DYSLIPIDEMIA

1. DYSLIPIDEMIA STEP 5

2. Simvastatin: Effects of the Drug • An HMG-CoA reductase inhibitor (statin) • Used together with lifestyle changes (smoking cessation, diet, weight-loss, exercise) • Slows the production of cholesterol in the body • Emphasize: Target reduction of LDL by 30-40% or LDL <77 mg/dl

3. Simvastatin: Effects of the Drug • Reduces LDL cholesterol and triglycerides in the blood • Increases HDL cholesterol in the blood • Decreases the risk of heart attacks, strokes, and death • Decreases the need for surgery to improve blood flow in people who have medical conditions that put them at high risk of developing heart and blood vessel problems

4. Simvastatin: Effects of the Drug • Peak time: 1-2 hours • Half-life: 3 hours • Full Benefit of the Drug: 4 weeks • What will happen if the drug is taken incorrectly or not at all? • Progressive increase in cholesterol levels • Higher risk for cardiovascular events

5. Simvastatin: Side Effects • Constipation • Stomach pain • Nausea • Headache

6. Simvastatin: Danger Signs • Muscle pain, tenderness, or weakness • Dark red urine • Lack of energy, tiredness, or weakness • Fever • Fever or chills • Flushing • Blisters • Rash • Hives • Itching • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs • Difficulty breathing or swallowing • Hoarseness • Joint pain • Sensitivity to light

7. Simvastatin: Instructions • How the drug should be taken • Initial dose is 40 mg once daily, taken at night. Adjusted not earlier than 4 weeks after initiation • Should not exceed maximum dose of 80 mg daily • Can be taken with or without food • Avoid drinking large quantities (more than 1 quart [1 liter] a day) of grapefruit juice while taking simvastatin.

8. Simvastatin: Instructions • How long the treatment should continue • Continue to take drugs even if you feel well • Do not stop taking drugs without consulting the doctor • To be sure this medication is helping your condition, lipid levels will need to be checked on a regular basis • Liver function may also need to be tested • Do not miss any scheduled visits to your doctor

9. Simvastatin: Warnings • Tell your doctor and/or pharmacist if you: • Are 65 years of age or older • Are Asian, especially if you are Chinese • Have or have ever had an underactive thyroid gland or kidney disease • Have liver disease • Drink large amounts of alcohol • Are allergic to simvastatin , any other medications, or any of the ingredients in simvastatintablets

10. Simvastatin: Warnings • Tell your doctor and/or pharmacist if you: • Are pregnant or plan to become pregnant • You should not become pregnant during your treatment with simvastatin. Simvastatin can harm the fetus. • Are breast-feeding • You should not breast-feed while you are taking simvastatin. • Are having surgery, including dental surgery • Ask your doctor about the safe use of alcoholic beverages while you are taking simvastatin. • Alcohol can increase the risk of serious side effects.

11. Simvastatin: Drug Interactions • Antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral) • Clarithromycin (Biaxin) • Erythromycin (E.E.S., E-Mycin, Erythrocin) • HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir) and saquinavir (Invirase, Fortovase) • Nefazodone (Serzone) • Telithromycin (Ketek)

12. Simvastatin: Drug Interactions • Prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products • Amiodarone (Cordarone, Pacerone) • Anticoagulants ('blood thinners') such as warfarin (Coumadin) • Cyclosporine (Sandimmune, Neoral) • Danazol • Digoxin (Lanoxin) • Other cholesterol-lowering medications such as fenofibrate (Tricor), gemfibrozil (Lopid), and niacin (nicotinic acid, Niacor, Niaspan); and verapamil (Calan, Covera, Isoptin, Verelan)

13. Simvastatin: Dietary Instructions • Eat a low-cholesterol, low-fat diet • Cottage cheese, fat-free milk, fish, vegetables, poultry, and egg whites • Increase the amount of soluble fiber in your diet with foods such as oatmeal, kidney beans, and apples. • Use monounsaturated oils. • Avoid foods with excess fat. • Fat intake reduced to 35-40g/day.

14. Simvastatin: Lifestyle Modification • Smoking cessation and avoidance of passive smoking • Smoking about doubles the risk for coronary heart disease • Start exercise regimen (vigorous, aerobic, habitual, continuing) • Proper weight management if needed • Weight reduction reduces BP, LDL, HDL, and increases HDL and glucose tolerance • Use waist circumference (> 90 cm) and BMI

15. Simvastatin: Missed A Dose? • Take the missed dose as soon as you remember it.

16. Simvastatin: Future Consultations • Future Consultations • When to come back • Come back for follow-up after 2-4 weeks • When to come earlier • Serious side effects, allergic reactions, etc. • What information will the doctor need for next appointment? • Repeat lipid profile after 6 weeks • Liver function tests prior to treatment, 2-3 months after, and annualy thereafter

17. Simvastatin: Future Consultations • Regular blood pressure monitoring • She is also at risk for hypertension and adverse cardiovascular events • Check for other co-morbid conditions like diabetes mellitus and obesity • Obesity is associated with higher risk for CVD, stroke, and all-cause mortality

18. Simvastatin: Everything Clear? • Whether everything is understood • Repeat the most important information • Whether the patient has any more questions

19. Reference • http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692030.html