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What is simvastatin for?

Simvastatin is a type of statin, a group of lipid-regulating medicines used to lower cholesterol in patients at increased risk of cardiovascular disease. It is used in combination with a healthy lifestyle and diet to reduce the level of “bad” cholesterol in the blood and raise the level of “good” cholesterol.

How does simvastatin work?

Cholesterol is a fatty substance produced by the liver that plays an important role in the functioning of all cells in the body. Having a high level of high-density lipoprotein (HDL), or “good” cholesterol, in the blood is good for you, but a high level of low-density lipoprotein, “bad” cholesterol, can build up the arteries and cause a blockage, creating a high risk of heart attack or stroke. Simvastatin works to inhibit an enzyme in the liver responsible for the production of LDL cholesterol, thus reducing overall levels in the blood. It’s used in combination with lifestyle modification, e.g. maintaining a healthy weight, eating a healthy diet that is low in saturated fats and exercising regularly.

How long do I need to take simvastatin for?

Statins such as simvastatin are usually taken for life, as the benefits will wear off once treatment ends. For this reason, they are usually only prescribed to patients at high risk of cardiovascular disease; such as those with a history of stroke or heart attack. The benefits of statins increase over time, and coming off them suddenly can be dangerous. Never stop taking statins without first consulting a doctor.

Simvastatin summary

Active ingredients

The active ingredient in simvastatin tablets is simvastatin.

Inactive ingredients

The inactive ingredients in simvastatin are lactose monohydrate, butylated hydroxyanisole (E320), ascorbic acid (E300), citric acid monohydrate (E 330), cellulose, microcrystalline (E460a), pregelatinised maize starch, magnesium stearate (E470B), hypromellose (E464), hydroxypropyl cellulose (E463), titanium dioxide (E171), talc (E553b), iron oxide yellow (E172) and iron oxide red (E172).

Inactive ingredients may vary depending on the manufacturer.

How to take simvastatin

Always take simvastatin as instructed by a doctor. The usual dose is between 10 and 40 mg taken once daily, although some patients may be prescribed a daily dose of up to 80 mg. You should take simvastatin in the evening, with a glass of water and with or without food.

When to take simvastatin

It is best to take simvastatin in the evening as your body synthesises most cholesterol at night.

What should I do if I miss a dose of simvastatin?

If you forget to take a dose, don’t worry, just take your next dose at the normal time. Never take a double dose to make up for a missed one.

Can I crush simvastatin?

Simvastatin should not be crushed or split but should instead be swallowed whole with a glass of water, with or without food.

Simvastatin side effects

Like all medications, simvastatin can cause side effects in some patients. 

If you experience either of the following, stop taking this medication and consult a doctor immediately:

• Signs of an allergic reaction, including swelling of the face, lips, tongue or throat, difficulty breathing, sudden wheezing, severe rash or itching, high fever
• Joint pain or inflammation
• Skin eruptions or inflammation, hives or sudden sensitivity to sunlight
• Sudden muscle aching, weakness, tenderness or pain
• Unusual bruising or bleeding
• Yellowing of the skin or eyes, itching, dark-coloured urine or pale-coloured stool
• Abdominal pain

Common or very common side effects (occur in up to 1 in 10 people):

• Asthenia (weakness)
• Constipation or diarrhoea
• Dizziness
• Flatulence
• Abdominal discomfort
• Headache
• Myalgia (muscle aches)
• Nausea
• Sleep disorders
• Thrombocytopenia (low platelets, manifested by easily bruising)

Uncommon:

• Alopecia (hair loss)
• Liver disorders
• Memory loss
• Pancreatitis (inflammation of the pancreas, manifested by upper abdominal pain)
• Paraesthesia (numbness)
• Sexual dysfunction
• Skin reactions
• Vomiting

Rare or very rare:

• Myopathy (painful muscles)
• Peripheral neuropathy (sensory symptoms such as tingling or pins and needles)
• Tendinopathy (painful tendons)
• Acute kidney injury
• Anaemia
• Muscle cramps

Frequency not known:

• Depression
• Diabetes mellitus (in those at risk)
• Interstitial lung disease

Contraindications

Do NOT take simvastatin if you are:

