Simvastatin: instructions and indications for use, a list of available analogues

What is Simvastatin and what is its composition?

Simvastatin is the active ingredient of the drug of the same name. It is a synthetic lipid-lowering drug from the statin group, produced by a special fungus from the genus Aspergillus by fermentation. It is an inactive compound that is transformed in the body by chemical reactions into an active structure.

The mechanism of action of this agent is to inhibit the reaction of synthesis of mevalont from HMG-CoA. This is the first link in the cascade of transformations leading to the formation of cholesterol.

As a result, the alkaloid Simvastatin leads to a decrease in the level of triglycerides, low and very low density lipoproteins, instead of increasing the concentration of high density lipoproteins. At the same time, it is safer, unlike its predecessors, due to the absence of mutagenic action and influence on the synthesis of steroid hormones.

The drug gives an effect only 1.5-2 weeks after the start of administration, which lasts only with regular use. If the patient stops the course of treatment, cholesterol returns to the starting level.

It is presented in the form of tablets in a shell, dissolving in the intestine, at a dosage of 10 or 20 mg of the active substance.

Indications for use

Due to its ability to lower cholesterol levels, indications for the use of Simvastatin include pathologies characterized by a high level of lipidemia and the presence of an atherosclerotic process:

• primary hypercholesterolemia;
• primary prevention of coronary heart disease and patients with predisposing risk factors (including diabetes mellitus or other metabolic pathologies);
• secondary prevention of complications of ischemic heart disease (especially myocardial infarction), as well as acute disorders of cerebral circulation (strokes);
• essential (primary) arterial hypertension;
• hypertriglyceridemia.
• dysbetalipoproteinemia;
• atherosclerosis of large arteries;
• metabolic syndrome.

Studies have shown the high effectiveness of this drug. So, it was found that taking Simvastatin reduces overall mortality by 14%, mortality associated with coronary heart disease by 18%, and complications of coronary artery disease (including heart attack) by 27%.

In contrast to patients receiving standard treatment, patients taking Simvastatin significantly reduced the progression of coronary atherosclerosis.

Method of administration of the drug and prescribed doses

The official instructions for the use of Simvastatin contain the following recommendations:

• in parallel with taking the medication, you should adhere to a hypocholesterol diet;
• the daily dose is taken once a day (preferably in the evening), the medicine is washed down with plain water;
• you can take the medication both before meals and after - this does not affect the therapeutic effect.
• the drug is not able to completely eliminate the causes of the disease, therefore it must be used regularly, over a long period of time;
• dosages are adjusted depending on the effect of treatment, for which the first time every 4 weeks it is necessary to carry out laboratory tests;
• if you miss a pill, you should take it as soon as possible in the same dose (you cannot double it).

The exact dosage depends on the specific pathology. The maximum daily allowance is no more than 80 mg. In this case, the reception must be divided by 2 times.

For hypercholesterolemia or other disorders of the lipid profile, the initial dose is 5-10 mg. If necessary, it is gradually (every month) increased to the maximum daily rate under the control of laboratory parameters. It should be remembered that too much of the drug can lead to myopathy, therefore it is better to use combination therapy.

Contraindications and side effects

When treating or preventing coronary artery disease, they start with 20 mg per day, in the future, an increase to 40 mg is possible. As in the previous case, constant medical supervision is necessary, and when the target values ​​of the lipid spectrum (LDL <1.95 mmol / L; total cholesterol <3.5 mmol / L) are achieved, the dosage should be reduced.

In patients with severe kidney or thyroid pathology, daily doses exceeding 10 mg are prescribed very carefully. If possible, acute conditions should be stopped first, and only then lipid-lowering therapy should be applied.

For adolescents after 10 years of age with a diagnosis of heterozygous familial hypercholesterolemia, the recommended dose is 10 mg, the upper limit is 40 mg.

Contraindications to Simvastatin and its side effects

• individual intolerance to simvastatin and auxiliary components
• myopathy and other diseases of the striated muscles;
• acute liver diseases in active steel;
• individual intolerance to lactose or galactose;

• simultaneous use of immunosuppressants;
• alcohol abuse;
• low blood pressure (hypotension);
• epilepsy;
• violation of water and electrolyte balance.

Despite its fairly high safety, after the appointment of Simvastatin, side reactions may occur, including:

• allergic reactions - most often manifested by urticaria, itchy skin, severe forms are rare;
• tachycardia;
• anemic syndrome;
• decreased potency.

In case of overdose, any of the above side effects may occur. There is no specific antidote, after the drug is discontinued, general detoxification and post-syndrome therapy is performed:

1. Gastric lavage and taking adsorbent drugs;
2. Monitoring of the functional parameters of the kidneys and liver;
3. Infusion therapy;
4. Symptomatic treatment;

The joint use of Simvastatin with the following drugs is prohibited:

• Itraconazole;
• Antibiotics clarithromycin, erythromycin;
• HIV protease inhibitors (saquinavir, fosamprenavir, indinavir and others);
• The antidepressant nafzodone;
• Cyclosporine.

It is not recommended to consume grapefruit juice while using simvastatin.

Special instructions

When driving a car and operating other complex mechanisms, care should be taken due to the possible development of dizziness.

Discontinuation of medication during pregnancy has little or no effect on the overall success of lipid-lowering therapy.

Women of childbearing age should stop using Simvastatin if they are not using contraception.

What analogues of Simvastatin are present on the Russian market?

Structural substitutes for this drug include:

• Aktalipid;
• Simvacard;
• Zorstat;
• Holvasim;
• Symbor;
• Zokor;
• Sincard.

The following medicines have a similar effect:

• Atorvastatin;
• Rosuvastatin;
• Lovasterol;
• Pravastatin;
• Holvasim.

Conclusions

Simvastatin belongs to the group of anti-lipidemic and cholesterol-lowering agents used in the treatment of cardiovascular and other diseases associated with metabolic disorders. This drug has a good effect, proven in numerous clinical studies and a fairly small range of restrictions and adverse reactions. Nevertheless, when using it, constant laboratory control is required, which excludes its independent use.