What is a Patient Information Leaflet and why is it useful?

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from this version because it may have been updated since your medicine was packaged.

Below is a text only representation of the Patient Information Leaflet. The original can be viewed in PDF format using the link above.

The text only version may be available from RNIB in large print, Braille or audio CD. For further information call RNIB Medicine Leaflet Line on 0800 198 5000. The product code(s) for this leaflet are: PL 17780/0150, PL 17780/0149, PL 17780/0151.

Simvastatin 10mg, 20mg & 40mg Film-Coated Tablets

PACKAGE LEAFLET: INFORMATION FOR THE USER

SIMVASTATIN 10 MG, 20 MG AND 40 MG, FILM-COATED TABLETS

Simvastatin

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

  • Keep this leaflet. You may need to read it again.
  • If you have further questions, ask your doctor or pharmacist.
  • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
  • If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

In this leaflet:

1. What simvastatin is and what it is used for
2. What you need to know before you take simvastatin
3. How to take simvastatin
4. Possible side effects
5. How to store simvastatin
6. Contents of the pack and other information

1. WHAT SIMVASTATIN IS AND WHAT IT IS USED FOR

The name of your medicine is Simvastatin 10mg, 20mg or 40mg film-coated tablets. Simvastatin is a medicine used to lower levels of total cholesterol, “bad” cholesterol (LDL cholesterol) and fatty substances called triglycerides in the blood. In addition, simvastatin raises levels of “good” cholesterol (HDL cholesterol). Simvastatin is a member of the class of medicines called statins.

Cholesterol is one of several fatty substances found in the bloodstream. Your total cholesterol is made up mainly of LDL and HDL cholesterol.

LDL cholesterol is often called “bad” cholesterol because it can build up in the walls of your arteries forming plaque. Eventually this plaque build-up can lead to narrowing of the arteries. This narrowing can slow or block blood flow to vital organs such as the heart and brain. This blocking of blood flow can result in a heart attack or stroke.

HDL cholesterol is often called “good” cholesterol because it helps keep the bad cholesterol from building up in the arteries and protects against heart disease.

Triglycerides are another form of fat in your blood that may increase your risk for heart disease.

You should stay on a cholesterol-lowering diet while taking this medicine.

Simvastatin is used in addition to your cholesterol-lowering diet if you have:

  • A raised cholesterol level in your blood (primary hypercholesterolaemia) or elevated fat levels in your blood (mixed hyperlipidaemia)
  • A hereditary illness (homozygous familial hypercholesterolaemia) that increases the cholesterol level in your blood. You may receive other treatments.
  • Coronary heart disease (CHD) or are at high risk of CHD (because you have diabetes, history of stroke, or other blood vessel disease). Simvastatin may prolong your life by reducing the risk of heart disease problems, regardless of the amount of cholesterol in your blood.

In most people, there are no immediate symptoms of high cholesterol. Your doctor can measure your cholesterol with a simple blood test. Visit your doctor regularly, keep track of your cholesterol, and discuss your goals with your doctor.

2. BEFORE YOU TAKE SIMVASTATIN

Do not take simvastatin:

  • if you are allergic (hypersensitive) to simvastatin or any of the other ingredients of these tablets (see Section 6: Contents of the pack and other information)
  • if you currently have liver problems
  • if you are pregnant or breast-feeding
  • if you are taking medicines(s) with one or more of the following active ingredients:
    • itraconazole, ketoconazole, posaconazole or voriconazole (used to treat fungal infections)
    • erythromycin, clarithromycin, or telithromycin (used to treat infections)
    • HIV protease inhibitors such as indinavir, nelfinavir, ritonavir, and saquinavir (HIV protease inhibitors are used for HIV infections)
    • boceprivir or telaprevir (used to treat hepatitis C virus infection)
    • nefazodone (used to treat depression)
    • cobicistat
    • gemfibrozil (used to lower cholesterol)
    • ciclosporin (used in organ transplant patients)
    • danazol (a man-made hormone used to treat endometriosis, a condition in which the lining of the uterus grows outside the uterus).
  • If you are taking or, in the last 7 days, have taken or been given a medicine called fusidic acid (used to treat bacterial infections)
    Do not take more than 40mg simvastatin if you are taking lomitapide (used to treat a serious and rare genetic cholesterol condition)

Ask your doctor if you are not sure if your medicine is listed above.

