SIMVADOR 20 MG TABLETS, SIMVASTATIN 20 MG TABLETS - patient leaflet, side effects, dosage

1. what simvastatin is and what it is used for

Simvastatin contains the active substance simvastatin. Simvastatin is a medicine used to lower levels of total cholesterol, “bad” cholesterol (LDL cholesterol), and fatty substances called triglycerides in your blood. In addition, Simvastatin raises levels of “good” cholesterol (HDL cholesterol). While taking this medicine you should stick to a cholesterol-lowering diet. This medicine belongs to the class of drugs called statins.

Cholesterol is one of several fatty substances found in the bloodstream. Your total cholesterol is made up mainly of LDL and HDL cholesterol.

LDL cholesterol is often called “bad” cholesterol because it can build up in the walls of your arteries forming plaque. Eventually this plaque build-up can lead to a narrowing of the arteries. This narrowing can slow or block blood flow to vital organs such as the heart and brain. This blocking of blood flow can result in a heart attack or stroke.

HDL cholesterol is often called “good” cholesterol because it helps keep the bad cholesterol from building up in the arteries and protects against heart disease.

Triglycerides are another form of fat in your blood that may increase your risk for heart disease.

You should stay on a cholesterol-lowering diet while taking this medicine.

Simvastatin is used along with dieting if you have:

• A raised cholesterol level in your blood (primary hypercholeste­rolaemia) or elevated fat levels in your blood (mixed hyperlipidaemia)
• A hereditary illness called homozygous familial hypercholeste­rolaemia which increases the cholesterol levels in your blood. You may also receive other treatments
• Coronary heart disease (CDH) or are at high risk of suffering from CDH. You are more likely to suffer from CDH if you have diabetes, have previously had a stroke, or have other blood vessel disease). Simvastatin may prolong your life by reducing the risk of heart disease problems, regardless of the amount of cholesterol in your blood.

In most people there are no immediate symptoms of high cholesterol. Your doctor or pharmacist can measure your cholesterol level by means of a simple blood test.

Visit your doctor regularly, keep track of your cholesterol, and discuss your goals with your doctor.

2. what you need to know before you take simvastatin

Do not take Simvastatin if you:

• are allergic (hypersensitive) to simvastatin, or to any of the other ingredients (see section 6: Contents of the pack and other information)
• currently have liver problems
• are pregnant or breastfeeding
• if you are taking one or more than one of the following drugs at the same time:

o itraconazole, ketoconazole, posaconazole or voriconazole (medicines for fungal infections)

o erythromycin, clarithromycin or telithromycin (used to treat for infections),

o HIV protease inhibitors such as indinavir, nelfinavir, ritonavir and saquinavir (HIV protease inhibitors are used for HIV infections)

o boceprevir or telaprevir (medicines for Hepatitis C virus infection)

o nefazodone (a medicine used to treat depression)

o cobicistat

o gemfibrozil ((used to lower cholesterol)

o ciclosporin (used in organ transplant patients)

o danazol (a man-made hormone used to treat endometriosis, a condition in which the lining of the uterus grows outside the uterus)

• if you are taking or have taken, in the last 7 days, a medicine called fusidic acid (a medicine used to treat bacterial infections) orally or by injection. The combination of fusidic acid and Simvastatin can lead to serious muscle problems.

Do not take more than 40 mg Simvastatin if you are taking lomitapide (used to treat a serious and rare genetic cholesterol condition).

Ask your doctor if you are not sure if your medicine is listed above.

Warnings and precautions

Talkto your doctor or pharmacist before taking Simvastatin ifyou:

• Have any medical conditions including allergies
• Regularly drink large amounts of alcohol
• Have ever had liver disease. Simvastatin may not be right for you.
• are due to have an operation -. You may need to stop taking Simvastatin for a short time
• Have severe lung disease
• if you are Asian, because a different dose may be applicable to you.

Blood tests

Before your start taking simvastatin and if you have any symptoms of liver problems while you take simvastatin your doctor should do a blood test.

Your doctor may also want you to have blood tests to check how well your liver is working after you start taking Simvastatin.

While you are on this medicine your doctor will monitor you closely if you have diabetes or are at risk of developing diabetes. You are likely to be at risk of developing diabetes if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure.

Important – Keep healthcare professionals informed

Contact your doctor immediately if you experience unexplained muscle pain, tenderness or weakness. This is because on rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage and in very rare cases deaths have occurred.

You will be more at risk of muscle breakdown if you are on higher doses of simvastatin particularly the 80 mg dose. The risk of muscle breakdown is also greater in certain patients. Talk to your doctor if any of the following apply:

• you drink large amounts of alcohol
• you have kidney problems
• you have thyroid problems
• you are 65 years or older
• you are female
• you have ever had muscle problems during treatment with cholesterol-lowering medicines “statins” or fibrates
• you or a close family member have hereditary muscle problems.

Also tell your doctor or pharmacist if you have a muscle weakness that is constant. Additional tests and medicines may be needed to diagnose and treat this.

