Simvastatin

Simvastatin

[1 tablet 4 cents]

ADMINISTRATION ROUTES:

  • PO

ALTERNATIVE NAMES:

  • Arrow Simva, Lipex, Simvarex

ICU INDICATIONS:

  1. secondary prevention in patients with coronary artery disease
  2. treatment of hypercholesterolaemia

PRESENTATION AND ADMINISTRATION:

  • Tablets:
    Arrow Simva 10mg, 20mg, 40mg, 80mg
    Lipex 10mg (peach), 20mg (tan), 40mg (red), 80mg (red)
    Simvarex 10mg (light pink), 20mg (tan), 40mg and 80mg (pink)

DOSAGE:

  • PO:
    Usually 40mg daily at night; slowly increase to a maximum of 80mg if required.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO: Not applicable

CLINICAL PHARMACOLOGY:

  • Simvastatin is a selective, competitive inhibitor of HMG-CoA reductase.

CONTRAINDICATIONS:

  1. Active liver disease or unexplained persistent elevations of serum transaminases.
  2. Hypersensitivity to any component of this medication.

WARNINGS

  • Liver Dysfunction:
    HMG-CoA reductase inhibitors, like some other lipid-lowering therapies, have been associated with biochemical abnormalities of liver function.
  • Skeletal Muscle:
    Rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with Simvastatin and with other drugs in this class.

PRECAUTIONS

  • General:
    Patients should be advised to report promptly unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever.
  • Laboratory Tests: CK should be measured if there is concern about development of myopathy due to statins.
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The risk of myopathy during treatment with other drugs of this class is increased with concurrent administration of cyclosporine, fibric acid derivatives, niacin (nicotinic acid), erythromycin, and azole antifungals
  • When multiple doses of simvastatin and digoxin were coadministered, steady-state plasma digoxin concentrations increased by approximately 20%. Patients taking digoxin should be monitored appropriately.

ADVERSE REACTIONS

  • Body as a Whole: Malaise
  • Digestive System: Constipation, derangement of LFTs, flatulence, dyspepsia, and abdominal pain
  • Nervous System: Insomnia, dizziness, paresthesia, somnolence
  • Skin: Pruritus
  • Musculoskeletal: Myalgia, myopathy

Critical Care Drug Manual

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