more than a 45 percent decrease in bad cholesterol (LDL), the starting dose is 40 mg per day. Some clinicians add on therapy, which lowers cholesterol by a different mechanism.
Over 60 Years of Age: Initially 5 mg daily. Increase dose as needed and tolerated by increments of 5 mg at intervals of 4 weeks. The total daily dose should not exceed 40 mg.

Conditions Requiring Dosing Adjustments

Liver Function: This drug achieves a high concentration in the liver and is subsequently eliminated in the bile. It can be a rare cause of liver damage, and
patients 'should be followed closely.

Kidney Function: In severe kidney failure, the dose should be started at 5 mg and the patient closely followed.

Heart Transplants: People who are getting immunosuppressive therapy should be started on 5 mg of simvastatin. The maximum dose in these patients should be 10 mg.

Dosing Instructions: The tablet may be crushed and taken without regard to eating, preferably at bedtime (the highest rates of cholesterol production occur between midnight and 5 A.M.). If you forget a dose: Take the missed dose as soon as you remember it, unless it's nearly time for your next dose-if that is the case, skip the missed dose and take the next dose right on schedule. DO NOT double doses. Talk with your doctor if you find yourself missing doses as there are many effective reminder systems available.

Please Note: The information contained on this page is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

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