What are the side effects of simvastatin for older adults?

In this article:

• Common side effects
• Serious side effects
• When side effects start
• When side effects end
• Interactions
• Safety measures
• Avoiding side effects
• Treating side effects
• Bottom line

In this article

• Common side effects
• Serious side effects
• When side effects start
• When side effects end
• Interactions
• Safety measures
• Avoiding side effects
• Treating side effects
• Bottom line

Simvastatin is a prescription medication that lowers the amount of low-density lipoprotein (LDL) cholesterol in your blood. Cholesterol is a waxy substance that naturally accumulates in your body, but too much LDL cholesterol—the “bad” kind—can build up in your arteries, blocking circulation to your heart and increasing your risk for heart disease.

Per the Centers for Disease Control and Prevention (CDC), about 11% of adults older than 60 have total cholesterol levels above the recommended range. Since the risk of heart disease increases with age, even in otherwise healthy adults, older adults with high cholesterol are at a particularly high risk for heart attack and stroke. Taking a cholesterol medication like simvastatin can help lower your risk for cardiovascular disease, but older adults need to be careful when adding new medications to their routine. Here’s why, plus what you should know about simvastatin side effects in older adults and how to take this medication safely.

Common side effects of simvastatin 

Simvastatin is part of a class of drugs called statins, which are some of the most commonly prescribed medications for lowering cholesterol. For many statins, including simvastatin, muscle pain and weakness are common side effects, occurring in up to 10% of people taking these medications. Simvastatin is more likely to increase muscle and joint pain in people over the age of 65, according to Mary Beth Fisher, DO, a cardiologist at University of Missouri Health Care. Other conditions that may be seen in older adults also increase this risk, like kidney dysfunction. Older adults should use it cautiously, talking to their provider if they notice an increase in muscle or joint pain that doesn’t go away. Simvastatin can also worsen an existing muscle condition called myasthenia gravis, Dr. Fisher adds. Additionally, there is an increased risk of upper respiratory infections, which occurred in nearly 10% of people in clinical trials of simvastatin.

Other common side effects of simvastatin include:

• Memory loss
• Constipation 
• Nausea
• Headache
• Vertigo
• Stomach pain
• Itchy skin

Serious side effects of simvastatin 

Some people experience serious side effects when taking simvastatin, including:

• Jaundice
• Liver problems
• Fever or chills
• Swelling
• Joint pain
• Loss of appetite
• Atrial fibrillation
• Severe muscle damage (rhabdomyolysis)

How soon do simvastatin side effects start?

Some people taking simvastatin may start noticing mild side effects like fatigue and nausea within the first few days, according to Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. Within a few weeks or months of starting the drug, side effects like muscle pain may become more noticeable. 

How long do simvastatin side effects last?

It depends on the symptom. Some go away in a few weeks as your body adjusts to the medication, but others last longer. For example, Dr. Chen says muscle pain often lasts a few days to a few weeks before improving, but dizziness often persists for longer.  

What are the long-term side effects of simvastatin?

While milder simvastatin symptoms usually go away as your body adjusts to the medication, some of the more serious side effects of the drug can be permanent, says Dr. Chen, including muscle damage, myopathy, and liver damage. People taking statins like simvastatin also have a 34% chance of developing Type 2 diabetes, per one study.

Not everyone experiences these more severe side effects, and some people don’t have the same chance of developing them as others, though the risks are higher for older adults.

“Risk factors for these side effects include being of an advanced age (over 80 years old), being female, or having a low body mass index,” says Dr. Chen.

It’s worth noting that most of the serious side effects are considered rare. For example:

• One to two percent of people taking simvastatin experience high levels of alanine aminotransferase (ALT), a blood enzyme associated with liver injury, but this often goes away on its own; serious liver damage has been found to be extremely uncommon.
• Severe muscle damage occurs in 1.5 out of every 100,000 people taking statins; higher doses are more likely to cause it, and people taking certain other medications are also at a higher risk.

