Simvastatin alternatives: What can I take instead of simvastatin?

Compare simvastatin alternatives | Crestor | Lipitor | Pravastatin | Zetia | Praluent | Natural alternatives | How to switch meds

Searching for a substitute for simvastatin is not an unusual situation. Despite the fact that the drug can lower the risk of heart attack, it has some unsavory characteristics. Well known is the potential for statin drugs like Zocor (the brand name for simvastatin) to cause muscle side effects like myalgia (muscle pain) and myopathy (weakness). Less common knowledge is the fact that simvastatin has an array of drug interactions. However, According to the American Heart Association, the positive benefits of statins for heart health typically outweigh the potential risk of side effects. Finding an alternative statin or a non-statin option for cholesterol management should not be difficult, but the process of changing medications should be done carefully and under the guidance of your healthcare provider. Knowing what your options are ahead of the conversation with a medical professional can make your appointment time much better spent. With that in mind, let’s get right to it.

What can I take in place of simvastatin?

Although not quite to the degree of uniqueness of snowflakes, no two statins are exactly alike. Just because simvastatin is failing you due to adverse effects, drug interactions, or disappointing effectiveness does not mean that another statin will not work out. 

Within the drug class, there is substantial variability in potency and metabolism. The robust evidence from clinical trials supporting statin use often warrants trying multiple class members before giving up. If you do move on from simvastatin and all statins, you could consider cholesterol absorption blockers, fibrates, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors as non-statin alternatives.

Other alternatives to simvastatin

• Lovaza (omega-3-acid esters)
• Vascepa (icosapent ethyl)
• Nexletol (bempedoic acid)
• Juxtapid (lomitapide)
• Niaspan (niacin ER)

Top 5 simvastatin alternatives

The following are some of the most common alternatives to simvastatin.

1. Crestor

If simvastatin is letting you down by not getting your cholesterol levels down low enough, Crestor could come to your rescue. As the most potent statin, in terms of bad cholesterol (low density lipoprotein or LDL) reduction, Crestor can do more for your numbers than simvastatin. Triglycerides are another detrimental form of cholesterol lowered by Crestor more than simvastatin. Fibrates like Tricor and Lopid have a more profound effect on triglycerides than either statin, but they accomplish less LDL lowering, a fact that limits their use. 

Crestor is also available as a generic drug, rosuvastatin, and it avoids many of the drug interactions that can plague simvastatin. Not all the news is good, however; the higher potency of Crestor could translate to a high risk of side effects. . Besides myalgias, the potential statin side effects can involve a change in bowel habits (such as constipation), elevated liver enzymes, elevated muscle enzymes, elevated glucose (blood sugar), and cognitive impairment (difficulty learning, remembering, or concentrating).

RELATED: Crestor side effects and how to avoid them

2. Lipitor

Power is not a problem for Lipitor either. Lipitor and its generic form, atorvastatin, are another example of statins that outperforms simvastatin in regards to LDL reduction, at the expense of potentially more adverse effects. Drug interactions are still a concern with Lipitor, albeit somewhat less than simvastatin. Another pharmacological advantage of Lipitor and Crestor are their long half-lives. This means you can take them any time of day you like, unlike simvastatin which should be taken at bedtime. In some cases, Lipitor and Crestor are even dosed every other day. Convenience and cholesterol-reducing power could be an appealing combo.

RELATED: 13 things you might not know about Lipitor 

3. Pravastatin

On the other hand, sacrificing potency is not always a bad thing when it comes to choosing between statin medications. Pravastatin will not lower LDL cholesterol as much as simvastatin, Crestor, or Lipitor, but it may help you avoid uncomfortable muscle symptoms. Based on the muscle risk, simvastatins’s maximum dose has been limited by the Food and Drug Administration (FDA) since 2011 to 40 mg per day in most instances, rather than its original 80 mg maximal dosing. If muscle pain is motivating you to look for an alternative to simvastatin, then pravastatin could be a good option to consider. 

Fans of grapefruit and grapefruit juice may be better off with pravastatin too. Simvastatin interacts with grapefruit, elevating the risk of side effects.

RELATED: Pravastatin vs. Lipitor: Differences, similarities, and which is better for you

4. Zetia

In some cases, perhaps your own, no statin therapy will work out. The cholesterol absorption inhibitor Zetia is one of most common statin alternatives and is often a next option. Instead of inhibiting the HMG-CoA reductase enzyme to lower LDL cholesterol like statins, Zetia and its generic version ezetimibe lower cholesterol by blocking the absorption of cholesterol in the intestine. By avoiding the statin mechanism, you may be able to avoid statin side effects. Unfortunately, you may not gain as much benefit either, since cholesterol reduction is commonly less with Zetia than most statins. 

Inhibiting cholesterol absorption with a bile acid sequestrant such as Welchol or Questran achieves small LDL reductions in a similar fashion. The LDL lowering that is achieved with cholesterol absorption blockers can be additive with a statin. In other words, some individuals take both Zetia and a statin like simvastatin to get their cholesterol numbers to goal.

RELATED: Lower your cholesterol with these 7 steps

5. Praluent

PCSK9 inhibitors, such as Praluent, can also be added to statins to gain additional benefit in cases of particularly high cholesterol. In other cases, when statins are ineffective or intolerable, PCSK9 inhibitors can be called upon to bring LDL numbers down on their own. They require an injection and commonly carry a hefty price tag, but their effectiveness may be alluring for those with coronary heart disease or atherosclerosis elsewhere in the body. If the price is daunting, try showing your SingleCare discount card at your local pharmacy to see if the expense is more manageable.

RELATED: Why you should monitor your cholesterol

Natural alternatives to simvastatin

Leaving no stone unturned in pursuit of finding the best alternative to simvastatin might bring you to consider natural options. The impact of a healthy diet and exercise should not be underestimated. Augmenting these lifestyle changes with dietary supplements is common. Berberine, niacin, and red yeast rice have some proven merit for LDL reduction. In fact, red yeast rice has a similar mechanism to statins. Alternatively, omega-3 fatty acids can lower high triglyceride levels and raise good HDL cholesterol (high density lipoprotein) levels. 

The label of being “natural” may make it seem that these supplements are harmless, but they each have their potential adverse effects. The scope of their side effects or drug interactions may not be fully known due to limited testing. Lean on your healthcare provider for medical advice when contemplating natural alternatives to discuss potential risk factors.

How to switch to a simvastatin alternative

Now that you have expanded your knowledge of simvastatin alternatives, getting an appointment with the prescribing healthcare professional is a good next step toward making a decision. The discussion should cover your concerns about simvastatin, review other options, and reference your list of over-the-counter drugs and prescription medicines to ensure no drug interactions exist. The final decision should be one that you both agree will help to improve your cholesterol numbers and overall health for years to come.