Metabolization | Simvastatin

Metabolization

The main area of application for simvastatin (Simvahexal®) is mainly hypercholesterolemia, where elevated cholesterol levels are found in the blood. Hypercholesterolemia can be caused by an unhealthy lifestyle, but also by a family genetic predisposition. Another very important field of application is the prevention of cardiovascular diseases, which can be caused by certain diseases such as diabetes mellitus or high blood pressure even when fat levels are normal.

In patients without risk factors, in whom a change in lifestyle does not result in a reduction in fat values, a target value for total cholesterol of less than 250 mg/dl and LDL of less than 160 mg/dl should be achieved under drug therapy. In patients who do not have coronary heart disease (CHD) but who have risk factors for it, such as high blood pressure, a total cholesterol level below 200 mg/dl and an LDL cholesterol level below 130 mg/dl is desirable. In patients who already have CHD, total cholesterol should be below 180 mg/dl and LDL cholesterol below 100 mg/dl if possible.

Contraindication

Simvastatin (Simvahexal®) should not be given during pregnancy and lactation as there are no studies available that could prove the safety of simvastatin. In addition, pregnant women are not disadvantaged by discontinuing the therapy. Even in case of hypersensitivity to the active substance or to ingredients of the tablets, the substance should not be given.

Unclear increases in liver values or an active disease of the liver are a contraindication for taking the drug, as liver values often increase during therapy with simvastatin. Since simvastatin is metabolised via the enzyme CYP3A4, parallel administration with inhibitors of this enzyme is not recommended. This can lead to an increase in simvastatin in the blood, which is associated with an increased incidence of undesirable side effects.

Side effects

As rare side effects of simvastatin (Simvahexal®), inflammation of the liver, constipation, nausea and vomiting may occur. In addition, headaches, anemia (low hemoglobin, a certain level of red blood cells), skin rashes or itching may occur as side effects of the therapy. In very rare cases, liver failure may also occur.

Dizziness and headaches may also occur. A very dangerous side effect is the occurrence of myopathies. They are associated with muscle pain and muscle weakness and are accompanied in the blood count by an increase in the muscle enzyme creatine kinase (CK).

The muscle disease may also manifest itself as so-called rhabdomyolysis. Rhabdomyolysis is a breakdown of the striated muscles in the body. Early detection of this side effect is therefore particularly important, so that patients must report any newly occurring muscle pain or weakness of the muscles immediately to their treating physician.

For this reason, when new muscle pain occurs under simvastatin therapy, the muscle enzyme creatine kinase (CK) should be determined to detect any muscle damage. The risk of muscle damage increases with increasing the dose. Other HMG-CoA reductase inhibitors can also cause this side effect.