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Simvastatin

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Information about simvastatin, a lipid-lowering medication used to reduce the risk of heart disease.

Generic and proprietary names

- Simvastatin/Zocor.

Action

- Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis.

Classification

- Statin.

- Antilipidemic.

- HMG-CoA reductase inhibitor.

Indications

- Primary hypercholesterolaemia.

- Heterozygous familial hypercholesterolaemia.

- Homozygous familial hypercholesterolaemia or combined hyperlipidaemia in patients who have not responded enough to dietary changes.

- Prevention of coronary events.

- To slow progress of coronary atherosclerosis in patients with coronary heart disease.

Contraindications

- Hypersensitivity.

- Pregnancy.

- Lactation.

- Active liver disease.

Cautions

- Past liver disease.

- Severe acute infection.

- Alcoholism.

- Trauma.

- Severe metabolic disorders.

- Hypotension.

- Uncontrolled seizure disorders.

- Electrolyte imbalances.

Common side-effects

- Rash.

- Pruritis.

- Alopecia.

- Nausea/vomiting.

- Bowel problems.

- Abdominal pain.

- Liver dysfunction.

- Lens opacities.

- Myalgia.

- Rhabdomyolysis.

- Headache.

- Peripheral neuropathy.

- Anaemia.

- Dizziness.

- Parasthesia.

- Peripheral neuropathy.

- Hepatitis.

- Jaundice.

- Pancreatitis.

- Myopathy.

Rare side-effects

- Reversible myositis.

- Hepatitis.

- Angiodema.

- Anaphylaxis.

Interactions

- Increased effects of warfarin.

- Digoxin, ciclosporin, amiodarone, verapamil, diltiazem, fibrates, nicotinic acid, erythromycin, clarithromycin, macrolide antibiotics, azole antifungals, immunosuppressants, protease inhibitors, grapefruit juice.

Administration

- Tablet.

Nursing considerations

- Carry out lipid profile.

- Assess cholesterol at six weeks.

- Perform liver function tests in first year of treatment.

- In the case of rhabdomyolysis with increased muscle tenderness and creatine phosphokinase, therapy should be discontinued.

- Renal tests for patients with impaired renal function.

- Eye tests before treatment, after one month, then annually.

Patient teaching

- Advise patients that blood and eye tests will be necessary throughout treatment.

- Blurred vision, severe gastrointestinal problems, dizziness or headaches must be reported.

- A low cholesterol diet and exercise programme are recommended.

- Medication should be stored in a closed container in a cool, dry, dark place, out of the reach of children.

- Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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