Simvastatin interactions

Simvastatin can interact with other medications and things in your diet. The most common interactions include:

• Some antibiotics: Simvastatin can interact with a group of antibiotics called macrolides, like azithromycin or clarithromycin, and some antifungal medications, like fluconazole. These medications may block the metabolism of the statin medication in your blood and increase your risk for side effects.
• Some other cholesterol-lowering medications: Some people need to take multiple medications to lower their cholesterol, but not all are safe to combine. For example, the American College of Cardiology recommends not taking simvastatin with gemfibrozil as it increases the risk of rhabdomyolysis.
• Protease inhibitors: Taking simvastatin with protease inhibitors like atazanavir and ritonavir can increase your risk for muscle damage.
• Alcohol: Drinking alcohol while taking statins may increase your risk for liver problems, but usually this happens when people regularly consume large amounts of alcohol.
• Grapefruit: Grapefruit and grapefruit juice can raise the concentration of simvastatin in your blood, putting you at higher risk for side effects, Dr. Fisher says.  
• Coffee: Some research suggests that drinking coffee can blunt the heart-protecting benefits of statins, but it’s not definitive. If you drink large amounts of coffee daily, be sure to tell your healthcare provider so they can help you assess the risk.

This is not a complete list of interactions. You should always seek medical advice from a healthcare professional before taking simvastatin so they can check for potential interactions with your diet, supplements, and other over-the-counter or prescription medications.

Safety measures while using simvastatin

Simvastatin isn’t right for everyone. Some people need to use caution when taking this drug, and other people shouldn’t use it at all. The U.S. Food and Drug Administration (FDA) requires a black box warning for all statins because of the potential for memory loss and cognitive changes. For simvastatin specifically, the FDA recommends that providers avoid prescribing very high doses of the medication, 80 milligrams, except in certain circumstances because of the high risk of muscle damage.

People with liver disease should avoid statin use, says Dr. Chen, because simvastatin could raise your risk for serious liver injury if you’re already susceptible.

People with Type 2 diabetes should also be aware that their A1C levels could rise slightly, Dr. Fisher says, though the overall benefits of statins in lowering your risk for heart disease usually outweigh the risks.

While there are things to consider when taking simvastatin, it’s not a habit-forming drug and is generally safe for most people. If you think you have taken an excessive amount of simvastatin, contact your local poison control center or your healthcare provider ASAP, or go to the nearest medical center for emergency care. 

How to avoid simvastatin side effects

People take statins like simvastatin for years—even decades—over the course of their lifetimes, says Jack Cappitelli, MD, internist and Chief Medical Officer of Summit Health’s New Jersey Region. You may notice some mild side effects when starting. Here are some best practices for taking simvastatin to help reduce or prevent adverse effects. 

1. 1. Take simvastatin in the evening because most of the body’s cholesterol is made at night, suggests Dr. Fisher. There isn’t a strong connection between simvastatin and drowsiness, she adds, but taking it at night can also offset any potential sleepiness from the drug.
   2. Foods don’t affect the absorption or effectiveness of simvastatin (other than grapefruit products) so you can take your medication with or without food, says Dr. Fisher.
   3. Take your simvastatin at the same time of day, every day, recommends Dr. Cappitelli.
   4. Don’t take statins if you have active liver disease.
   5. Don’t switch to a lower dose or stop taking simvastatin without talking to your provider first. Stopping statins can increase your risk of having a heart attack or stroke.

How to treat side effects of simvastatin

Most side effects of simvastatin, like muscle aches, headaches, stomach pain, and constipation are mild and tend to go away after a few weeks on the medication. You can talk to your provider about treating these side effects with medications, like OTC pain relievers or stool softeners, but make sure your provider knows about your other medications and health history so they can recommend treatments that are safe for you. 

If your side effects persist for more than a few weeks, it’s worth talking to your provider, especially if you continue to have muscle aches or pain, says Dr. Cappitelli. Because of the risk of muscle damage with long-term use of simvastatin, your provider will likely want to know if this side effect persists. 

“In most cases, we consider switching to another drug in that class of medications or stopping altogether if the muscle aches are severe,” says Dr. Cappitelli. There are many other statin medications—such as atorvastatin, pravastatin, lovastatin, or rosuvastatin—that could work for you. 

“Once [the medication is stopped], the symptoms should stop.” If the symptoms don’t stop,  Dr. Cappitelli adds, then your provider will start looking for other potential causes of your muscle pain. 

Bottom line: Is simvastatin safe for older adults?

For most older adults, simvastatin is safe and can reduce the risk of heart disease, especially if their total cholesterol levels are higher than recommended. Some people experience mild side effects like muscle aches, upper respiratory infections, constipation, and headache in the first few weeks after starting simvastatin, but these side effects usually go away over time. Some serious effects, like liver damage and muscle damage, can become permanent, but these are rare. 

That said, simvastatin isn’t right for everyone; people with liver disease should usually avoid taking it, and people with muscle conditions may find that their symptoms worsen on simvastatin. If you’ve started taking simvastatin and your initial side effects haven’t gone away after a few weeks, talk to your healthcare provider.