Simcor is a cholesterol-lowering agent available only by prescription. Composed of two medications, simvastatin and niacin, it's used to reduce triglycerides, total cholesterol and LDL, or bad cholesterol. It also increases the good HDL cholesterol that removes excess cholesterol from the blood and arterial walls. This medication is prescribed for patients who have been on niacin or simvastatin therapy alone and have not obtained the desired results.
Mechanism of Action
Simvastatin is a HMG-CoA reductase inhibitor, typically called a statin drug. It blocks the HMG-CoA reductase enzyme, which is the main enzyme needed for cholesterol formation. Niacin works by blocking the formation of VLDL, which is converted into LDL; this can result in a decrease in triglycerides, because components found in VLDL contribute to serum triglycerides levels.
Dosing and Administration
Simcor may contain 500, 750 or 1,000 mg of niacin and 20 or 40 mg of simvastatin. Patients who have not taken niacin before should start on niacin 500 mg and simvastatin 20 mg once daily at bedtime, while those on niacin therapy may start on niacin 500 mg and simvastatin 20 mg, according to the "Drug Information Handbook." Patients on simvastatin may be started on niacin 500 mg and simvastatin 40 mg. The dose may be increased every four weeks as needed but may not exceed 2,000 mg of niacin and 40 mg of simvastatin. Simcor should be given with a nonfat snack at bedtime.
Dosage Adjustment
Simvastatin may interact with certain medications, so it is important to disclose to your doctor all the medications you use. The dose of simvastatin should not exceed 10 mg per day when used with cyclosporine, danazol or gemfibrozil. The dose of simvastatin should not exceed 20 mg per day when given with amiodarone or verapamil. Patients with mild to moderate kidney impairment do not require a dosage adjustment, but caution should be used. Patients with severe kidney impairment should use Simcor cautiously or avoid it unless already tolerating doses of simvastatin above 10 mg. Simcor is contraindicated in patients with active liver disease.
Side Effects
Niacin can cause many adverse reactions, but most of these side effects do not require discontinuation of Simcor. Flushing -- redness and feeling hot in the face and chest -- and itching may occur after a dose of Simcor; to prevent this, take 325 mg of aspirin about 30 minutes before taking the drug. Taking Simcor with a meal and starting on a low dose may also help prevent flushing. Gastrointestinal side effects seen with Simcor include diarrhea and nausea. If these worsen, talk to your physician. Headache and back pain are other side effects of Simcor that may be bothersome. They should lessen with continued use of the drug, but you may use a painkiller to treat them. Pain that is not alleviated by painkillers or becomes severe requires medical attention, however.
References
- "Drug Information Handbook"; Lora L. Armstrong et al.; 2009
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. DiPiro et al.; 2008
- University of Maryland Medical Center: Vitamin B3
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