Generic name: Simvastatin

Why is this medication prescribed?
Simvastatin is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol and certain fatty substances in your blood. Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats may help to prevent heart disease, angina (chest pain), strokes, and heart attacks.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?
Simvastatin comes in tablets to take by mouth. It usually is taken once a day at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take simvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continue to take simvastatin even if you feel well. Do not stop taking simvastatin without talking to your doctor.

What special precautions should I follow?
Before taking simvastatin,

• tell your doctor and pharmacist if you are allergic to simvastatin or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antacids, anticoagulants ('blood thinners') such as warfarin (Coumadin), cholestyramine (Questran), clarithromycin (Biaxin), clofibrate (Atromid-S), cyclosporine (Sandimmune, Neoral), digoxin (Lanoxin), erythromycin, fenofibrate (TriCor), gemfibrozil (Lopid), HIV protease inhibitors such as ritonavir (Norvir) and saquinavir (Invirase), itraconazole (Sporanox), ketoconazole (Nizoral), nefazodone (Serzone), niacin (nicotinic acid), and vitamins.
• tell your doctor if you have or have ever had liver, kidney, or heart disease; a severe infection; low blood pressure; or seizures.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking simvastatin, stop taking simvastatin and call your doctor immediately. Simvastatin can harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking simvastatin.
• talk to your doctor about the safe use of alcohol while taking this drug. Alcohol increases the side effects caused by simvastatin.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Simvastatin may make your skin sensitive to sunlight.

What special dietary instructions should I follow?
Avoid drinking large quantities of grapefruit juice (more than 1 quart a day) while taking simvastatin.

Eat a low-cholesterol, low-fat diet. This kind of diet includes cottage cheese, fat-free milk, fish (not canned in oil), vegetables, poultry, egg whites, and polyunsaturated oils and margarines (corn, safflower, canola, and soybean oils). Avoid foods with excess fat in them such as meat (especially liver and fatty meat), egg yolks, whole milk, cream, butter, shortening, lard, pastries, cakes, cookies, gravy, peanut butter, chocolate, olives, potato chips, coconut, cheese (other than cottage cheese), coconut oil, palm oil, and fried foods.

What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue the regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?
Although side effects from simvastatin are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

• gas
• stomach pain or cramps
• diarrhea
• constipation
• heartburn
• headache
• blurred vision
• dizziness
• rash or itching
• upset stomach

If you experience the following symptom, call your doctor immediately:

• muscle pain, tenderness, or weakness with or without a fever

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison controlcenter at 1-800-222-1222. If the victim has collapsedor is not breathing, call local emergency services at911.

What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before and during treatment to check your response to simvastatin.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.