• Allergic to any of the ingredients in this medication
• Pregnant or planning to become pregnant (you should carefully use contraception for the duration of treatment and for one month after stopping)
• Breastfeeding
• Taking any medications that interact with simvastatin (see list below and speak to your doctor for advice)

Before taking simvastatin, tell your doctor and take special care if you:

• Have a history of liver problems
• Have any thyroid problems
• Have ever had muscle problems e.g. myopathy or rhabdomyolysis
• Have a personal or family history of muscle disorder
• Drink a lot of alcohol or have a history of alcohol abuse
• Have any kidney problems

Drug interactions

Do NOT take simvastatin if you are taking any of the following medications:

• Antifungal medications such as itraconazole or ketoconazole
• Medication for the treatment of HIV, such as indinavir, nelfinavir, ritonavir, cobicistat or saquinavir
• Nefazodone (antidepressant)
• Antibiotics such as erythromycin, clarithromycin, telithromycin
• Danazol
• Gemfibrozil
• Immunosuppressants such as ciclosporin

Before taking simvastatin, tell your doctor if you are taking any other medicines, including those bought over the counter without a prescription. In particular, tell your doctor if you are taking any of the following:

• Immunosuppressants 
• Niacin or nicotinic acid in doses greater than or equal to 1 g per day
• Any other cholesterol-lowering medicines
• Amiodarone (used to treat irregular heartbeat)
• High blood pressure medications such as verapamil and diltiazem
• Blood-thinning medications such as warfarin
• Fusidic acid for bacterial infection

Simvastatin food interactions

You should not drink grapefruit juice while taking simvastatin, as it can increase the concentration of this medication in your system.

You can drink alcohol while taking simvastatin, but you should stick to the recommended guideline of no more than 14 units per week. Drinking too much alcohol can increase the risk of developing liver and muscle-related side effects.

How to switch high cholesterol medication

Simvastatin is a prescription medication that must only be taken following consultation with a doctor. It can also be purchased at a low, 10 mg dose from a pharmacy - however, you should still consult a doctor before switching to this medication. Your doctor will place you on a low-cholesterol diet and start by prescribing you a low dose which may be increased gradually over time.

Simvastatin vs other statins

There are five types of statin available on prescription in the UK. The main difference between statins is their lowering effect on cholesterol levels: simvastatin, fluvastatin and pravastatin are low-intensity statins, which are sufficient for lowering cholesterol in most patients. For patients with very high cholesterol levels, a high-intensity statin such as atorvastatin or rosuvastatin may be more suitable. 

People react differently to different statins, so if you are experiencing troublesome side effects speak to your doctor about the possibility of switching to a different statin.

Is simvastatin a cure?

Simvastatin is not a cure for high cholesterol, and your cholesterol levels will rise again if you stop taking this medication. However, simvastatin helps to lower cholesterol and reduce the risk of experiencing a heart attack or stroke. It is most effective when accompanied by the appropriate lifestyle and diet. To make the best of simvastatin, you should follow a healthy, low-cholesterol diet, exercise regularly, quit smoking and lose weight if you are overweight.

How can I tell if simvastatin is working?

You will not be able to feel simvastatin working. However, your doctor may wish to conduct regular blood tests to monitor the level of your cholesterol. It is more important to concentrate on leading a healthy lifestyle to make the most of the benefits of simvastatin.

Is simvastatin a blood thinner?

Simvastatin is not a blood thinner. It works by reducing the level of “bad” cholesterol in the blood and increasing the level of “good” cholesterol. It may be taken in combination with blood-thinning medication if you are at increased risk of blood clots.

How is high cholesterol diagnosed?

There are not usually any symptoms of high cholesterol and diagnosis is through blood testing.

How can I lower my cholesterol?

Limiting intake of foods that contain cholesterol, saturated fat and trans fat is the easiest way to manage cholesterol. Simvastatin is prescribed in addition to dietary changes if; your levels of cholesterol have not been lowered by diet or exercise, you are at a greater risk of a stroke or heart attack, you are suffering from coronary heart disease, or you have inherited a condition that increases your cholesterol e.g. homozygous familial hypercholesterolaemia.