Simvastatin dosage, forms, and strengths

Simvastatin lowers cholesterol levels. As a prescription statin, simvastatin blocks the liver enzymes that synthesize “bad” LDL cholesterol. At the same time, simvastatin increases “good” HDL cholesterol. Available as a tablet or oral liquid, simvastatin doses are taken by mouth once daily.

Simvastatin forms and strengths

Simvastatin comes in two dosage forms and can be taken as a generic or brand-name tablet (Zocor), or as a brand-name oral suspension called FloLipid. The oral suspension form may be convenient for those with difficulty swallowing.

• Tablet: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg

• Oral suspension (liquid): 20 mg/5 mL, 40 mg/5 mL

Simvastatin dosage for adults

Simvastatin lowers cholesterol and fat levels in the blood. Healthcare providers use it to treat people with high cholesterol (primary hyperlipidemia), high fats (hypertriglyceridemia), or hereditary cholesterol problems (familial hypercholesterolemia or primary dysbetalipoproteinemia). They also use it to reduce the risk of heart attack, stroke, or death in people with normal or slightly elevated cholesterol levels who also have heart problems or similar risk factors.

Simvastatin is not 100% safe for everyone. Doctors will not use it in people with liver failure, serious and progressing liver cirrhosis, or known allergies to simvastatin. Doctors avoid simvastatin in pregnant women. Chinese patients have an increased risk of experiencing some side effects of simvastatin such as muscle pain or muscle damage, so prescribers may monitor these patients more carefully and start with a lower dose. 

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*80 mg dose is not recommended due to increased risk of myopathy (a disease of muscle tissue); this dose is restricted to patients who have been taking simvastatin 80 mg daily chronically (12 months or more) without evidence of muscle toxicity

Simvastatin dosage for high cholesterol

High cholesterol is a silent disease that affects 71 million Americans. Although there are usually no symptoms, the condition can eventually result in blocked arteries, heart disease, heart attack, stroke, and similar outcomes. The first-line treatments for high cholesterol are HMG-CoA reductase inhibitors or “statins.” These drugs block the liver’s ability to synthesize low-density lipoprotein cholesterol (LDL-C) which is responsible for plaque formation and buildup in the body’s arteries. 

In most people, high cholesterol is linked to age and lifestyle. However, some people are born with conditions that produce high cholesterol. Doctors also use simvastatin for those conditions, as well. Simvastatin is also used to treat high triglycerides, even if cholesterol levels are normal or near normal.

Statins like simvastatin and atorvastatin are often the first drugs a clinician will prescribe. Doses are taken once daily by mouth. 

• Standard simvastatin dosage for high cholesterol: 20–40 mg once daily

• Maximum simvastatin dosage for high cholesterol: 40 mg daily

Simvastatin dosage for the prevention of cardiovascular disease

Statins are also used as preventive medications. Some people whose cholesterol levels are normal can benefit from taking statins. These are people at risk of serious cardiovascular events such as heart disease, heart attack (myocardial infarction), and stroke because of existing heart disease, plaque buildup, high blood pressure, and similar conditions. Besides lowering cholesterol levels, statins also help prevent future disease by reducing swelling around atherosclerotic plaques and improving blood vessel health.

Again, atorvastatin and simvastatin may be the first statins tried. Dosages are the same as those used for high cholesterol.

• Standard simvastatin dosage for the prevention of cardiovascular problems: 20–40 mg once daily

• Maximum simvastatin dosage for the prevention of cardiovascular problems: 40 mg daily

Simvastatin dosage for children

Simvastatin is FDA approved to treat children 10 years of age and older with a genetic disorder called heterozygous familial hypercholesterolemia (HeFH). Affecting 1 in 200 children, HeFH causes high cholesterol and puts children at a high risk of developing cardiovascular disease at a young age. Statins are the first-line treatment. Pediatric doses are usually the same as for adults but may start at a lower dose. 

• Standard simvastatin dosage for children 10 years of age and older with heterozygous familial hypercholesterolemia: 10–40 mg once daily

• Maximum simvastatin dosage for children 10 years of age and older with heterozygous familial hypercholesterolemia: 40 mg daily

Simvastatin dosage restrictions

Dosage changes are not required for people with mild to moderate hepatic impairment or kidney disease. Because of the risk of muscle damage, people with severe kidney impairment (creatinine clearance <30 mL/min) will be started at the lowest recommended dosage of 5 mg daily. 

Doctors never prescribe simvastatin to people with liver failure or severe and worsening cirrhosis of the liver.

How to take simvastatin

People prescribed simvastatin can take either tablets or a brand-name liquid version:

• Follow all the prescriber’s instructions when taking simvastatin.

• Do not take more simvastatin than prescribed or take it more often than prescribed. The dose may change during treatment. 

• Take the daily dose in the evening.

• How to take simvastatin tablets:

  • Take simvastatin tablets with or without food.

  • Swallow the tablet whole with a drink of water.

  • Store simvastatin tablets at room temperature.

• How to take simvastatin oral suspension (FloLipid):

  • Take simvastatin oral suspension on an empty stomach.

  • Shake the bottle well for 20 seconds before measuring a dose.

  • Measure doses with the calibrated oral syringe or other medical dosing device provided by the pharmacist. Do not use kitchen measuring devices or tableware to measure doses.

