This medicine contains the active ingredient simvastatin, which is a type of medicine called a statin. It works by reducing the production of cholesterol by the liver. For the sake of simplicity, there are two sorts of cholesterol; a ''''bad'''' sort called low density lipoprotein (LDL) and a ''''good'''' sort called high density lipoprotein (HDL). LDL is deposited in the arteries and increases the risk of heart disease by clogging and narrowing the arteries (atherosclerosis), while HDL actually protects the arteries against this. Simvastatin decreases the production of LDL cholesterol by blocking the action of the enzyme in the liver (called HMG-CoA reductase) that is responsible for its production. This decreases the amount of cholesterol in the liver cells, which causes them to take up LDL cholesterol from the blood. The decreased cholesterol production and increased removal of LDL cholesterol from the blood ultimately results in lowered blood cholesterol levels. As the body produces most cholesterol at night, statins are generally more effective if taken at night. Simvastatin also causes a small decrease in the production of other ''''bad fats'''' in the blood called triglycerides, and a small increase in the level of HDL cholesterol. This results in lowered levels of ''''bad fats'''' and raised levels of ''''good fats'''' in the blood. Statins have an important role in the prevention of coronary heart disease. They reduce the risk of excess cholesterol being deposited in the major blood vessels of the heart. Any blockage in the blood vessels limits the amount of blood and therefore oxygen being carried to the heart muscle. In severe cases this can result in a heart attack (myocardial infarction). Statins also reduce the risk of stroke by decreasing the risk of excess cholesterol being deposited in the blood vessels leading to the brain. These fat deposits can cause blockage and therefore limit blood and oxygen supply to certain parts of the brain. Simvastatin is therefore used to reduce high blood levels of cholesterol and other fats when these cannot be lowered by diet and exercise alone. This helps to reduce the risk of hardening of the arteries (atherosclerosis) and the problems described above that this can cause. It is important to continue to follow a cholesterol-lowering diet and exercise regime while taking simvastatin. Simvastatin is also used for people who already have coronary heart disease caused by high cholesterol levels. In these people simvastatin slows down the hardening of the arteries and reduces the risk of needing procedures to improve blood supply to the heart, such as a balloon dilation of an artery or a heart bypass graft. It also reduces the risk of heart attack and death.

HOW TO USE THIS PRODUCT:
Zocor
Main Use Active Ingredient Manufacturer
High cholesterol levels Simvastatin Merck Sharp amp; Dohme

How does it work?
This medicine contains the active ingredient simvastatin, which is a type of medicine called a statin. It works by reducing the production of cholesterol by the liver.
For the sake of simplicity, there are two sorts of cholesterol; a bad sort called low density lipoprotein (LDL) and a good sort called high density lipoprotein (HDL). LDL is deposited in the arteries and increases the risk of heart disease by clogging and narrowing the arteries (atherosclerosis), while HDL actually protects the arteries against this.

Simvastatin decreases the production of LDL cholesterol by blocking the action of the enzyme in the liver (called HMG-CoA reductase) that is responsible for its production. This decreases the amount of cholesterol in the liver cells, which causes them to take up LDL cholesterol from the blood. The decreased cholesterol production and increased removal of LDL cholesterol from the blood ultimately results in lowered blood cholesterol levels.

As the body produces most cholesterol at night, statins are generally more effective if taken at night.

Simvastatin also causes a small decrease in the production of other bad fats in the blood called triglycerides, and a small increase in the level of HDL cholesterol. This results in lowered levels of bad fats and raised levels of good fats in the blood.

Statins have an important role in the prevention of coronary heart disease. They reduce the risk of excess cholesterol being deposited in the major blood vessels of the heart. Any blockage in the blood vessels limits the amount of blood and therefore oxygen being carried to the heart muscle. In severe cases this can result in a heart attack (myocardial infarction).

Statins also reduce the risk of stroke by decreasing the risk of excess cholesterol being deposited in the blood vessels leading to the brain. These fat deposits can cause blockage and therefore limit blood and oxygen supply to certain parts of the brain.

Simvastatin is therefore used to reduce high blood levels of cholesterol and other fats when these cannot be lowered by diet and exercise alone. This helps to reduce the risk of hardening of the arteries (atherosclerosis) and the problems described above that this can cause. It is important to continue to follow a cholesterol-lowering diet and exercise regime while taking simvastatin.

