Lipid-Lowering Agent (Statin) Pregnancy: Contraindicated

Simvastatin

Brand names: Zocor

Adult dose

Dose: 10–40 mg

Route: Oral

Frequency: Once daily at night

Max: 40 mg/day (80 mg restricted — MHRA 2012)

Start 10–20 mg at night. MHRA 2012: 80 mg dose restricted to patients already established on it without myopathy — do not start new patients on 80 mg. Take at night (simvastatin has shorter half-life than atorvastatin — hepatic cholesterol synthesis peaks at night).

Paediatric dose

Route:

Seek specialist opinion — not typically used in children; atorvastatin or rosuvastatin preferred

Dose adjustments

Renal

Caution if eGFR <30 — increased risk of myopathy; use lower doses.

Hepatic

Contraindicated in active liver disease.

Clinical pearls

MHRA 2012: 80 mg dose restricted due to myopathy risk — many patients now switched to atorvastatin 40–80 mg for equivalent or better efficacy with less interaction risk
4S trial: simvastatin significantly reduced all-cause mortality in patients with established coronary disease
Fusidic acid interaction is a common clinical pitfall — stop simvastatin for the course

Contraindications

Active liver disease
Pregnancy
Breastfeeding
Concomitant potent CYP3A4 inhibitors (itraconazole, HIV protease inhibitors, fusidic acid, gemfibrozil)

Side effects

Myalgia
Rhabdomyolysis (higher risk at 80 mg)
Elevated CK
Elevated LFTs

Interactions

Amiodarone: max 20 mg simvastatin
Amlodipine/diltiazem: max 20 mg simvastatin
Fusidic acid: severe rhabdomyolysis — suspend simvastatin for duration of fusidic acid course
Ciclosporin: simvastatin contraindicated
Gemfibrozil: contraindicated

Monitoring

LFTs at baseline
CK if symptomatic myalgia
Fasting lipid profile

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2012 (Simvastatin 80mg); 4S Trial (Lancet 1994). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways