Simvastatin and Niacin (Oral)

Simvastatin and niacin is used in patients to help lower the levels of cholesterol and triglyceride in the blood.

Overview

Simvastatin and niacin is a drug combination that is used in conjunction with a healthy diet as prescribed by the doctor. When used in conjunction with a healthy diet and exercise, this medication will work to help remove cholesterol and triglyceride fats from the blood stream.

If left untreated, the high levels of cholesterol and triglyceride in the blood can lead to a blocking of arteries and blood vessels, eventually leading to heart attacks and strokes.

Simvastatin and niacin work in combinations for the treatment of cholesterol and lipid fat disorders too.

Niacin is a vitamin (B3), which works to effectively lower the amount of cholesterol in the blood stream.

Simvastatin is a member of the group of medicines known as HMG-CoA inhibitors or statins. Simvastatin inhibits an enzyme in the body that is needed for the production of cholesterol, preventing the body from producing it and thus reducing the amount in the blood.

This medication is only available with a doctor's prescription and is available in the form of extended-release tablets as Simcor tablets.

This treatment is not a cure for high cholesterol levels or high levels of triglyceride and lipid fats in the blood. Instead, it is a treatment that helps to temporarily lower these levels to assist the patient in getting these under control. The patient will be issued with a diet plan and exercise plan by the doctor and they should follow this closely to ensure that they are able to lower their cholesterol and fat levels naturally so that they can cease the use of this medication.

This medication is not suitable for use in pregnant women nor in women who may get pregnant during use. Fetal development has been demonstrated to be affected in pregnant women and the risks of use outweigh the potential benefits of use. Breastfeeding mothers should not use this treatment either, as nursing infants have been shown to be affected by the treatment.

Condition treated

  • High cholesterol
  • High triglyceride fat levels
  • High lipid fat levels

Type of medicine

  • Simvastatin - HMG-CoA inhibitor
  • Niacin - Vitamin

Side Effects

In addition to the wanted effect of helping the patient to temporarily lower cholesterol and fat levels in the blood, this medication combination can also have unwanted effects on the body. While not all of these side effects may occur in the patient if some occur then they may require the patient to seek medical attention.

Patients using this medication should check with their doctor immediately if they experience any of the following side effects:

Frequency of incidence not known:

  • Black stools with a tar-like appearance
  • Chills when warm
  • Darkened coloration of urine
  • Dizziness or unsteadiness
  • Feverishness
  • Headaches
  • Lightened coloration of stools
  • Loss of hunger
  • Muscle cramping
  • Muscle spasms
  • Nausea
  • Rash with or without lesions
  • Severe pains of the abdomen or stomach
  • Stiffness or pain in the muscles
  • Tenderness of the muscles or feelings of undue weakness
  • Unpleasant and unusual breath odor
  • Unusual tiredness
  • Unusual weakness
  • Vomiting
  • Vomiting of bloody material
  • Yellow eyes
  • Yellow skin

Other side effects can occur that would not necessitate that you visit a doctor. These side effects may abate over time as your body gets used to the treatment. If, however, they are ongoing or bothersome then you should inform your doctor at your next checkup and they may be able to help you to alleviate the discomfort that you are experiencing. The following side effects would not usually necessitate visiting your doctor:

Occurring commonly:

  • Feeling of warmth on the skin
  • Redness of the face
  • Redness of the neck
  • Redness of the arms
  • Redness of the upper chest

Occurring less commonly:

  • Back or side pain
  • Diarrhea
  • Itchiness of the skin

Other side effects that have not been listed herein may occur. In cases where other side effects do occur, you should contact your doctor. If you are concerned about your immediate wellbeing, however, then you should contact the emergency services and inform them of the medication you have taken.

Dosage

This medication should only be taken as your doctor has directed you. You should not use more of it than prescribed and should not use it more frequently than ordered. Do not continue use for a longer period than prescribed by your doctor.