  • Store simvastatin oral suspension at room temperature protected from heat. Do not refrigerate or freeze.

  • Discard any unused medicine 30 days after the bottle has been opened.

Simvastatin dosage FAQs

How long does it take simvastatin to work?

 When consistently taken, it usually takes about four weeks before cholesterol levels are noticeably lower in blood tests.

How long does simvastatin stay in your system?

The half-life of simvastatin and its active version is four to five hours. Clinical studies have shown that simvastatin levels fall to 10% of their peak levels 12 hours after a dose is taken. 

What happens if I miss a dose of simvastatin?

If a dose is missed, take it as soon as it’s remembered. Skip the missed dose if it’s almost time for the next dose. Take the next dose at its regular time. Do not take more than one dose to make up for a missed dose.

How long can you take simvastatin?

Simvastatin is a long-term and potentially lifelong treatment. Most people started on a statin will take statins for months or years as long as they work and don’t cause serious adverse effects. 

How do I stop taking simvastatin?

Do not stop taking simvastatin until talking to a doctor. If you experience severe side effects such as an allergic reaction, muscle pain (myopathy), muscle damage (rhabdomyolysis), or jaundice, immediately contact the prescriber. In those cases, the doctor may tell you to stop taking simvastatin. 

Discontinuing simvastatin will not cause withdrawal symptoms, but cholesterol levels could rise dramatically. To avoid this, a healthcare professional will need to substitute another statin or lipid-lowering treatment such as ezetimibe, fibrates, bile acid sequestrants, niacin, or monoclonal antibody injections (PCSK-9 inhibitors).

What is the maximum dosage for simvastatin?

The maximum dosage of simvastatin is 40 mg daily. 

In exceptional cases, higher doses of up to 80 mg daily are permitted in people already taking doses that high provided they have not yet experienced muscle pain as a side effect.

Can you overdose on simvastatin?

Yes. Taking too much simvastatin increases the risk of myopathy (muscle pain) and rhabdomyolysis (severe muscle damage). Call a poison helpline or get medical help if too much simvastatin is taken, particularly if there’s muscle pain or weakness. No matter how much simvastatin is taken, always get immediate medical help if you experience severe muscle pain.

What interacts with simvastatin?

Do not take any of the following drugs with simvastatin until talking to the doctor:

• Macrolide antibiotics such as clarithromycin or erythromycin

• Oral azole antifungal drugs such as ketoconazole, itraconazole, posaconazole, or voriconazole

• Antiviral drugs called protease inhibitors

• Paxlovid (which contains the HIV protease inhibitor ritonavir)

• HIV/AIDS drugs that contain cobicistat

• Cyclosporine, danazol, gemfibrozil, nefazodone

To avoid other possible drug interactions, make sure the prescriber knows about all the prescription drugs, over-the-counter medications, and supplements being taken, especially:

• Blood thinners called coumarin anticoagulants such as warfarin

• Fibric acid derivatives such as fenofibrate

• The heart medications amiodarone, digoxin, Multaq (dronedarone), or ranolazine

• The blood pressure drugs verapamil, diltiazem, or amlodipine 

• The cholesterol drug Juxtapid (lomitapide)

• The antibiotic daptomycin

• The gout medication colchicine 

• Large doses of niacin

Tell the healthcare provider if you regularly drink grapefruit juice. Your dose may need to be adjusted, or you may need to discontinue it.

What happens when you mix simvastatin and alcohol?

Alcohol does not interact with simvastatin but can increase the risk of liver damage in people taking statins. Tell the doctor if you drink two or more alcoholic drinks daily.

Is it safe to take simvastatin during pregnancy?

It is not safe to take simvastatin during pregnancy. Simvastatin could harm an unborn baby. Immediately tell the prescriber if you get pregnant or think you’re pregnant. The prescriber may need to stop simvastatin therapy.

Is it safe to take simvastatin while breastfeeding?

Breastfeeding is not recommended in women taking simvastatin. Healthcare providers don’t know if it’s present in breast milk in those taking simvastatin, but other statins have shown to pass into breast milk.. Healthcare providers believe it may cause problems in a nursing infant.

What should I tell the doctor?

Tell the doctor about all the drugs you take and all your medical conditions past and present, especially:

• Unexplained muscle pain or similar problems

• Kidney problems

• Liver disease

• Thyroid problems

• Myasthenia gravis

Tell the doctor if you’re pregnant, breastfeeding, older than 65, or of Chinese descent. Tell the doctor if you drink two or more alcoholic drinks daily or regularly drink grapefruit juice.

What are the side effects of simvastatin?

The most common side effects of simvastatin are:

• Upper respiratory tract infections

• Headache

• Stomach pain

• Constipation

• Nausea

One of the most serious side effects of simvastatin is muscle pain and muscle damage (rhabdomyolysis), particularly at higher doses. Immediately talk to the prescriber if you experience unexplained muscle pain or weakness. Simvastatin can also raise blood sugar or cause liver problems.

Sources

• FloLipid simvastatin suspension prescribing information, DailyMed (NIH National Library of Medicine)

• Simvastatin, Statpearls

• Simvastatin tablet prescribing information, DailyMed (NIH National Library of Medicine)

• Zocor drug summary, Prescriber’s Digital Reference (PDR)