Warnings and precautions

Tell your doctor:

  • about all your medical conditions including allergies.
  • if you drink large amounts of alcohol.
  • if you have ever had liver disease. Simvastatin may not be right for you.
  • if you are due to have an operation. You may need to stop taking simvastatin tablets for a short time.
  • if you are Asian, because a different dose may be applicable to you.

Your doctor should do a blood test before you start taking simvastatin and if you have any symptoms of liver problems while you take simvastatin. This is to check how well your liver is working.

Your doctor may also want you to have blood tests to check how well your liver is working after you start taking simvastatin.

While you are on this medicine your doctor will monitor you closely if you have diabetes or are at risk of developing diabetes. You are likely to be at risk of developing diabetes if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure.

Tell your doctor if you have severe lung disease.

Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness. This is because on rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare deaths have occurred. Also tell your doctor or pharmacist if you have a muscle weakness that is constant. Additional tests and medicines may be needed to diagnose and treat this.

The risk of muscle breakdown is greater at higher doses of simvastatin, particularly the 80 mg dose. The risk of muscle breakdown is also greater in certain patients. Talk with your doctor if any of the following applies:

  • you consume large amounts of alcohol
  • you have kidney problems
  • you have thyroid problems
  • you are 65 years or older
  • you are female
  • you have ever had muscle problems during treatment with cholesterol-lowering medicines called “statins” or fibrates
  • you or a close family member have a hereditary muscle disorder.

Other medicines and simvastatin

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicine(s) with any of the following active ingredients. Taking simvastatin with any of these drugs can increase the risk of muscle problems (some of these have already been listed in the above section “Do not take simvastatin”).

  • Ciclosporin (often used in organ transplant patients).
  • Danazol (a man-made hormone used to treat endometriosis, a condition in which the lining of the uterus grows outside the uterus).
  • Medicines with an active ingredient like itraconazole, ketoconazole, fluconazole, posaconazole or voriconazole (used to treat fungal infections).
  • Fibrates with an active ingredient like gemfibrozil and bezafibrate (used to lower cholesterol).
  • Erythromycin, clarithromycin telithromycin, or fusidic acid (used to treat bacterial infections). Do not take fusidic acid while using this medicine. Also see section 4 of this leaflet.
  • HIV protease inhibitors such as indinavir, nelfinavir, ritonavir, and saquinavir (used to treat HIV).
  • Boceprivir or telaprevir (used to treat hepatitis C virus infection).
  • Nefazodone (used to treat depression).
  • Medicines with the active ingredient cobicistat
  • Amiodarone (used to treat an irregular heartbeat).
  • Verapamil, diltiazem or amlodipine (used to treat high blood pressure, chest pain associated with heart disease, or other heart conditions).
  • Lomitapide (used to treat a serious and rare genetic cholesterol condition).
  • Colchicine (used to treat gout)

As well as the medicines listed above, tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including those obtained without a prescription. In particular, tell your doctor if you are taking medicine(s) with any of the following active ingredients:

  • medicines with an active ingredient to prevent blood clots, such as warfarin, phenprocoumon or acenocoumarol (anticoagulants)
  • fenofibrate ( also used to lower cholesterol)
  • niacin (also used to lower cholesterol)
  • rifampicin (used to treat tuberculosis).

You should also tell any doctor who is prescribing a new medicine for you that you are taking simvastatin.

Simvastatin with food and drink

Grapefruit juice contains one or more components that alter how the body uses some medicinal products, including simvastatin. Consuming grapefruit juice should be avoided.

Pregnancy and Breast-feeding

Do not take simvastatin if you are pregnant, trying to get pregnant or think you may be pregnant. If you get pregnant while taking simvastatin, stop taking it immediately and contact your doctor.

Do not take simvastatin if you are breast-feeding, because it is not known if the medicine is passed into breast-milk.

Ask your doctor or pharmacist for advice before taking any medicine.

Children

Safety and effectiveness have been studied in 10-17 year old boys and in girls who had started their menstrual period (menstruation) at least one year before (see Section 3: How to take simvastatin). Simvastatin has not been studied in children under the age of 10 years. For more information, talk to your doctor.

Driving and using machines

Simvastatin is not expected to interfere with your ability to drive or use machinery. However, it should be taken into account that some people get dizzy after taking simvastatin.

Simvastatin tablets contain lactose

Simvastatin tablets contain a sugar called lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

3. HOW TO TAKE SIMVASTATIN

Your doctor will determine the appropriate tablet strength for you, depending on your condition, your current treatment and your personal risk status.

Always take simvastatin exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Remember to keep to a low-fat diet and exercise while taking simvastatin.

The usual doses are:

People with coronary heart disease (CHD)

The usual dose is 20 to 40 mg a day, taken in the evening. The maximum dose is 80 mg a day, taken in the evening.

People with high levels of blood fats (Hyperlipidaemia)

The usual starting dose is 10 mg a day, taken in the evening. The maximum dose is 80 mg a day, taken in the evening.

People with inherited high cholesterol levels (Homozygous familial hypercholesterolaemia)

The usual dose is 40 mg a day, taken in the evening. The doctor may ask you to take a higher dose of 80 mg each day, taken in three doses through the day (20 mg, 20 mg and a 40 mg dose taken in the evening).

The 80 mg dose is only recommended for adult patients with very high cholesterol levels and at high risk of heart problems who have not reached their cholesterol goal on lower doses.

Children (10 -17 years old)

The recommended usual starting dose is 10 mg a day in the evening. The maximum recommended dose is 40 mg a day.

Your doctor may ask you to take a lower dose, particularly if you are taking certain medicines listed above or if you have kidney problems.

Keep taking the medicine until your doctor tells you to stop.

Take simvastatin in the evening, with or without food.

Always swallow the tablets with plenty of water.

Taking another medicine for lowering your cholesterol at the same time as simvastatin

If your doctor has prescribed simvastatin with another medicine for lowering cholesterol containing any bile acid sequestrant, you should take simvastatin at least 2 hours before or at least 4 hours after taking a resin-type medicine.

If you take more simvastatin than you should

If you take more simvastatin than you should, tell your doctor or go to your nearest hospital straight away. Take the carton and any simvastatin tablets left with you so that the doctors know what you have taken.

If you forget to take simvastatin

If you forget to take a dose, take it as soon as you remember, unless it is time for your next dose. Do not take a double dose.

If you stop taking simvastatin

Continue taking simvastatin, unless your doctor tells you to stop. Your blood cholesterol levels may rise again once you stop taking simvastatin.

If you have any further questions on the use of this product, ask your doctor or your pharmacist.

4. POSSIBLE SIDE EFFECTS

Like all medicines, simvastatin can cause side effects, although not everybody gets them.

Stop taking simvastatin and see a doctor or go to a hospital straight away if you experience:

  • muscle pain, tenderness, weakness or cramps. On rare occasions, these muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare deaths have occurred.
  • hypersensitivity (allergic) reactions including:
    • swelling of the face, tongue and throat which may cause difficulty in breathing
    • severe muscle pain usually in the shoulders and hips
    • rash with weakness of limbs and neck muscles
    • pain or inflammation of the joints (polymyalgia rheumatica)
    • inflammation of the blood vessels (vasculitis)
    • unusual bruising, skin eruptions and swelling (dermatomyositis), hives, skin sensitivity to the sun, fever, flushing
    • shortness of breath (dyspnoea) and feeling unwell
    • lupus-like disease picture (including rash, joint disorders, and effects on blood cells)
  • inflammation of the liver with the following symptoms: yellowing of the skin and eyes, itching, dark-coloured urine or pale-coloured stool, feeling tired or weak, loss of appetite; liver failure (very rare: may affect up to 1 in 10,000 people).
  • inflammation of the pancreas often with severe abdominal pain.