In addition to this prescribing this medication combination, your doctor will also provide you with a diet plan that is low in sugars, fats and cholesterols. It is essential that you follow this plan in order to lower your cholesterol and fat levels and reduce the risks of heart attack and stroke. Failing to do so will prevent this treatment from working effectively and will prevent you from being able to stop taking it in the future. Your doctor will also prescribe regular exercise to help you lower the high levels,

The extended-release tablet should not be crushed or broken in any way. It should be swallowed whole. This will allow the tablet to release the medication gradually as intended.

You should never change the dose of this medication that you are taking without consulting the doctor. Taking too great an amount of Simvastatin will put you at risk of serious muscular problems occurring.

This medication should ideally be before you go to bed with a low-fat meal or snack.

This medication should be used with caution if you are also taking any of the following medications:

  • Amiodarone (Cordarone®)
  • Amlodipine (Norvasc®)
  • Ranolazine (Ranexa®)

When used in conjunction with one another there is an increased risk of muscle injury, leading to failure of the kidneys.

If you are also using the following treatments then you need to ensure that there is a 4-6 hour gap between the use of the medications:

  • Cholestyramine (Questran®)
  • Colestipol (Colestid®)

Patients should be sure not to drink large quantities of grapefruit juice when using this medication. Doing so can increase the level of Simvastatin in the body and can put the patient at risk.

The following dosing information is a guideline only. Your doctor will prescribe you a set dose depending on your weight, condition and other factors. Do not change the dose you have been prescribed unless directed to do so by your doctor.

For treatment of high cholesterol levels:

In patients not receiving Simvastatin or Niacin therapies:

  • Adults - One tablet daily taken in the evening with a low-fat meal or snack. The dose may be adjusted up to 2000mg of niacin and 40mg of simvastatin.
  • Children - Use and dose to be determined by the prescribing doctor.

In patients receiving Niacin therapy:

  • Adults - One tablet is taken daily in the evening with a low-fat meal or snack. The dose may be adjusted up to a total of 2000mg of niacin and 40mg of simvastatin.
  • Children - Use and dose to be determined by the prescribing doctor.

In patients receiving Simvastatin therapy:

  • Adults - One tablet is taken daily in the evening with a low-fat meal or snack. The dose may be adjusted up to a total of 2000mg of niacin and 40mg of simvastatin.
  • Children - Use and dose to be determined by the prescribing doctor.

If you miss a dose you should take it as soon as possible. If, however, it is nearly time for your next dose then you should skip the dose and return to your normal dosing schedule. If you are taking other medications that need to be taken with a certain time gap from the Simvastatin and Niacin combination then you should never take tablets within a shorter time period. Do not ever take a double dose of this medication.

Interactions

The use of this medication may interact with the use of other medications that you may have been prescribed or may be taking for another reason. You should inform your doctor of all medications that you are taking whether they are herbal remedies, over the counter medications or other prescribed medications. This is particularly important if you take any of the following medications:

The following medications are not recommended for use in addition to the combination of simvastatin and niacin. Your doctor may wish to change one or more of the medications you have been prescribed.

  • Voriconazole
  • Tipranavir
  • Telithromycin
  • Telaprevir
  • Saquinavir
  • Ritonavir
  • Posaconazole
  • Paritaprevir
  • Nelfinavir
  • Nefazodone
  • Mifepristone
  • Mibefradil
  • Lopinavir
  • Ketoconazole
  • Itraconazole
  • Indinavir
  • Idelalisib
  • Gemfibrozil
  • Fosamprenavir
  • Erythromycin
  • Darunavir
  • Danazol
  • Cyclosporine
  • Cobicistat
  • Clarithromycin
  • Boceprevir
  • Atazanavir
  • Amprenavir

The use of the following medications in conjunction with the combination of Simvastatin and niacin would not normally be recommended. If both are required then your doctor may wish to change the dose or frequency of one or the other.

