simvastatin at a glance
Medicine class
Statin (HMG-CoA reductase inhibitor).
Main roles
Treats high cholesterol and helps prevent cardiovascular events in people at increased risk.
Food
Tablets and liquid can be taken with or without food.
Important food interaction
Avoid grapefruit and grapefruit juice because they can increase simvastatin exposure and muscle-toxicity risk.
What is simvastatin used for?
Licensed uses include:
Primary hypercholesterolaemia or mixed dyslipidaemia when diet and other non-medicine measures have not been sufficient.
Homozygous familial hypercholesterolaemia alongside diet and other lipid-lowering treatment, or when those treatments are unsuitable.
Reducing cardiovascular illness and death in people with established atherosclerotic cardiovascular disease or diabetes, alongside management of other risk factors.
How does simvastatin work?
Simvastatin is converted in the liver to an active form that blocks an enzyme involved in cholesterol production. This reduces cholesterol synthesis and increases liver uptake of LDL cholesterol from the blood. Triglycerides also fall and HDL cholesterol may rise modestly.
simvastatin preparations and strengths
Oral suspension
Route: Oral
Strengths: 20 mg/5 mL, 40 mg/5 mL
Tablet
Route: Oral
Strengths: 10 mg, 20 mg, 40 mg, 80 mg
How to take simvastatin
Follow the dispensing label and product leaflet. Simvastatin can be taken with or without food.
Swallow tablets whole with water.
Measure oral suspension with the supplied device, not a household spoon.
Selected suspensions can be given through compatible NG or PEG tubes using product-specific flushing instructions; they have not been tested with latex tubes.
Continue any cholesterol-lowering diet recommended by the treating team.
simvastatin side effects
Common or expected effects
- Headache or dizziness
- Feeling sick
- Constipation, diarrhoea, indigestion or wind
- Muscle aches
- Sleep problems
Get urgent medical advice
- Unexplained muscle pain, cramps, tenderness or weakness, which can indicate myopathy or rhabdomyolysis
- Yellow skin or eyes, which can indicate liver inflammation
- Severe abdominal pain, which can indicate pancreatitis
- Swelling of the throat or tongue, widespread itchy rash or difficulty breathing, which can indicate a severe allergic reaction
simvastatin in pregnancy
The selected UK product licences contraindicate simvastatin during pregnancy. Available studies have not shown a clear increase in birth defects, but evidence remains limited. Anyone who is pregnant, planning pregnancy or exposed inadvertently should contact their prescriber.
simvastatin while breastfeeding
The selected product licences contraindicate breastfeeding during simvastatin treatment. UK specialist guidance says cautious use may sometimes be considered with monitoring of infant feeding, growth and weight gain, although other statins are preferred and direct evidence for simvastatin in milk is unavailable. Individual prescriber assessment is required.
simvastatin interactions
Simvastatin has important interactions with medicines that increase its concentration or independently affect muscle.
Potent CYP3A4 inhibitors, including clarithromycin, erythromycin, azole antifungals, HIV protease inhibitors, cobicistat-containing medicines and nefazodone
These can markedly increase simvastatin exposure and muscle-toxicity risk; concurrent use is contraindicated by the selected product information.
Ciclosporin, danazol or gemfibrozil
Concurrent use is contraindicated because of increased simvastatin exposure and risk of myopathy or rhabdomyolysis.
Common questions about simvastatin
Answers are fully visible for fast scanning and source review.
Can simvastatin be taken with food?
Yes. It can be taken with or without food.
Why should grapefruit be avoided?
Grapefruit inhibits CYP3A4, increasing simvastatin exposure and muscle-toxicity risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.