Children

Safety and effectiveness of Simvastatin have been studied in 10–17 year-old boys and in girls who had started their menstrual period (menstruation) at least one year before (see section 3: How to take Simvastatin). Simvastatin has not been studied in children under the age of 10 years. For more information, talk to your doctor.

Other medicines and Simvastatin

Tell your doctor if you are taking, have recently taken or might take any other medicine(s) with any of the following active ingredients. Taking Simvastatin with any of the following medicines can increase the risk of muscle problems (some of these have already been listed in the above section “Do not take Simvastatin”).

• If you need to take oral fusidic acid to treat a bacterial infection you will need to temporarily stop using this medicine. Your doctor will tell you when it is safe to restart Simvastatin. Taking Simvastatin with fusidic acid may rarely lead to muscle weakness, tenderness or pain (rhabdomyolysis). See more information regarding rhabdomyolysis in section 4.
• ciclosporin – (a medicine often used in organ transplant patients)
• danazol (a man-made hormone used to treat endometriosis, a condition in which the lining of the uterus grows outside the uterus)
• medicines with an active ingredient like ketoconazole, itraconazole, fluconazole, posaconazole or voriconazole (medicines for fungal infections)
• Fibrates with an active ingredient like gemfibrozil or bezafibrate (medicines to lower cholesterol)
• erythromycin, clarithromycin, telithromycin (medicines for bacterial infections).
• HIV protease inhibitors such as indinavir, nelfinavir, ritonavir, and saquinavir (medicines for AIDS)
• Hepatitis C antiviral agents such as boceprevir, telaprevir, elbasvir or grazoprevir (medicines for hepatitis C virus infection)
• nefazodone (a medicine for depression)
• medicines with the active ingredient cobicistat
• amiodarone (used to treat an irregular heartbeat),
• verapamil, diltiazem or amlodipine (which are used to treat high blood pressure, chest pain associated with heart disease, or other heart conditions).
• lomitapide (used to treat a serious and rare genetic cholesterol condition)
• daptomycin (a drug used to treat complicated skin and skin structure infections and bacteraemia). It is possible that side effects affecting the muscles may be higher when this medicine is taken during treatment with simvastatin (Simvastatin). Your doctor may decide that you stop taking Simvastatin for a while
• colchicine (a medicine used to treat gout).

As well as the medicines listed above, tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including those obtained without a prescription. In particular, tell your doctor if you are taking medicine(s) with any of the following active ingredients:

• Medicines with an active ingredient to prevent blood clots, such as warfarin, phenprocoumon or acenocoumarol (anticoagulants)
• Fenofibrate (another medicine for lowering cholesterol)
• Niacin (another medicine for lowering cholesterol)
• rifampicin (a medicine used to treat tuberculosis)

You should also tell any doctor who is prescribing a new medicine for you that you are taking Simvastatin.

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Simvastatin with food and drink

Grapefruit juice

contains one or more components that alter how the body uses some medicinal products, including simvastatin. You should not drink grapefruit juice if you are taking Simvastatin.

Pregnancy and breast-feeding

DO NOT take Simvastatin if you are pregnant, think you may be pregnant or are trying to get pregnant or if you get pregnant while taking Simvastatin. STOP taking the medicine and contact your doctor immediately.

Do not take Simvastatin if you are breastfeeding because it is not known if simvastatin passes into the breast milk.

Ask your doctor or pharmacist for advice before taking any medicine. SimvastatinSim­vastatinSimvas­tatin

Driving and using machines

Simvastatin is not expected to interfere with your ability ability to drive or use machines. However, simvastatin can cause dizziness in some people. So make sure you are not affected before you drive or use machines.

Simvastatin contains lactose

Simvastatin tablets contain a sugar called lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. how to take simvastatin

Your doctor will determine the appropriate tablet strength for you, depending on your condition, your current treatment and your personal risk status.

Always take Simvastatin exactly as your doctor has told you. If you are not sure, check with your doctor or pharmacist.

You should stay on a cholesterol-lowering diet while taking Simvastatin.

Dosage:

The recommended dose is simvastatin 5 mg, 10 mg, 20 mg, 40 mg, or 80 mg by mouth once a day

Adults:

The usual starting dose is 10, 20 or, in some cases, 40 mg a day. Your doctor may adjust your dose after at least 4 weeks to a maximum of 80 mg a day. Do not take more than 80 mg a day.

Your doctor may prescribe lower doses, particularly if you are taking certain medicinal products listed above or have certain kidney conditions.

The 80 mg dose is only recommended for adult patients with very high cholesterol levels and at high risk of heart disease problems who have not reached their cholesterol goal on lower doses.

Children and adolescents

For children (10–17 years old), the recommended usual starting dose is 10 mg a day in the evening. The maximum recommended dose is 40 mg a day.

Method of administration:

Take Simvastatin in the evening. You can take it with or without food. Keep taking Simvastatin unless your doctor tells you to stop.