  • Warfarin
  • Verapamil
  • Tadalafil
  • Simvastatin
  • Simeprevir
  • Rosuvastatin
  • Risperidone
  • Ranolazine
  • Quinupristin
  • Pitavastatin
  • Pazopanib
  • Niacin
  • Lumacaftor
  • Lovastatin
  • Lomitapide
  • Fusidic Acid
  • Fluconazole
  • Fenofibric Acid
  • Fenofibrate
  • Eslicarbazepine Acetate
  • Eltrombopag
  • Diltiazem
  • Delavirdine
  • Daptomycin
  • Dalfopristin
  • Conivaptan
  • Colchicine
  • Clofibrate
  • Ciprofloxacin
  • Ciprofibrate
  • Cerivastatin
  • Ceritinib
  • Carbamazepine
  • Bezafibrate
  • Azithromycin
  • Atorvastatin
  • Amlodipine
  • Amiodarone
  • Acenocoumarol

The use of the following treatments in conjunction with simvastatin and niacin can increase the patient's risk of the occurrence and severity of certain side effects. If both medications are still required then your doctor may wish to amend the frequency of use or dose of one or more of the medications.

  • Warfarin
  • Ticagrelor
  • St John's Wort
  • Rifampin
  • Phenytoin
  • Pectin
  • Oxcarbazepine
  • Oat Bran
  • Levothyroxine
  • Interferon Beta
  • Fosphenytoin
  • Efavirenz
  • Dronedarone
  • Digoxin
  • Dasatinib
  • Clopidogrel
  • Bosentan
  • Alitretinoin
  • Albiglutide

Interactions can also occur with other medications not listed herein. You should inform your doctor of all medications you are taking, even when they are not listed.

Medications can also interact with foods, drinks, alcohol and tobacco. In the case of simvastatin and niacin, patients should avoid the consumption of the following substances as they can interact with the medication:

  • Cranberry juice
  • Grapefruit juice
  • Alcohol (Ethanol)

Other medical conditions from which you suffer can also impact the use of a medication. You should tell your doctor about all medical problems from which you suffer and this is particularly important in the following cases:

The following conditions may cause side effects to worsen:

  • History of alcohol abuse
  • Chinese ancestry
  • Hypothyroidism
  • Severe kidney disease
  • Liver disease

This medication should not be used in patients suffering from the following:

  • Arterial bleeding
  • Active liver disease
  • Elevated liver enzymes
  • Active peptic ulcer disease

Patients suffering from the following conditions can be at risk of muscle and kidney problems developing:

  • Dehydration
  • Severe electrolyte disorders
  • Severe endocrine disorders
  • Epilepsy
  • Hypotension
  • Recent major surgery trauma
  • Severe metabolic disorders
  • Sepsis

Increased blood sugar levels may impact the following condition:

  • Diabetes
  • This condition may be worsened by the use of this treatment:
  • Gout

Other medical conditions not listed herein may also affect the use of this treatment combination. Ensure that you inform your doctor of all medical conditions from which you suffer.

Warnings

Before using this medication should consider the risk of doing so in relation the benefits that you will gain from using the treatment. This consideration should be made with your doctor and you should take the following factors into account:

Allergies - You should inform your doctor of any and all allergies from which you suffer or have suffered in the past. This is especially important if you have ever reacted unusually to any medications previously.

Pediatric - Safety and efficiency of use in children has not been established. Discuss use with your doctor.

Geriatric - No limiting factors have been demonstrated to date in the use of this treatment on the elderly. Be cautious of other conditions of the muscles, liver, kidney and heart that may affect the suitability of this medicine for use.

Pregnancy - This treatment should never be used in pregnant women or in women who are likely to or may become pregnant during use. There is a demonstrable impact on fetal development, which will always outweigh the benefits of use. Women using this treatment should use effective contraception at all times. If you believe you have become pregnant during use then you should inform your doctor immediately.

