March 28, 2023

In this video I describe the purpose of simvastatin, side effects, and how I use it in my practice. Disclaimer: This is YouTube. Do not stop or change any of your medications without consulting with your health care provider. This video constitutes health education, not medical advice.

Hi i’m dr nathan ritter from this video is about simvastatin a super common cholesterol medication it decreases ldl cholesterol and decreases the chance of stroke heart attack and death it’s been around since 1992 it’s generic so it’s not too expensive it’s a well-studied medicine and a large trial of people who had known prior coronary blockage

Or heart attack or had high risk for this occurring in this large trial it decreased the chance of death overall from 12 to 8 percent over five years that’s a big difference and it’s an important result because it’s not just decreasing heart attack but rather decreasing the overall chance of death dosing ranges from 10 milligrams per day on the low side up

To the at this point relatively rarely used 80 milligram per day maximum dose side effects of the usual statin side effects muscle aches most common thing maybe one in five people uh joint aches one in fifty people um constipation diarrhea bloating relatively common one in a hundred chance more or less of liver inflammation and then it would be controversial

About whether or not it could cause cognitive dysfunction um it does not appear to cause dementia um i’ve had a couple of patients who said they really had mental cloudiness or fogginess with a medication i consider it possible indeed that it can cause those symptoms and then there would be a host of rare reactions to the medicine rash would be an unusual thing

But really basically with any medication if you start it and then you start having a symptom then there’s a solid chance that the medication is causing the symptom in any event overall it’s pretty well tolerated i’d say 75 percent of people who are started on simvastatin end up tolerating it one of the big drawbacks with simvastatin is medicine interactions and

Really it’s one of the things that’s kind of killed it um simvastatin isn’t prescribed in new people that much anymore because there are alternatives at torvistad and rosuvastatin simvastan interacts with amlodipine varapamil diltiazem these are all commonly used blood pressure medications that also have other uses and you have to use a low dose of simvastatin

When you’re using those medications they’re so common that people basically now avoid using simvastatin in anybody who’s on one of those medicines that’s really decreased the number of simvastatin prescriptions in addition a number of years back there was an fda warning about the high dose of simvastatin 80 milligrams per day as having a significant chance of

Causing rhabdomyolysis which is an extreme case of muscle damage due to the medication in my experience i haven’t had any patient who had rhabdomyolysis with sibistatin 80 milligrams but it can certainly happen so we were discouraged from using the 80 milligram dose from the time of that announcement i’ve got quite a few patients who were on 80 milligrams per day

At that time and tolerating it for a decade or more so in those patients i didn’t change the dose and to this point generally they’ve tolerated but that’s another thing the 80 milligram dose warning from the fda that damaged simvastatin’s reputation and decreased its use so how do i use it in my daily practice i have patients who’ve been on it for years i leave

Them on it if they’re doing well so say somebody had a heart attack in 2007 and i put them on simvastatin 40 milligrams per day at that time now many years have gone by and they’ve done well no further strokes or heart attacks they’ve tolerated the medication their ldl cholesterol is quite low below 100 or below 70. and i don’t change the medicine because i’ve

Had plenty of patients where when i do change simvastatin to atorvastatin that they feel poorly and now we’ve got to put the patient back on simvastatin and go through a process of getting the patient off the medicine and i don’t like switching patients back and forth so in any event somebody’s done well on simostat for a long time i leave them on it if i’ve got

A new patient who had a heart attack uh recently um i don’t use symbiostatin i would give that patient a torvastatin 40 milligrams per day or resuve statin 20 milligrams per day in younger patients with very bad cholesterol levels i’ll use the maximum dose of atorvastatin 80 milligrams or the maximum dose of resuvas den 40 milligrams but really in a patient who

Has developed a harder blood vessel problem now it would be i basically never would start simvastatin and then in another group of patients people have high risk for having blockage say somebody whose father died of a heart attack at 50 and whose sister had sense at age 55 that person has significant risk for having a blood vessel problem him or herself and

I might consider giving that person a statin um i wouldn’t choose a simvastatin to to start with i would use a torvastatin or suvastatin um and uh then if they failed the torva stat and then i would use versus den and vice versa um and if they failed those two medications uh i would probably try pravastatin because travis denton is better tolerated in general

Than simvastatin so simvastatin isn’t being started in new patients basically hardly ever by me anyway at this point i do want to emphasize that overall it’s a good medication and it’s worth continuing people who’ve done well on it so i consider it effective um it’s just not my first second or third choice for a statin at this point in a new patient thanks for

Watching as always hit like and subscribe i appreciate it helps you get the feedback leave any questions below and i’ll try to answer them see you next time

Transcribed from video
Simvastatin Explained. Details about a common statin medication. By CardioGauge