Zocor

Zo·cor (zkôr)

A trademark for the drug simvastatin.

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simvastatin

Simvador (UK), Zocor

Pharmacologic class: HMG-CoA reductase inhibitor

Therapeutic class: Antihyperlipidemic

Pregnancy risk category X

Action

Inhibits hepatic enzyme HMG-CoA reductase, interrupting cholesterol synthesis and low-density lipoprotein (LDL) consumption. Net effect is total cholesterol and serum triglyceride reductions.

Availability

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

⊘Indications and dosages

➣ Coronary artery disease; hyperlipidemia

Adults: 20 to 40 mg P.O. daily in evening, adjusted q 4 weeks based on response. Range is 5 to 80 mg/day.

➣ Hypercholesterolemia

Adults: Initially, 40 mg P.O. daily at bedtime. Alternatively, 80 mg daily divided as 20 mg in morning, 20 mg in afternoon, and 40 mg at bedtime.

Children and adolescents ages 10 to 17: Initially, 10 mg P.O. daily in evening. Range is 10 to 40 mg daily, adjusted at intervals of 4 weeks or longer.

Dosage adjustment

• Severe renal impairment
• Concurrent use of amiodarone, fibrates, niacin, or verapamil
• Elderly patients

Contraindications

• Hypersensitivity to drug or its components
• Active hepatic disease or unexplained persistent serum transaminase elevations
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• renal impairment; severe acute infection; hypotension; severe metabolic, endocrine, or electrolyte problems; uncontrolled seizures; visual disturbances; myopathy; major surgery; trauma; alcoholism
• history of hepatic disease
• concurrent use of amiodarone, clarithromycin, cyclosporine, digoxin, erythromycin, gemfibrozil and other fibrates, itraconazole, ketoconazole, nefazodone, nicotinic acid, protease inhibitors, verapamil, or warfarin
• cross-sensitivity to other drugs that can affect steroid levels
• females of childbearing age
• children younger than age 18 (safety not established).

Administration

• Check liver function tests before starting therapy.
• Give with evening meal. Don't give with large amounts of grapefruit juice.

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache, asthenia

GI: nausea, vomiting, diarrhea, constipation, abdominal pain or cramps, flatulence, dyspepsia

Musculoskeletal: myalgia, rhabdomyolysis

Respiratory: upper respiratory infection

Interactions

Drug-drug. Amiodarone, verapamil: increased risk of severe myopathy or rhabdomyolysis

Digoxin: increased digoxin blood level and possible toxicity

Other lipid-lowering drugs (such as fibrates, gemfibrozil, nicotinic acid): myopathy

Potent CYP3A4 inhibitors (clarithromycin, cyclosporine, erythromycin, itraconazole, ketoconazole, nefazodone, protease inhibitors): increased risk of severe myopathy or rhabdomyolysis

Propranolol: decreased bioavailability of both drugs

Warfarin: increased anticoagulant effects

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels

Drug-food. Grapefruit juice (more than 1 qt daily): increased drug blood level, greater risk of adverse reactions

Drug-herbs. Red yeast rice: increased risk of adverse reactions

Drug-behaviors. Alcohol use: increased risk of hepatotoxicity

Patient monitoring

☞ Watch closely for myositis and other adverse musculoskeletal reactions. Know that drug may cause rhabdomyolysis.
• Monitor liver function tests, CBC, and lipid levels.
• In patients receiving warfarin concurrently, closely monitor prothrombin time and International Normalized Ratio.

Patient teaching

• Advise patient to take with evening meal, but not with large amounts of grapefruit juice.
• Tell patient drug may take up to 4 weeks to be effective.
☞ Caution patient to stop taking drug and contact prescriber if she suspects she is pregnant.
☞ Teach patient to recognize and report signs and symptoms of myopathy or hepatic disorders.
• Instruct patient to avoid alcohol and red yeast rice.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

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Zocor®

Simvastatin, see there

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Patient discussion about Zocor.

Q. Is it true that Zocor helps to prevent heart attacks? I am a 54 years old male, and I have family history of cardio vascular diseases. My physician prescribed me Zocor and said it will lower the chance for heart attacks. If it is true how come not all of the population is taking this drug? Is it really a good way to prevent cardio vasculare diseases?

A. Zocor is a drug that is used to lower the risk of heart attack. It works by lowering the LDL (the bad cholesterol). The reason why not everyone is taking it is that not every one has a high bad cholesterol.

Q. My husband takes Zocor (20mg) for his hyperlipidemia. by mistake he took 3 pills (60mg). What to do? My husband suffers from high blood lipids and he is treated with Zocor (Simvastatin). he should take one pill of 20 mg per day. By accident he took 3 pills (60mg) in one day. what to do?

A. You need to call your GP. Zocor doses are between 20-80 mg but maybe your husband has other problems (mainly in his kidneys) that will interfere with the normal way of cleaning the body from the drug.
Zocor overdose symptoms will be myalgia and red urine (in a severe overdose) if your husband have one of those symptoms go to the ER as soon as possible.