simvastatin (Zocor)

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Introduction

Tradename: Zocor.

Indications

cost-effective[13]

Contraindications

pregnancy category = x

safety in lactation = -

Dosage

Pharmacokinetics

elimination via liver

1/2life = 1.9-3 hours

protein binding = 95 %

Monitor

Adverse effects

Drug interactions

Laboratory

Mechanism of action

Clinical trials

  • 11-year follow-up on 20,000 high-risk patients randomized to simvastatin or placebo for 5 yeard

More general terms

Additional terms

Component of

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990. pg 882
  3. Merck & Company
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. 6.0 6.1 Prescriber's Letter 7(8):45 2000
  7. 7.0 7.1 Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
  9. 9.0 9.1 9.2 Prescriber's Letter 9(8):44 2002
  10. 10.0 10.1 Prescriber's Letter 10(3):14 2003
  11. 11.0 11.1 Do All Statins Need to be Taken in the Evening? Prescriber's Letter 10(12):70 2003 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=191206&pb=PRL (subscription needed) http://www.prescribersletter.com
  12. 12.0 12.1 Kureishi Y, Luo Z, Shiojima I, Bialik A, Fulton D, Lefer DJ, Sessa WC, Walsh K. The HMG-CoA reductase inhibitor simvastatin activates the protein kinase Akt and promotes angiogenesis in normocholesterolemic animals. Nat Med. 2000 Sep;6(9):1004-10. Erratum in: Nat Med 2001 Jan;7(1):129. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10973320
  13. 13.0 13.1 Journal Watch 25(14):114, 2005 Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R; Heart Protection Study Collaborative Group. Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet. 2005 May;365(9473):1779-85. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15910950
  14. 14.0 14.1 Prescriber's Letter 15(10): 2008 Rhabdomyolysis with Combined Use of Amiodarone and Simvastatin Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241002&pb=PRL (subscription needed) http://www.prescribersletter.com
  15. 15.0 15.1 15.2 FDA Medwatch Zocor (simvastatin): increased risk of muscle injury with high doses http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm205404.htm
    Prescriber's Letter 17(4): 2010 Increased Risk of Muscle Injury with High-Dose Zocor (Simvastatin) COMMENTARY: Increased Risk of Muscle Injury with High-Dose Zocor (Simvastatin) CHART: Clinically Significant Statin Drug Interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260409&pb=PRL (subscription needed) http://www.prescribersletter.com
  16. 16.0 16.1 16.2 16.3 Physician's First Watch for June 9, 2011 Journal Watch, Massachessetts Medical Society
    FDA MedWatch Zocor (simvastatin): Label Change - New Restrictions, Contraindications, and Dose Limitations http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258384.htm
  17. Prescriber's Letter 18(9): 2011 COMMENTARY: New Restrictions, Contraindications, and Dose Limitations for Zocor (Simvastatin) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270902&pb=PRL (subscription needed) http://www.prescribersletter.com
    Prescriber's Letter 18(11): 2011
  18. 18.0 18.1 Heart Protection Study Collaborative Group Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20,536 high-risk individuals: a randomised controlled trial The Lancet, Early Online Publication, 22 November 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22115874 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61125-2/abstract
    Original Text
    Kohli P and Cannon CP Statins and safety: can we finally be reassured? PMID: https://www.ncbi.nlm.nih.gov/pubmed/22115875 The Lancet, Early Online Publication, 22 November 2011 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61544-4/fulltext
  19. 19.0 19.1 19.2 Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  20. 20.0 20.1 Carter AA et al. Risk of incident diabetes among patients treated with statins: Population based study. BMJ 2013 May 23; 346:f2610. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23704171
    Huupponen R and Viikari J. Statins and the risk of developing diabetes. BMJ 2013 May 23; 346:f3156 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23709567
  21. 21.0 21.1 21.2 Deprecated Reference
  22. Egan A, Colman E. Weighing the benefits of high-dose simvastatin against the risk of myopathy. N Engl J Med. 2011 Jul 28;365(4):285-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21675881
  23. 23.0 23.1 Evangelista MT et al. Simvastatin as a novel therapeutic agent for venous ulcers: A randomized, double-blind, placebo-controlled trial. Br J Dermatol 2014 Feb 7 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24506834 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/bjd.12883/abstract;jsessionid=C488DE8C1D402816D9BD8A4E59150390.f03t0
  24. 24.0 24.1 Suraweera C, de Silva V, Hanwella R. Simvastatin-induced cognitive dysfunction: two case reports. J Med Case Rep. 2016 Apr 5;10(1):83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27048383 Free PMC Article
  25. 25.0 25.1 25.2 25.3 25.4 25.5 25.6 Wiggins BS, Saseen JJ, Page RL 2nd et al Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease. A Scientific Statement From the American Heart Association. Circulation. 2016;134:00-00 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27754879 <Internet> http://circ.ahajournals.org/content/circulationaha/early/2016/10/17/CIR.0000000000000456.full.pdf
  26. Rowan C, Brinker AD, Nourjah P et al Rhabdomyolysis reports show interaction between simvastatin and CYP3A4 inhibitors. Pharmacoepidemiol Drug Saf. 2009 Apr;18(4):301-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19206087
  27. 27.0 27.1 Stevens KN, Creanor S, Jeffery A et al Evaluation of Simvastatin as a Disease-Modifying Treatment for Patients With Parkinson Disease. A Randomized Clinical Trial. JAMA Neurol. Published online October 31, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36315128 https://jamanetwork.com/journals/jamaneurology/fullarticle/2797508
  28. 28.0 28.1 28.2 28.3 28.4 28.5 Windle ML Rapid Rx Quiz: Statin Intolerance and Related Concerns Medscape. September 01, 2022 https://reference.medscape.com/viewarticle/979515
  29. HIGHLIGHTS OF PRESCRIBING INFORMATION ZOCOR(simvastatin) Tablets https://www.merck.com/product/usa/pi_circulars/z/zocor/zocor_pi.pdf

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