Simvastatin
Brand Name: Zocor
Pregnancy Category X
Drug classes: Antihyperlipidemic, HMG CoA inhibitor
Therapeutic actions
Inhibits HMG co-enzyme A, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.
Indications
· Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures
· To reduce the risk of stroke,
· Treatment of patients with isolated hypertriglyceridemia
· Treatment of type III hyperlipoproteinemia
Contraindications
· Contraindicated with allergy to simvastatin, fungal byproducts, pregnancy, lactation.
· Use cautiously with impaired hepatic and renal function, cataracts.
Adverse effects
Headache, asthenia, sleep disturbances, Flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure, Sinusitis, pharyngitis, Rhabdomyolysis, acute renal failure, arthralgia, myalgia
Drug Interactions:
· Increased risk of myopathy and rhabdomyolysis with amiodarone, verapamil; do not exceed 20 mg simvastatin daily
· Increased risk of myopathy and rhabdomyolysis with clarithromycin, erythromycin, HIV protease inhibitors, itraconazole, ketoconazole, nefazodone; avoid concomitant use, or suspend therapy during treatment with clarithromycin, erythromycin, itraconazole, and ketoconazole
· Increased risk of myopathy and rhabdomyolysis with cyclosporine, fibrates, niacin; monitor patient closely if use together can’t be avoided. Don’t exceed 10 mg simvastatin daily
· Digoxin levels may increase slightly; closely monitor plasma digoxin levels at the start of simvastatin therapy
· Increased risk for hepatotoxicity with hepatotoxic drugs; avoid concurrent use
· Simvastatin may slightly enhance the anticoagulant effect of warfarin; monitor PT and INR at the start of therapy and during dose adjustment
Nursing considerations
· Ensure that patient has tried a cholesterol-lowering diet regimen for 3–6 mo before beginning therapy.
· Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM.
· Advise patient that this drug cannot be taken during pregnancy; advise the use of barrier contraceptives.
· Arrange for regular follow-up during long-term therapy. Consider reducing dose if cholesterol falls below target.
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