Simvastatin, also known as Zocor, is a type of drug known as a statin. Statins are one of the most commonly prescribed drugs in the UK, with an estimated 7 million people prescribed them annually. They work by:

  • Lowering your levels of low-density lipoprotein (LLD) and triglycerides, considered 'bad cholesterol' and fats
  • Increasing your levels of high-density lipoprotein (HLD), considered 'good cholesterol'
  • Stabilising blood vessel linings to improve general circulation and heart health, thereby reducing the risk of heart attacks or strokes

Simvastatin is well tolerated by most people, and its benefits seem to far outweigh its risks. The British Heart Foundation describes statins generally as one of the most studied and safest types of medication available. But, as with any medication, it's possible to experience side effects and it's important to know what these are so you can recognise any signs or symptoms and take appropriate action.

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Common Side Effects

Side effects are considered to be common if they affect 1 in 10 users of the medication or more. Most of the common side effects of Simvastatin are classified as relatively minor:

Less severe Severe
  • Nose, throat or sinus infections
  • Diarrhoea, infrequent bowel movements or gas
  • Stomach aches or nausea
  • Dizziness
  • Headaches
  • Heartburn
  • Rashes
  • Myopathy related to the SCLO1BI gene variant*

  • * A Boston Heart paper identified a link between those who experience myopathy and those with inherited variations of a gene known as SLCO1B1. They found that the presence of gene variants reduced the effectiveness of statins for these patients and made them as much as 17 times more likely to experience myopathy as a side effect.

Uncommon Side Effects

Side effects that are classified as uncommon are ones that affect between 1 in 100 and 1 in 1000 individuals that are taking the medication. Below are some of the uncommon side effects classified according to their severity.

Less severe Severe
  • Sinus irritation, congestion or flu like symptoms
  • Backache and other muscle pain
  • Eczema
  • Burning stomach
  • Fatigue or low energy
  • Muscle problems including aches, spasms and pain
  • Atrial fibrillation – a rapid and irregular heartbeat

Rare Side Effects

Rare side effects are experienced by between 1 in 1,000 and 1 in 10,000 people taking Simvastatin. While your likelihood of experiencing these side effects is low, they can be more severe if you do experience them. The following are some of the more rare side effects that you should be aware of.

Less severe Severe
  • Decreased or increased libido
  • Blurred vision
  • Anxiety
  • Memory loss or confusion
  • Insomnia
  • Cough or nasal inflammation
  • Mood changes and depression
  • Dry mouth or skin
  • Enlarged breasts
  • Weakness
  • Fever or involuntary quivering
  • Hair loss
  • High blood sugar
  • Appetite loss or taste problems
  • Numbness, tingling or pain in hands and feet
  • Vomiting
  • Water retention
  • Abnormal liver test functions, hepatitis, liver failure or yellowing of the skin and eyes
  • Arthritis
  • Bronchitis, trouble breathing or lung tissue problems
  • Cataracts
  • Chest pain
  • Decrease blood platelets or white blood cells
  • Erythema Multiforme – including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
  • Hives
  • Muscle or skin inflammation
  • Purple or brown skin blotches
  • Severe allergic reaction
  • Lupus like syndrome or muscle damage due to autoimmunity including kidney failure
  • Pancreatitis
  • Paralysis of eye muscles
  • Urinary tract infections
  • Vasculitis – inflammation of blood vessels

How to prevent the risk of side effects

There are a number of steps you can take to reduce your risk of side effects:

  • If you're taking Simvastatin it is recommended that you avoid grapefruit and grapefruit juice altogether as they can increase your risk of side effects.
  • Notify your doctor on any other medications or herbal remedies you are taking, so they can ensure none will negatively interact with Simvastatin and increase your chance of side effects.

Drugs it can interact with include:

  • CYP3A4 Inhibitors
  • Other cholesterol lowering drugs
  • Calcium channel blockers
  • Other drugs that increase the chance of Myopathy such as amiodarone, dronedarone and ranolazine
  • Digoxin used to treat heart failure
  • Drugs that treat gout such as Colchicine and Niacin
  • Blood thinners such as warfarin
  • Avoid Simvastatin and notify your doctor if you have a history of liver disease or alcohol abuse
  • Avoid Simvastatin and notify your doctor if you could be pregnant
  • Notify your doctor if you have low thyroid function or diabetes as this can place you at an increased risk of experiencing severe muscle breakdown
  • Notify your doctor if you have kidney disease, as you may need your prescribed dosage of Simvastatin lowered

Dealing with side effects

If you notice any symptoms of the more severe side effects, you should speak to your doctor immediately. In particular, if you notice any yellowing of the skin, dark urine or severe stomach pains, as these could indicate liver problems. A rare side effect of Simvastatin is serious muscle problems, which can lead to rhabdomyolysis and autoimmune myopathy. You should speak to your doctor if you notice symptoms such as muscle pain, tenderness and weakness.

While it's rare, it is possible to have an allergic reaction to Simvastatin. If you notice any signs of a severe allergic reaction such as swelling of the face or throat, rashes or trouble breathing you should seek emergency medical assistance immediately.

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