A synthetic drug based on an organic compound produced as a fermentation byproduct of a fungus, Zocor® is a member of a class of medication known as the statins. Like other statins, Zocor®, also known as simvastatin, is used to treat elevated blood cholesterol levels alongside adjustments to diet and exercise. Patients of Chinese decent or who have a DNA variant known as single nucleotide polymorphism may be at increased risk of developing myopathy — a potentially serious side effect to Zocor® — especially if the medication is used in combination with therapeutic levels of niacin. It is essential that the Zocor® dosage be adjusted according to the condition to be treated, the age of the patient, the level of kidney function, and the concomitant use of drugs with which it interacts.
When administering the medication to reduce the risk of cardiovascular incident or to treat elevated levels of blood lipids in adults, an initial Zocor® dosage of 10 to 20 mg should given orally once daily following the evening meal. A maintenance dose of between 5 to 40 mg may also be given in the evening. A starting Zocor® dosage of 40 mg is recommended for patients with a history of cerebrovascular disease like stroke, peripheral vascular disease, cardiovascular events or diabetes.
Adolescent patients with heterozygous familial hypercholesterolemia may begin preventative use of statins a year after the start of puberty. An initial Zocor® dosage of 10 mg orally should be given once daily. A maintenance dose of between 10 and 40 mg can be given as well, with increases to dosage evaluated at monthly intervals. Adults with homozygous familial hyperchoesterolemia should receive a 40 mg dose once per day as an adjunct to other lipid lowering therapies.
Adjustments to the standard dose must be made for patients suffering from a moderate-to-severe reduction in kidney function. Patients with a creatinine clearance level of less than 25 milliliters per minutes should be given an initial Zocor® dosage of no greater than 5 mg once daily. Close monitoring should accompany any increases in dosage.
Similarly, the concomitant use of ranolazine or amlodipine necessitate a daily maximum Zocor® dosage of 20 mg. Patients using verapamil, diltiazem or amiodarone should be given no more than 10 mg of Zocor® per day. Zocor® may also react with supplemental niacin when the daily niacin dose exceeds 1,000 mg. The use of combination drug regimens are considerably higher than monotherapy and should be carefully considered.