Simvastatin is also used for people who already have coronary heart disease caused by high cholesterol levels. In these people simvastatin slows down the hardening of the arteries and reduces the risk of needing procedures to improve blood supply to the heart, such as a balloon dilation of an artery or a heart bypass graft. It also reduces the risk of heart attack and death.

What is it used for?
Coronary heart disease
High blood cholesterol levels (primary hypercholesterolaemia) Inherited high blood cholesterol levels (familial hypercholesterolaemia) Inherited high levels of fat (lipids) in the blood (mixed hyperlipidaemia)
Warning!
It is recommended that you avoid drinking excessive amounts of alcohol while taking this medicine.
This medicine may very rarely have side effects on the muscles. For this reason you should inform your doctor immediately if you experience any muscular symptoms such as pain, tenderness, cramps, or weakness while taking this medicine, particularly if it is accompanied by a fever or feeling generally unwell. Your doctor may need to check for side effects on the muscles by taking a blood test to measure the level of a compound called creatinine kinase in your blood. If this is the case, the test should not be done following strenuous exercise.
There is insufficient information regarding the safety and efficacy of this medicine in children. It is not recommended for children.
You should have blood tests to monitor your liver function (liver function tests) before starting treatment and regularly throughout treatment with this medicine.
You should should continue eating a cholesterol-lowering diet during treatment with this medicine. Discuss this with your doctor. You should avoid drinking large amounts (over one litre a day) of grapefruit juice while taking this medicine, as this could affect the metabolism of the medicine and hence the amount of the medicine in your blood. However, drinking one 250ml glass daily should not cause any problems.

Use with caution in
Decreased kidney function
History of liver disease
Individuals who consume large quantities of alcohol
Not to be used in
Active liver disease
Breastfeeding
Life long inherited blood diseases which can cause a variety of symptoms, including mental health problems (porphyrias) Pregnancy
Unexplained raised results in liver function tests
Women of child-bearing potential, unless effective contraception is used to prevent pregnancy
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby.Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
This medicine should not be used during pregnancy and pregnancy should be avoided for one month following discontinuation of treatment. Adequate contraception should be used by women of child bearing potential. Seek medical advice from your doctor.
There is no information available about the safety of this medicine during breastfeeding. For this reason, the manufacturer states that it should not be used during breastfeeding. Seek medical advice from your doctor.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Headache
Rash
Excess gas in the stomach and intestines (flatulence)
Disturbances of the gut such as diarrhoea, constipation, nausea,
vomiting or abdominal pain
Inflammation of the pancreas (pancreatitis)
Indigestion (dyspepsia)
Hair loss (alopecia)
Alteration in results of liver function tests
Pins and needles (paraesthesia)
Dizziness
Low red blood cell count (anaemia)
Inflammation of the liver (hepatitis)
Pain in the muscles (myalgia)
Muscle breakdown (rhabdomyolysis)
Weakness or loss of strength (asthenia)
Increased blood levels of CPK (creatine phosphokinase), an enzyme released from damaged muscle.
The side effects listed above may not include all of the side effects reported by the drugs manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?
There may be an increased risk of side effects on the muscles (myopathy) if this medicine is taken with any of the following medicines:

- ciclosporin (the maximum daily dose of simvastatin should not exceed 10mg in people taking ciclosporin)
- fibrates for lowering cholesterol, eg bezafibrate, gemfibrozil (the maximum daily dose of simvastatin should not exceed 10mg in people taking a fibrate medicine)
- nicotinic acid or niacin (the maximum daily dose of simvastatin should not exceed 10mg in people taking more than 1g daily of nicotinic acid)
- amiodarone (the maximum daily dose of simvastatin should not exceed 20mg in people taking amiodarone)
- verapamil (the maximum daily dose of simvastatin should not exceed 20mg in people taking verapamil)
- diltiazem
- itraconazole
- ketoconazole
- erythromycin
- clarithromycin
-HIV protease inhibitors, eg nelfinavir
- nefazadone.
These medicines should be avoided where possible in people taking simvastatin.

The anti-blood-clotting effect of anticoagulants such as warfarin may be increased by simvastatin. For this reason, if you are taking an anticoagulant your doctor may want to check your blood-clotting time (INR) when you start or stop treatment with simvastatin, and if your simvastatin dose is altered.