Zocor


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simvastatin

Apo-Simvastatin (CA), Co Simvastatin (CA), Dom-Simvastatin (CA), Gen-Simvastatin (CA), Novo-Simvastatin (CA), Nu-Simvastatin (CA), PHL-Simvastatin (CA), PMS-Simvastatin (CA), Ranzolont (UK), Ratio-Simvastin (CA), Riva-Simvastatin (CA), Sandoz Simvastatin (CA), 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

Adjunct to diet to reduce risk of coronary heart disease (CHD) deaths, cardiovascular events, and hyperlipidemia

Adults: Initially, 10 to 20 mg P.O. daily in the evening. For patients at high risk for a CHD event due to existing CHD, diabetes, peripheral vessel disease, or history of stroke or other cerebrovascular disease, initial dosage is 40 mg/day. Range is 5 to 40 mg/day. Restrict use of 80-mg dose to patients who have been taking simvastatin 80 mg long term (for example, for 12 months or more) without evidence of muscle toxicity. Patients unable to achieve their LDL-C goal utilizing 40-mg dose should not be titrated to 80-mg dose, but should be placed on alternative LDL-C-lowering treatment that provides greater LDL-C lowering effects.

Adjunct to other lipid-lowering treatments (such as LDL apheresis) or if such treatments are unavailable for patients with homozygous familial hypercholesterolemia

Adults: 40 mg/day P.O. in the evening.

Heterozygous familial hypercholesterolemia after failure of an adequate trial of diet therapy

Adolescent boys and postmenarchal girls ages 10 to 17: Initially, 10 mg P.O. daily in the evening. Range is 10 to 40 mg/day; maximum dose is 40 mg/day. Adjust at intervals of 4 weeks or longer.

Dosage adjustment

• Severe renal impairment

• Concurrent use of amiodarone, amlodipine, diltiazem, fibrates, niacin, ranolazine, verapamil, or voriconazole

• Elderly patients

Contraindications

• Hypersensitivity to drug or its components

• Active hepatic disease or unexplained persistent serum transaminase elevations

• Concurrent use of cyclosporine, danazol, gemfibrozil, or strong CYP3A4 inhibitors

• Women who are pregnant or may become pregnant

• Breastfeeding patients

Precautions

Use cautiously in:

• severe 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, liver enzyme abnormalities

• concurrent use of amiodarone, amlodipine, colchicine, digoxin, diltiazem, and lipid-modifying dosages (1 g/day or more) of niacincontaining products, other fibrates, ranolazine, verapamil, or warfarin

• concurrent use of simvastatin in dosages exceeding 20 mg/day with lipid-modifying dosages (1 g/day or more) of niacin-containing products in Chinese patients (avoid use)

• large quantities of grapefruit juice (avoid use)

• elderly patients

• children younger than age 10 (safety not established).

Administration

• Check liver function tests before starting therapy.

• Give with evening meal. Don't give with large amounts of grapefruit juice.

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, calcium channel blockers (such as amlodipine, diltiazem, verapamil), colchicine, other lipid-lowering drugs (such as fibrates or lipid-modifying doses of niacin-containing products), ranolazine, voriconazole: increased risk of myopathy including rhabdomyolysis

Cyclosporine, danazol, diltiazem, gemfibrozil, nefazodone, strong CYP3A4 inhibitors (clarithromycin, erythromycin, HIV protease inhibitors, itraconazole, ketoconazole, posaconazole, telithromycin): increased risk of severe myopathy or rhabdomyolysis

Digoxin: slightly increased digoxin blood level

Warfarin: modestly 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-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 use.

• 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.

Zocor

(zō′kôr′)
A trademark for the drug simvastatin.

simvastatin

A lipid-lowering HMG-CoA reductase inhibitor used to improve lipid profiles and reduce mortality from coronary heart diseasse, diabetes and stroke.
 
Effect
Decreases total cholesterol by 27%, LDL-C by 35–60%, triglycerides by 20–37%, and increases HDL-C by 5–9%.
 
Adverse effects
Constipation, flatulence, dyspepsia, abdominal pain, myalgia, muscle weakness.

Zocor®

Simvastatin, see there.

Zocor

A brand name for SIMVASTATIN.

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. there are several drugs that are used to decrease the chance of a heart attack and i heard Zocor is one of them. it is a good prevention method but it won't help every one and it shouldn't be used without the GP's recommendation

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.

More discussions about Zocor
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The new study found that people at high risk of heart problems who took Vytorin for seven years cut their risk of suffering one by 6 percent -- by 8 percent if they took the drug most faithfully -- compared to others taking just Zocor. Vytorin also proved safe.
A Zocor coupon can be downloaded from the AffordRx website at no cost.
Some statins, such as Zocor, don't linger in the blood for long, Liao says.
For someone with a history of CAD, the goal LDL level is less than 70 mg/dL, which you have achieved with your current dose of Zocor. I would not recommend changing to Crestor.
For the statin market, annual growth jumped to 9%, compared with 6% annually prior to the introduction of generic Zocor.(1),(2) But for Pfizer's Lipitor, a branded competitor, sales dropped 6% in 2007, compared with growth of 4% in 2006 (Figure 1).(2),(3) The lack of differentiation (in the eyes of payers) between Zocor and Lipitor played a major role in the decline--about 80% of patients on Lipitor had been using formulations of comparable efficacy to Zocor; thus, there was almost immediate substitution of Lipitor with generic simvastatin.(4)
Abbott also provided Niaspan, and Merck Pharmaceuticals provided Zocor.
In one sense, both Zetia and Zocor did what was asked of them.
Zocor lowers bad cholesterol in the blood by blocking an enzyme in the liver; Zetia blocks absorption of cholesterol from food in the intestine.
In addition, if combined with Sustiva, the following drugs may require a change in the dose of either Sustiva or the other medicine: Ritadin (ritampin); Sporanox (itraconazole); Nizoral (ketoconazole); calcium-channel blockers (for example, Cardizem, Tiazac, and others); and the cholesterol-lowering medications Lipitor (atorvastatin), Pravachol (pravastatin), and Zocor (simvastatin).
Food & Drug Administration (FDA) announced in late June that it had approved the first generic version of the cholesterol-lowering medication simvastatin (Zocor).
Some of these include Zoloft, for the treatment of depression and certain types of anxiety disorders, and statin Zocor for high cholesterol levels.
Researchers studied 57 patients who had undergone coronary bypass surgery one year earlier and who had not responded to the statin drug Zocor. They were instructed to eat a very low-fat diet, the diet plus white grapefruit or the diet plus red grapefruit.