Rare side effects (may affect up to 1 in 1,000 people):

  • low red blood cell count (anaemia)
  • numbness or weakness of the arms and legs
  • headache, tingling sensation, dizziness
  • digestive disturbances (abdominal pain, constipation, flatulence, indigestion, diarrhoea, nausea, vomiting)
  • rash, itching, hair loss
  • weakness
  • memory loss, confusion

Very rare side effects (affect less than 1 in 10,000 people)

  • trouble sleeping (insomnia)
  • poor memory

Not known (frequency cannot be estimated)

  • erectile dysfunction
  • depression
  • inflammation of the lungs causing breathing problems including persistent cough and/or shortness of breath or fever

tendon problems, sometimes complicated by rupture of the tendon

Other possible side effects reported with some statins:

  • sleep disturbances, including nightmares
  • sexual difficulties
  • diabetes. This is more likely if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure. Your doctor will monitor you while you are taking this medicine.
  • muscle pain, tenderness, or weakness that is constant that may not go away after stopping simvastatin (frequency not known).

Laboratory tests

Elevations in some laboratory blood tests of liver function and a muscle enzyme (creatine kinase) have been observed.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow card Scheme at: www.mhra.gov.uk/yellowcard.

By reporting side effects you can help provide more information on the safety of this medicine.

5. HOW TO STORE SIMVASTATIN

Keep out of the sight and reach of children.

Do not use simvastatin after the expiry date which is stated on the packaging after 'EXP'. The first two digits indicate the month and the last four digits indicate the year. The expiry date refers to the last day of the month.

This medicinal product does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. FURTHER INFORMATION

What Simvastatin tablets contain

  • The active substance is simvastatin.
  • The other ingredients are: lactose anhydrous, microcrystalline cellulose, pre-gelatinised maize starch, butylhydroxyanisole (E320), magnesium stearate and talc. The tablets are film-coated with a solution containing hydroxypropyl cellulose, hypromellose, titanium dioxide (E171) and talc.

What Simvastatin tablets look like and contents of the pack

Simvastatin 10 mg film-coated tablets are oblong, white scored tablets, with SVT on one side and 10 on the other side.

Simvastatin 20 mg film-coated tablets are oblong, white scored tablets, with SVT on one side and 20 on the other side.

Simvastatin 40 mg film-coated tablets are oblong, white scored tablets, with SVT on one side and 40 on the other side.

They are supplied in blister packs of 14, 28, 30, 49, 50, 84, 98, 100 and 300 tablets. (Final printed leaflet to include only marketed pack sizes).

Marketing Authorisation Holder and Manufacturer

Marketing authorisation Holder:

Zentiva
One Onslow Street
Guildford
Surrey
GU1 4YS
UK

Manufacturers:

Synthon Hispania SL
Poligono las Salinas
08830 Sant Bio de Llobregat
Spain

Synthon BV
Microweg 22
6545 CM Nijmegen
The Netherlands

Sanofi-Aventis Sp. z o.o.
Drug Production and Distribution Plant
ul. Lubelska 52
35-233 Rzeszów
Poland

(only the actual release site to be included on the final printed leaflet)

This medicinal product is authorised in the Member States of the EEA under the following names:

< {Name of the Member State} > < {Name of the medicinal product} >

< {Name of the Member State} > < {Name of the medicinal product} >

(Not included on UK PIL)

This leaflet does not contain all the information about your medicine. If you have any questions or you are not sure about anything ask your doctor or pharmacist.

This leaflet was last updated in October 2015

© 2015 Zentiva