DYSLIPIDEMIA

STEP 5

Simvastatin: Effects of the Drug

• An HMG-CoA reductase inhibitor (statin)• Used together with lifestyle changes (smoking

cessation, diet, weight-loss, exercise)• Slows the production of cholesterol in the

body• Emphasize: Target reduction of LDL by 30-40%

or LDL <77 mg/dl

Simvastatin: Effects of the Drug

• Reduces LDL cholesterol and triglycerides in the blood

• Increases HDL cholesterol in the blood• Decreases the risk of heart attacks, strokes, and

death• Decreases the need for surgery to improve

blood flow in people who have medical conditions that put them at high risk of developing heart and blood vessel problems

Simvastatin: Effects of the Drug

• Peak time: 1-2 hours• Half-life: 3 hours• Full Benefit of the Drug: 4 weeks• What will happen if the drug is taken

incorrectly or not at all?– Progressive increase in cholesterol levels– Higher risk for cardiovascular events

Simvastatin: Side Effects

• Constipation• Stomach pain• Nausea• Headache

Simvastatin: Danger Signs

• Muscle pain, tenderness, or weakness

• Dark red urine• Lack of energy, tiredness,

or weakness• Fever• Fever or chills• Flushing• Blisters• Rash

• Hives• Itching• Swelling of the face,

throat, tongue, lips, eyes, hands, feet, ankles, or lower legs

• Difficulty breathing or swallowing

• Hoarseness• Joint pain• Sensitivity to light

Simvastatin: Instructions

• How the drug should be taken– Initial dose is 40 mg once daily, taken at night.

Adjusted not earlier than 4 weeks after initiation – Should not exceed maximum dose of 80 mg daily – Can be taken with or without food– Avoid drinking large quantities (more than 1 quart

[1 liter] a day) of grapefruit juice while taking simvastatin.

Simvastatin: Instructions

• How long the treatment should continue– Continue to take drugs even if you feel well– Do not stop taking drugs without consulting the

doctor– To be sure this medication is helping your

condition, lipid levels will need to be checked on a regular basis

– Liver function may also need to be tested– Do not miss any scheduled visits to your doctor

Simvastatin: Warnings

• Tell your doctor and/or pharmacist if you:– Are 65 years of age or older– Are Asian, especially if you are Chinese– Have or have ever had an underactive thyroid

gland or kidney disease– Have liver disease– Drink large amounts of alcohol– Are allergic to simvastatin , any other medications,

or any of the ingredients in simvastatin tablets

Simvastatin: Warnings

• Tell your doctor and/or pharmacist if you:– Are pregnant or plan to become pregnant

• You should not become pregnant during your treatment with simvastatin. Simvastatin can harm the fetus.

– Are breast-feeding• You should not breast-feed while you are taking simvastatin.

– Are having surgery, including dental surgery• Ask your doctor about the safe use of alcoholic

beverages while you are taking simvastatin.– Alcohol can increase the risk of serious side effects.

Simvastatin: Drug Interactions

• Antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral)

• Clarithromycin (Biaxin)• Erythromycin (E.E.S., E-Mycin, Erythrocin)• HIV protease inhibitors such as indinavir

(Crixivan), ritonavir (Norvir) and saquinavir (Invirase, Fortovase)

• Nefazodone (Serzone)• Telithromycin (Ketek)

Simvastatin: Drug Interactions

• Prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products

• Amiodarone (Cordarone, Pacerone)• Anticoagulants ('blood thinners') such as warfarin (Coumadin)• Cyclosporine (Sandimmune, Neoral)• Danazol• Digoxin (Lanoxin)• Other cholesterol-lowering medications such as fenofibrate

(Tricor), gemfibrozil (Lopid), and niacin (nicotinic acid, Niacor, Niaspan); and verapamil (Calan, Covera, Isoptin, Verelan)

Simvastatin: Dietary Instructions

• Eat a low-cholesterol, low-fat diet– Cottage cheese, fat-free milk, fish, vegetables,

poultry, and egg whites• Increase the amount of soluble fiber in your

diet with foods such as oatmeal, kidney beans, and apples.

• Use monounsaturated oils.• Avoid foods with excess fat.• Fat intake reduced to 35-40g/day.

Simvastatin: Lifestyle Modification

• Smoking cessation and avoidance of passive smoking– Smoking about doubles the risk for coronary heart

disease• Start exercise regimen (vigorous, aerobic, habitual,

continuing)• Proper weight management if needed– Weight reduction reduces BP, LDL, HDL, and increases

HDL and glucose tolerance– Use waist circumference (> 90 cm) and BMI

Simvastatin: Missed A Dose?

• Take the missed dose as soon as you remember it.

Simvastatin: Future Consultations

• Future Consultations– When to come back • Come back for follow-up after 2-4 weeks

– When to come earlier• Serious side effects, allergic reactions, etc.

– What information will the doctor need for next appointment?• Repeat lipid profile after 6 weeks• Liver function tests prior to treatment, 2-3 months

after, and annualy thereafter

Simvastatin: Future Consultations

• Regular blood pressure monitoring– She is also at risk for hypertension and adverse

cardiovascular events• Check for other co-morbid conditions like

diabetes mellitus and obesity– Obesity is associated with higher risk for CVD,

stroke, and all-cause mortality

Simvastatin: Everything Clear?

• Whether everything is understood• Repeat the most important information• Whether the patient has any more questions

Reference

• http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692030.html