Taking other cholesterol-lowering medicines at the same time as Simvastatin

Your doctor may ask you to take a medicine called colestyramine whilst you are taking simvastatin. This medicine can interfere with the way in which Simvastatin works. You must take Simvastatin 2 hours before or 4 hours after you have taken colestyramine.

If you take more Simvastatin than you should please contact your doctor or pharmacist.

Take the medicine pack with you.

If you forget to take Simvastatin do not take a double dose to make up for a forgotten tablet. Just take your normal amount of Simvastatin at the usual time the next day.

If you stop taking Simvastatin talk to your doctor or pharmacist because your cholesterol may rise again.

4. possible side effects

Like all medicines Simvastatin can cause side effects, although not everybody gets them. Simvastatin

The following terms are used to describe how often side effects have been reported:

• Rare (may affect up to 1 of 1000 people).
• Very rare (may affect up to 1 of 10,000 people).
• Not known (frequency cannot be estimated from the available data).

If any of the below mentioned serious side effects happen, stop taking the medicine and tell your doctor immediately or go to the emergency room at your nearest hospital.

The following rare serious side effects were reported:

• muscle pain, tenderness, weakness, or cramps. On rare occasions, these muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare deaths have occurred.
• hypersensitivity (allergic) reactions including: swelling of the face, tongue and throat which may cause difficulty in breathing (angioedema), severe muscle pain usually in the shoulders and hips, rash with weakness of limbs and neck muscles,
• pain or inflammation of the joints (polymyalgia rheumatica),
• inflammation of the blood vessels (vasculitis), unusual bruising, skin eruptions and swelling (dermatomyositis), hives, skin sensitivity to the sun, fever, flushing, shortness of breath (dyspnoea) and feeling unwell, lupus-like disease picture (including rash, joint disorders, and effects on blood cells), inflammation of the liver with the following symptoms: yellowing of the skin and eyes, itching, dark-coloured urine or pale-coloured stool, feeling tired or weak, loss of appetite; liver failure (very rare), inflammation of the pancreas often with severe abdominal pain.
• The following very rare serious side effects were reported: a serious allergic reaction which causes difficulty in breathing or dizziness (anaphylaxis), rash that may occur on the skin or sores in the mouth (lichenoid drug eruptions), muscle rupture, gynecomastia (breast enlargement in men). The following side effects have also been reported rarely: low red blood cell count (anaemia), numbness or weakness of the arms and legs,
• headache, tingling sensation, dizziness, blurred vision; impaired vision, digestive disturbances (abdominal pain, constipation, flatulence, indigestion, diarrhoea, nausea, vomiting), rash, itching, hair loss, weakness, trouble sleeping (very rare), poor memory (very rare), memory loss, confusion.
• The following side effects have also been reported but the frequency cannot be estimated from the available information (frequency not known): erectile dysfunction, depression, inflammation of the lungs causing breathing problems including persistent cough and/or shortness of breath or fever, tendon problems, sometimes complicated by rupture of the tendon.
• Additional possible side effects reported with some statins: sleep disturbances, including nightmares, sexual difficulties, diabetes. This is more likely if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure. Your doctor will monitor you while you are taking this medicine. muscle pain, tenderness, or weakness that is constant that may not go away after stopping Simvastatin (frequency not known).

Laboratory alues

Elevation in some laboratory blood tests of liver function and a muscle enzyme (creatine kinase) have been observed.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

You can also report side effects directly via the Yellow Card Scheme Website: or search for MHRA Yellow Card in the Google Play orApple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5. how to store simvastatin

Keep this medicine out of the sight and reach of children.

Do not store them above 25°C.

Do not use these tablets after the expiry date which is stated on the pack.

The expiry date refers to the last day of that month.

Disposal

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. contents of the pack and other informationthe active substance is simvastatin.

The other ingredients are:

Lactose monohydrate, cellulose microcrystalline (E460), starch pregelatinised, citric acid

monohydrate (E330), ascorbic acid (E300), butylhydroxyanisole (E320), isopropyl alcohol and magnesium stearate (E572), hydroxypropyl­cellulose(E463), hydroxypropyl­methylcellulo­se (E464), titanium dioxide (E171), talc (E553b).

In addition Simvastatin 10mg, 20mg, 40mg, 80mg Tablets contain iron oxide red (E172), Simvastatin10mg, 20mg, 80mg Tablets contain iron oxide yellow (E172) and Simvastatin 20mg, 40mg, 80mg Tablets contain iron oxide black (E172).

What Simvastatin Tablets look like and the contents of the pack

Simvastatin Tablets are available in four strengths.

• – The peach coloured, oval-shaped, biconvex, film-coated tablets marked “10” on one side and breakline on the other side contain 10 mg simvastatin.

• – The tan coloured, oval-shaped, biconvex, film-coated tablets marked “20” on one side and breakline on the other side contain 20mg simvastatin.

• – The brick-red coloured, oval-shaped, biconvex, film-coated tablets marked “40” on one side and breakline on the other side contain 40mg ismvastatin.

• – The brick-red coloured, capsule-shaped, biconvex, film-coated tablets marked “80” on one side and breakline on the other side contain 80mg simvastatin.

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