CLINICAL PHARMACOKINETICS AND PRACTICAL APPLICATIONS OF SIMVASTATIN

被引:167
作者
MAURO, VF [1 ]
机构
[1] MED COLL OHIO, PHARM SERV, TOLEDO, OH 43699 USA
关键词
D O I
10.2165/00003088-199324030-00002
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Since simvastatin is metabolised by the cytochrome P450 system, a potential for drug interactions exists. Elevated HMG-CoA reductase inhibitory activity has been observed when simvastatin was administered concurrently with cyclosporin, possibly increasing the risk of myopathy and subsequent rhabdomyolysis which are associated with simvastatin use. Simvastatin has also been shown to potentiate the effects of warfarin. A rapid decrease in cholesterol levels is observed within the first 2 weeks of simvastatin treatment Tolerance to these effects has not been observed. Simvastatin can be administered as a single dose, preferably in the evening. Simvastatin is well absorbed from the gastrointestinal tract but is highly extracted by the liver and only 7% of the dose reaches the general circulation intact. The peak inhibition of HMG-CoA reductase activity occurs within 2 to 4 hours. Increasing the dose of simvastatin from 5 to 120mg increases the pharmacological activity in a linear fashion. The several metabolites tend to remain within the liver and the intestines (via biliary excretion). Some gastrointestinal reabsorption of metabolites may occur. Simvastatin is eliminated mainly in the faeces due to biliary excretion but only a small percentage of the dose is found in the stool in the form of the parent compound or simvastatin acid. Since simvastatin is metabolised by the cytochrome P450 system, a potential for drug interactions exists. Elevated HMG-CoA reductase inhibitory activity has been observed when simvastatin was administered concurrently with cyclosporin, possibly increasing the risk of myopathy and subsequent rhabdomyolysis which are associated with simvastatin use. Simvastatin has also been shown to potentiate the effects of warfarin. A rapid decrease in cholesterol levels is observed within the first 2 weeks of simvastatin treatment. Tolerance to these effects has not been observed. Simvastatin can be administered as a single dose, preferably in the evening.
引用
收藏
页码:195 / 202
页数:8
相关论文
共 33 条
[1]   LOVASTATIN - WARFARIN INTERACTION [J].
AHMAD, S .
ARCHIVES OF INTERNAL MEDICINE, 1990, 150 (11) :2407-2407
[2]   MEVINOLIN - A HIGHLY POTENT COMPETITIVE INHIBITOR OF HYDROXYMETHYLGLUTARYL-COENZYME-A REDUCTASE AND A CHOLESTEROL-LOWERING AGENT [J].
ALBERTS, AW ;
CHEN, J ;
KURON, G ;
HUNT, V ;
HUFF, J ;
HOFFMAN, C ;
ROTHROCK, J ;
LOPEZ, M ;
JOSHUA, H ;
HARRIS, E ;
PATCHETT, A ;
MONAGHAN, R ;
CURRIE, S ;
STAPLEY, E ;
ALBERSSCHONBERG, G ;
HENSENS, O ;
HIRSHFIELD, J ;
HOOGSTEEN, K ;
LIESCH, J ;
SPRINGER, J .
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA-BIOLOGICAL SCIENCES, 1980, 77 (07) :3957-3961
[3]   LOVASTATIN AND RHABDOMYOLYSIS [J].
AYANIAN, JZ ;
FUCHS, CS ;
STONE, RM .
ANNALS OF INTERNAL MEDICINE, 1988, 109 (08) :682-683
[4]   HYPERLIPIDEMIA AFTER HEART-TRANSPLANTATION - REPORT OF A 6-YEAR EXPERIENCE, WITH TREATMENT RECOMMENDATIONS [J].
BALLANTYNE, CM ;
RADOVANCEVIC, B ;
FARMER, JA ;
FRAZIER, OH ;
CHANDLER, L ;
PAYTONROSS, C ;
COCANOUGHER, B ;
JONES, PH ;
YOUNG, JB ;
GOTTO, AM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 19 (06) :1315-1321
[5]   LOW-DOSE SIMVASTATIN FOR THE TREATMENT OF HYPERCHOLESTEROLEMIA IN RECIPIENTS OF CARDIAC TRANSPLANTATION [J].
BARBIR, M ;
ROSE, M ;
KUSHWAHA, S ;
AKL, S ;
MITCHELL, A ;
YACOUB, M .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 1991, 33 (02) :241-246
[6]   TISSUE SELECTIVITY OF THE CHOLESTEROL-LOWERING AGENTS LOVASTATIN, SIMVASTATIN AND PRAVASTATIN IN RATS INVIVO [J].
GERMERSHAUSEN, JI ;
HUNT, VM ;
BOSTEDOR, RG ;
BAILEY, PJ ;
KARKAS, JD ;
ALBERTS, AW .
BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS, 1989, 158 (03) :667-675
[7]  
GRUNDY SM, 1988, NEW ENGL J MED, V319, P24
[8]   LOVASTATIN (MEVINOLIN) IN THE TREATMENT OF HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA - A MULTICENTER STUDY [J].
HAVEL, RJ ;
HUNNINGHAKE, DB ;
ILLINGWORTH, DR ;
LEES, RS ;
STEIN, EA ;
TOBERT, JA ;
BACON, SR ;
BOLOGNESE, JA ;
FROST, PH ;
LAMKIN, GE ;
LEES, AM ;
LEON, AS ;
GARDNER, K ;
JOHNSON, G ;
MELLIES, MJ ;
RHYMER, PA ;
TUN, P .
ANNALS OF INTERNAL MEDICINE, 1987, 107 (05) :609-615
[9]   EFFECTIVENESS OF MEVINOLIN ON PLASMA-LIPOPROTEIN CONCENTRATIONS IN TYPE-II HYPERLIPOPROTEINEMIA [J].
HOEG, JM ;
MAHER, MB ;
ZECH, LA ;
BAILEY, KR ;
GREGG, RE ;
LACKNER, KJ ;
FOJO, SS ;
ANCHORS, MA ;
BOJANOVSKI, M ;
SPRECHER, DL ;
BREWER, HB .
AMERICAN JOURNAL OF CARDIOLOGY, 1986, 57 (11) :933-939
[10]  
HOFFMAN WF, 1986, J MED CHEM, V29, P849, DOI 10.1021/jm00155a040