Simvastatin
Sources
Simvastatin (Zocor)
Clinical Summary
Simvastatin is an HMG-CoA reductase inhibitor (statin) used for cholesterol lowering and cardiovascular risk reduction.
Documented on November 2022 medication list. Dose: 10 mg once daily at bedtime. Prescribed under the brand name Simvastatin (generic).
Status: Discontinued. By May 2026 (handwritten Rx), Ishamma was on Atorvastatin (Evitof) instead. The switch to atorvastatin occurred at an unknown date between November 2022 and May 2026.
Dosing History
| Date | Dose | Frequency | Route | Context | Status |
|---|---|---|---|---|---|
| 2022-11-25 | 10 mg | Once daily (bedtime) | Oral | Nov 2022 medication list | Active |
| Unknown (between 2022–2026) | — | — | — | Switched to atorvastatin | Discontinued |
Clinical Context
Simvastatin 10 mg/day is a low-intensity statin. The switch to atorvastatin represents either:
1. Dose escalation — need for stronger LDL lowering (moderate/high-intensity)
2. Formulary/cost change — different brand/preference
3. Guidelines compliance — ACC/AHA guidelines recommend at least moderate-intensity statin for diabetes patients >40
[!info] Statin Transition: Simvastatin → Atorvastatin
This switch is relevant in the context of posaconazole initiation (AML treatment, Dec 2025).
- Simvastatin is also CYP3A4 metabolized — the same dangerous interaction with posaconazole exists
- Atorvastatin at unknown dose replaced it — both are CYP3A4 substrates, so the CYP3A4 risk persists
- The safer alternative would be switching to pravastatin or rosuvastatin (non-CYP3A4), but this was not done
- See Atorvastatin for active drug interaction concern
Pharmacology
- Drug class: HMG-CoA reductase inhibitor (statin)
- Mechanism: Inhibits HMG-CoA reductase → reduced hepatic cholesterol synthesis → LDL receptor upregulation → reduced plasma LDL
- Half-life: ~2 hours (active metabolite 3–5 hours)
- Metabolism: CYP3A4 (major pathway) — same interaction pathway as atorvastatin
- Simvastatin 10 mg intensity: Low-intensity statin (LDL reduction ~30%)
Related
- Atorvastatin — Current statin (replaced simvastatin)
- Posaconazole — CYP3A4 inhibitor: would have interacted with simvastatin (and does interact with atorvastatin)
- Lipid Panel — LDL 90 mg/dL (Mar 2026, on atorvastatin — optimal)
- Diabetes Mellitus — Primary indication for statin
Medication page created 2026-05-06 from Nov 2022 historical medication list (raw/clinic-notes/2026-05-06_note.md). Discontinued at unknown date before 2026-05-04; replaced by atorvastatin.