Breastfeeding - Harmful effects have been demonstrated in infants nursing from mothers when using this treatment. Babies should not be breastfed by a mother who is using this treatment. An alternative medication should be prescribed to breastfeeding mothers.

Your doctor will need to carry out regular check-ups on you while you are using this treatment. They will need to check for the occurrence of unwanted side effects and will need to carry out blood checks to test levels of cholesterol in the body.

Inform your doctor immediately if you develop unexplained muscle pain during use. This can be a sign of myopathy or immune-mediated necrotizing myopathy (IMNM), which are very serious conditions that can be caused by high doses of simvastatin.

Symptoms of kidney problems should be reported to a doctor immediately. The symptoms to look out for include:

  • Darkened urine
  • Diarrhea
  • Fever
  • Muscle cramping
  • Muscle spasming
  • Unusual tiredness
  • Unusual weakness

Patients with Chinese heritage will be at an increased risk of muscle injury from use of this treatment. You should inform your doctor of your Chinese heritage before beginning treatment.

Any doctor or dentist that is treating you should be informed that you are using this medication. You will need to stop use several days before receiving any surgery or medical tests as these may be affected by use.

Symptoms of liver damage should be reported to a doctor immediately. The symptoms to look out for include:

  • Upper stomach pain
  • Paleness of stools
  • Darkened urine
  • Loss of hunger
  • Nausea
  • Unusual tiredness
  • Unusual weakness
  • Yellow eyes
  •  Yellow skin

This medication may affect your blood sugar levels. This can impact you if you are diabetic. Ensure that you inform your doctor if you notice a change in levels.

This medication can make you dizzy or less alert. Remember that it is your responsibility at all times to ensure that you are safe to drive or operate any machinery that could cause injury to you or others around you.

This medication should not be taken in addition to vitamin supplements that contain niacin.

This medication should not be taken with alcohol. Avoid consuming alcohol with the use of this medication.

This medication can cause flushing which is a reddening of the skin and body. To avoid flushing you should avoid hot drinks, spicy foods and alcohol at the times you are taking this medication.

This medication should not be taken alongside any other treatments without first discussing these with your doctor.

Storage

This medication should be stored in it's original sealed container. Store at room temperature away from light, moisture and heat.

Medications should be keep out of the reach of children at all times.

Outdated or unwanted medication should be disposed of properly and safely as directed to by your doctor or healthcare professional.

Summary

Simvastatin and niacin is used for the treatment of high levels of cholesterol, triglyceride fats or lipid fats in the blood. The combination medication used vitamin B3 (niacin) and an enzyme inhibitor (simvastatin) to lower the levels of these unwanted substances in the blood.

This medication will always be prescribed in addition to a healthy diet and exercise and is intended only as an aid in lowering the levels while the patient makes healthy life changes in order to lower these levels naturally. It is vitally important that you follow the diet plan and exercise plan as set out by your doctor in order to lower your risk of exposure to serious health conditions.

High levels of cholesterol, triglyceride fats and lipid fats in the blood will all have the effect of clogging the arteries and blood vessels, increasing the blood pressure and ultimately causing a heart attack or stroke in the patient. The use of simvastatin and niacin is a temporary solution that enables the patient to have the risk reduced over a short term, but it is not a cure for the condition.

The use of simvastatin and niacin exposes the patient to serious potential side effects including kidney damage, liver damage and muscle damage. These side effects can occur, but will not always occur in the patient.

The use of this treatment should be ceased when the patient is able to control their levels through diet and exercise, but not before. Stopping treatment without having fixed the underlying problem will rapidly expose the patient to dangerous levels once again.

This medication has been demonstrated to be harmful to fetal development and to breastfeeding infants. This medication should not be prescribed to pregnant women, women who may get pregnant during treatment, nor to women who are nursing an infant. The risks of doing so greatly outweigh the benefits of the treatment and should not be done in any circumstances. Alternative medications can be prescribed to these patients.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
Content Source: