Simvastatin is a prescription drug from the statin group used to lower cholesterol levels. This is to counteract deposits on the vessel walls and reduce the risk of stroke or heart attack. However, the intake of simvastatin is associated with a variety of side effects. Some - such as nausea or headache - are comparatively harmless. On the other hand, if muscle pain occurs, you should stop the treatment as the active substance can damage the muscles.
Effect of simvastatin
Simvastatin is prescribed for high cholesterol when it can not be lowered by a low-fat diet, weight reduction, or exercise. The active ingredient ensures that less cholesterol is produced in the liver, lowers the level of "bad" LDL cholesterol and raises the level of "good" HDL cholesterol. This improves the ratio of blood lipids to one another.
The use of simvastatin not only lowers the blood lipid level but also counteracts the deposition of cholesterol on the vessel walls. This reduces the risk of a stroke or a heart attack. Thus, life expectancy can be increased in patients with coronary heart disease.
Simvastatin is generally used in:
- elevated cholesterol or fat levels in the blood
- homozygous familial hypercholesterolemia - a hereditary disease associated with elevated cholesterol levels in the blood
- Patients with cardiovascular disease or at increased risk for such disease
Side effects of simvastatin
Most patients taking simvastatin have no side effects during treatment. Occasionally there may be an increase in liver enzymes GOT and GPT (transaminases).
In rare cases, side effects such as headache, dizziness, itching, rash, difficulty sleeping, fever, hair loss, and weakness were also observed. It can also cause gastrointestinal problems such as nausea, vomiting, diarrhea, constipation and abdominal pain. It may also be associated with depression, difficulty breathing, joint inflammation and joint pain, as well as inflammation of the pancreas.
In addition, simvastatin may also affect the liver, blood and muscles. Similar to the side effects mentioned above, these symptoms rarely occur.
- Liver: hepatitis, permanent increase in liver enzyme levels, jaundice
- Blood: anemia and blood disorders
- Muscles: Muscle cramps, muscle aches, muscle weakness, muscle disorders, muscle damage
If you experience problems with your muscles during treatment with simvastatin, you must inform your doctor immediately.
Statins can damage the nerves
Simvastatin, like all other statins, can have a damaging effect on the nerves. As a result, symptoms such as numbness in the arms or legs, and muscle twitching may occur during treatment. In such cases, the treatment must be stopped immediately.
Statins like simvastatin are also typical for increasing blood sugar levels. This may increase the risk of diabetes mellitus. The likelihood of this depends primarily on whether other risk factors such as obesity already exist. If this is the case, the blood sugar must be checked at regular intervals.
Dosage of simvastatin
Simvastatin is available in the form of tablets with different dosages. Low-dose tablets contain 5, 10, 20 or 30 milligrams, higher doses of 40, 60 or 80 milligrams. It takes about two weeks for the effect to take effect. Four to six weeks after the start of treatment, the change in cholesterol levels reaches its peak.
To lower blood lipid levels, patients are advised to start with a daily dose of 10 to 20 milligrams of simvastatin initially, and 20 to 40 milligrams can be started for very high levels. If necessary, the dose can be increased up to 80 milligrams. However, this dose is rarely prescribed today. More than 80 milligrams per day should definitely not be taken.
Homozygous familial hypercholesterolaemia is usually started with 40 milligrams and the dose can be increased up to 80 milligrams. In general, the intake is then in the morning (20mg), at noon (20mg) and in the evening (40mg). To prevent cardiovascular disease, usually between 20 and 40 milligrams of simvastatin are prescribed.
Simvastatin is broken down in the body via the enzyme CYP-3A4. Therefore, substances that might inhibit the activity of the enzyme should not be taken or should only be taken concurrently with the active substance under certain conditions. Otherwise, there may be an increase in side effects, especially an increased risk of destroying muscle fibers. Interactions can occur with:
- Fungi with active ingredients such as ketoconazole and itraconazole
- Macrolide antibiotics such as clarithromycin or erythromycin
- blood lipid lowering fibrates such as gemfibrozil or fenofibrate
- the antidepressant nefazodone
- Heart and blood pressure medicines such as amiodarone, verapamil, diltiazem and amlodipine
- HIV protease inhibitors such as ritonavir, nelfinavir or tipranavir
- Hepatitis C drugs such as boceprevir or telaprevir
- the immunological Ciclosporin
- the testosterone derivative danazol
- grapefruit juice
If co-administration of simvastatin and ciclosporin is unavoidable, the dose of simvastatin must be reduced. Otherwise, by taking the muscle disease rhabdomyolysis can be caused. This results in a resolution of striated muscle fibers.
Pay attention to contraindications
Simvastatin should not be taken if hypersensitivity to the active substance is present. In addition, intake is also contraindicated in:
- an acute disease of the liver (hepatitis) or elevated levels of certain liver enzymes (transaminases)
- elevated blood creatine kinase levels
- a disease of the skeletal muscle, which is associated with a destruction of muscle fibers.
Only with particular care may simvastation be used in patients over the age of 70, with hypothyroidism, with impaired renal function and with chronic alcohol abuse. There is an increased risk of destroying muscle fibers here.
This risk is also increased in patients with hereditary skeletal muscle disease in the family. Therefore, simvastatin should be taken here only after a thorough benefit-risk analysis by the attending physician. This also applies to patients who have had muscle problems as part of previous treatment with blood lipid (statin or fibrate).
pregnancy and breast feeding period
Simvastatin should not be taken during pregnancy. So far, it can not be ruled out with certainty that taking the active ingredient causes damage to the unborn child. If there is a desire to have children, the intake of the cholesterol-lowering should be stopped immediately.
Whether or not simvastatin passes into breast milk has so far not been clarified. Therefore, the drug should not be better used during lactation. Even children and adolescents should be prescribed the drug only in exceptional cases, since the safety of simvastatin for this age group could not be proven beyond doubt.