About half of statins prescriptions in the United States are for simvastatin. It is the market leader in terms of number of prescriptions, if not in terms of costs to consumers and insurance companies
Simvastatin is available in 5, 10, 20, 40, and 80 mg tablets. The daily dosing range is 5-80 mg with a recommended starting dose of 20 to 40 mgs daily, taken with meals.
In 2010, the Food and Drug Administration issued an advisory on the risk of side effects from the highest dosage (80 mg/day) of simvastatin. In June 2011 the agency said that dosage should not be given to new patients because of reports of myopathy.
Simvastatin in the Body
Most of the medicine is absorbed in the intestine. About 15% typically exits through the feces. Once in the bloodstream, most is metabolized. A little is removed by the kidneys. After ingestion, peak bloodstream concentration is in 80 to 160 minutes. Simvastatin has a shorter half-life in the body than atorvastatin.
Researchers have found the drug starts to work several days after the patient starts taking it and peaks in about 2 weeks, leveling off if a constant dosaging is maintained.
This drug is not approved for pregnant women, and there is some indication that cholesterol synthesis may be important in fetal development, so statin drugs should definitely not be given. If pregnancy occurs during treatment, alert your doctor, who will almost certainly discontinue simvastatin.
Patients who drink large amounts of alcohol or have a history of liver disease are sometimes not prescribed simvastatin because of concerns about the drug's effect on the liver.
Like other statins, simvastatin can be taken with meals. Generally the drug should be taken in the evening or night to increase efficacy.
Brand Names for Simvastatin
Simvastatin was developed in 1981 and patented by Merck & Co. Simvastatin was first approved for use in Sweden in 1988; it did not receive United States FDA approval until December of 1991. Merck sold it under the brand name Zocor and had exclusive rights until the patent expired in 2006. Other companies can now make simvastatiin as it has "gone generic". Only Merck can still use the name Zocor, however.
Simvastatin for Primary Prevention
One way to divide patients is between those who have had specific CVD events and those who have not. If someone has experienced a stroke or heart attack, we say the statins are given for secondary prevention. The goal is to prevent another event. People who have never had such an event can be given statins as primary prevention. Primary prevention patients are the higher-hanging fruit. There is a benefit from treating them, but it is not as great on average as the benefit from treating people who have already had heart attacks.
And studies have shown that statin medications do indeed reduce the incidence of strokes in people who take them.
Simvastatin was under patent for years and sold in the United States under the brand name Zocor. That brand is still pretty strong, and many medical professionals commonly refer to simvastatin as "generic Zocor". Other names the medicine has been sold under around the world include Zorced; Zimstat, Sinvacor, Sivastin, Simvatin, and Lodales .
Simvastatin is also part of the combination pill Vytorin. More on that here.