lovastatin vs. simvastatin comparison
Both lovastatin (Mevacor, Altoprev) and simvastatin (Zocor) are members of
the statin family of cholesterol-lowering drugs. Statins revolutionized the
treatment and prevention of a host of cardiovascular diseases including coronary
artery disease and other cholesterol-related problems that cause debilitating
and fatal heart attacks and strokes.
Lovastatin and simvastatin are chemically similar. The central difference
between these two statins is that simvastatin tends to be more effective at
lowering the targeted bloodstream cholesterol levels. Doctors may keep
lovastatin in reserve for drug combinations or if a patient has an undesirable
reaction to a typically more potent statin.
Side effects for each medication are nearly identical. They include:
- liver damage,
- muscle inflammation and damage, and
- increases in blood sugar levels as seen in diabetes.
Both Mevacor and Zocor react badly with the same drugs, including
blood thinners like warfarin (Coumadin).
Another difference between lovastatin and simvastatin is that lovastatin
works better when you take it with food, whereas if you take simvastatin, it
makes no difference when you eat.
What are lovastatin and simvastatin?
Lovastatin and simvastatin are both members of the class of drugs called
statins, which also includes:
Statins work to lower cholesterol in the bloodstream, which is in the form of
low-density lipoproteins (LDL). LDL is what doctors are talking about when they
say “bad cholesterol.”
Cholesterol is vital to your body’s functions, performing tasks as diverse as
providing cell structure, lining nerves, and aiding digestive processes, among
many others. A healthy person’s body can easily balance cholesterol levels, and
healthy liver is capable of making all the body’s necessary cholesterol from
simpler fat molecules. Foods also contain cholesterol, however. If your diet is
poor and/or you have a genetic predisposition, this extra cholesterol courses
through your bloodstream in the form of LDL molecules. Over time, these bits of
LDL accumulate in arteries, constricting the blood flow. Often, this leads to
catastrophic effects such as debilitating or fatal heart attacks and strokes.
Statins like Mevacor and Zocor bind with a cholesterol precursor
chemical called hydroxymethylglutaryl-coenzyme A reductase or HMG-CoA (statins are also called HMG-CoA inhibitors).
HMG-CoA is one step in the process the liver cells use to manufacture cholesterol
from simpler molecules. Statins throw a wrench in the works of the liver’s
cholesterol-making process by preventing HMG-CoA from turning into
cholesterol. This forces the body’s cholesterol balancing impulse to kick in,
meaning the liver cells absorb more LDL from the blood stream, meaning less of
it is floating around to add to plaque deposits.
Lovastatin and simvastatin also raise levels of high-density lipoprotein
(HDL), the so-called “good cholesterol.” HDL is beneficial because it acts like
a scavenger, capturing LDL molecules and taking them to the liver for
processing. Researchers don’t understand how statins raise bloodstream HDL as
well as they understand how the drugs lower bloodstream LDL.
What are the uses for lovastatin and simvastatin?
- heart attack,
- hospitalization for
congestive heart failure, and
- revascularization procedures in individuals with
coronary artery disease.
Lovastatin and simvastatin reduce the risk of heart attack,
stroke, angina and revascularization procedures in adults with multiple risk factors for
coronary artery disease.
Lovastatin and simvastatin also prevent
heart attacks and
strokes in patients with
type 2 diabetes with multiple risk factors for
coronary artery disease.
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What are the side effects of lovastatin and simvastatin?
The potential side effects of lovastatin and simvastatin are nearly
identical. The most common reactions include headache, nausea, vomiting,
diarrhea, abdominal pain, muscle pain and abnormal liver tests. People sometimes
have allergic reactions to lovastatin or simvastatin.
The chief worry for people taking Mevacor and Zocor is liver damage.
Though statin-induced liver damage is rare, it can be serious. Both medications tend to
cause important chemical markers in the liver to rise above normal, which is why
doctors prescribing statins to their patients keep a close eye on them through
frequent liver tests. If the levels are at three times the upper limit of
normal, doctors will cease administering the drugs.
Another rare but serious side effect is the potential breakdown of skeletal
muscles, which release the protein myoglobin into the bloodstream. This
condition, called rhabdomyolosis, can kill you by destroying your kidneys,
which aren’t equipped to filter myoglobin.
Lovastatin and simvastatin also can raise blood sugar levels,
mimicking conditions seen in patients with diabetes.
In the U.S., 1 in every 4 deaths is caused by heart disease.
How should lovastatin and simvastatin be taken (dosage)?
- The dose range for Mevacor is 10-80 mg daily given preferably in the evening when it may be most effective.
- The usual starting dose is 20 mg once daily, and the maximum dose is 80 mg daily.
- Blood cholesterol determinations are performed at regular intervals during treatment so that adjustments in dosage can be made.
- The recommended dose range of Zocor is 10 mg to 40 mg,
and it is administered once daily in the evening with or without food. Therapy
usually is initiated with 10 or 20 mg daily, but individuals who have a high
risk of heart disease can be started on 40 mg daily.
- Simvastatin 80 mg is
restricted to patients who have been taking simvastatin 80 mg chronically (for
example, for 12 months or more) without evidence of muscle toxicity because the
80 mg dose is associated with increased risk of muscle toxicity, including rhabdomyolysis. Patients who are currently tolerating the 80 mg dose of
simvastatin who need to start an interacting drug that should not be taken with
simvastatin or is associated with a dose cap for simvastatin should be switched
to an alternative statin or statin-based regimen with less potential for the
- Patients that require more than the 40 mg dose should be switched to an alternative drug.
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Which drugs interact with lovastatin and simvastatin?
A large number of drugs can compromise your body’s ability to get rid of
lovastatin and simvastatin. Higher concentrations of these drugs in the body can
increase the chances of dangerous side effects. Examples of drugs that decrease elimination of lovastatin
- erythromycin (E-Mycin),
- ketoconazole (Nizoral),
- itraconazole (Sporanox),
- clarithromycin (Biaxin),
- telithromycin (Ketek),
Don’t binge on grapefruit juice if you take either lovastatin or simvastatin.
More than a liter a day will increase muscle toxicity.
Amiodarone (Cordarone), verapamil (Calan, Verelan, Isoptin),
and some others will also increase the risk of muscle toxicity for statins. You
may be able to still take lovastatin or simvastatin if you are on these other
drugs, but the doctor will have to adjust your statin dose accordingly.
Lovastatin may increase the
effect of warfarin (Coumadin),
a blood thinner; warfarin toxicity is a danger for people taking that drug plus
lovastatin or simvastatin, so doctors keep watch for that possibility.
This is not a complete list of medications that interact with lovastatin and
simvastatin, so make sure to tell your doctor about all the other medications
you’re taking if they prescribe you either of these drugs.
Are lovastatin and simvastatin safe to take during pregnancy or while breastfeeding?
- Under no circumstances should you take statins while pregnant or nursing. Cholesterol is crucial for the proper formation of the developing fetus and for a growing infant. You shouldn't take statins even if you think you might become pregnant.
- Statins are also passed on in breast milk, so don't take them if you're nursing, either.