Talk:Simvastatin

FDA

I was disconcerted to see the FDA equated to Federal Drug Administration. It is not ! The acronym FDA stands for Food and Drug Administration. It controls the purity of both foods and drugs.

Nwbeeson 17:43, 12 February 2007 (UTC)

Penicillium

Tabutterick 17:27, 7 October 2006 (UTC)—From website: By 1976, Akira Endo had isolated the first inhibitor (compactin) from yeast cultures in Sankyo, Japan. Correction needed:

Akira Endo had isolated the first inhibitor (compactin ML-236B) from the fungus, Penicillium citrinium in Sankyo, Japan. ref: Liao and Laufs, 2005. Pleiotropic Effects of Statins. Annu. Rev. Pharmacol.Toxicol:45:89-118

Pen. is not a yeast but a filamentous fungi. Since you listed the organism that sim. was isolated from you might want to include the name of this organism too.

Thank you for your time and I hope this is helpful. Tammy Butterick Third yr. Graduate Student UMN-Twin Cities Dept of Pharmacology [email address removed]

Question

My zocor was left in a rural mail box all day on a 90* day. checked temp. inside box. was over 150. Any damage? How tolerant is it to heat? Suggested max. was 89.

Sorry, you'd better check with a real pharmacist. JFW | T@lk 16:35, 2 January 2008 (UTC)

Linkspam

This article has been spammed several times now with the following link:

• Flash animation explaining in detail the mechanism of action of simvastatin. Requires flash 8 for visualisation

It is a fairly basic Flash animation that basically rehashes information already provided on statin with regards to the MOA of statins. I find it of no added informational value over the content already on the page. This Argentinian website has one other Flash animation (on benzodiazepines) and that is the entire content of the site. JFW | T@lk 16:35, 2 January 2008 (UTC)

urine

Does Simvastatin cause urine to be bright yellow? —Preceding unsigned comment added by 98.111.89.67 (talk) 01:21, 21 May 2009 (UTC)

No, I have taken of the Simvastatin for five years and it not yellow makes my urine to be. If ewe have of Urine of Yellow, it could be the drink they call Mountain Due, but likely Vitimin Bee. — Preceding unsigned comment added by 141.116.212.32 (talk) 20:57, 19 March 2012 (UTC)

Price

Article says "In the UK in 2008 the typical per patient cost to the NHS of simvastatin was approx £1.50." - but per how much? Per tab, per year? 82.31.207.100 (talk) 12:00, 22 July 2009 (UTC)

Deleted entry on Side effects

Dear Jfdwolff, you deleted my entry citing: this is excessive - please offer concise content based on the report, but ideally wait until the SEARCH trial has been formally reported.

I think my EDIT was a major event - worth posting - when the largest "watchdog body" (FDA) in the English speaking world, announces new guidelines AND labeling revisions on a drug.

You also "undo-ed" my removal of "citation needed" at: The maximum dose must not be more than 80 mg/day.[citation needed]

As noted in the history, I replaced the "citation needed" with a link to: [1]. There it is clearly stated: ... U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg ...

I reinsert the reference there.

When it comes to "side effects", I ask you kindly to cut away "the excessive" parts of my EDIT and reinsert the rest.

Albeit, I do think a mentioning of absolute and relative contraindications - as well as risk factors for side effects - is a natural part of an up-to-date and informing Wiki-article, dealing with a prescription drug.

I post this to your Wiki-page too.

Regards! 81.225.115.68 (talk) 16:34, 23 March 2010 (UTC)

This stuff has been known for ages. A single sentence, referenced with the FDA link, should be more than adequate. You are free to insert this yourself. JFW | T@lk 20:32, 23 March 2010 (UTC)

simvastatin... possible side effect

I have been taking simvastatin 10 mg. for approx 6mos. In that time I have developed severe itching on my left forearm, and now my right. It usually starts in the evening and is really severe at nightime. After trying about everything from ointments to removing any gold jewerly, several trips to my regular doctor, and also the dermatologists. The only thing that calms the itching, which causes a rase to appear, is ice packs. I am inquiring about medications at this point after so much lost sleep. I take the simvastatin10 mg. at nighttime, and a Losartan Potassium 25 mg, in the morning for Blood pressure. The only other med I take is Prilosec, which I have taken for many years.I need to research this med. as it lists rash and itching as a possible side effect. I am suffering terribly with this problem, and will welcome any imput about this situation. If you look up severe itching on the wed, many people suffer from this, just as I do. I am in my mid fifty's and female. Could this medication be the culprit......please advise.. — Preceding unsigned comment added by 184.19.128.71 (talk) 14:16, 9 December 2011 (UTC)

Please see WP:MEDICAL. Wikipedia authors do not give advice. Regards, Ariconte (talk) 20:01, 9 December 2011 (UTC)

Simvastatin 40mg contraindicated with amlodipine?

Should amlodipine be added as contraindicated when taking 40mg simvastatin daily?

I am a patient who (like others) has recently been taken off 40mg simvastatin and had it replaced with 20mg atorvastatin, due to also taking amlodipine 10mg. I had no noticeable side effects, but was informed all patients (in Scotland, UK) taking both amlodipine and simvastatin were deemed at higher risk of developing rhabdomyolysis, and therefore the simvastatin 40mg was being replaced with atorvastatin 20mg.

I believe the higher risk may be due to the amlodipine combination making the simvastatin 40mg more like an 80mg blood level, which is associated with increased risk of muscle damage or wasting. I do not know of the source for this contraindication, although I was advised by a doctor.

Daveco333 (talk) 15:20, 14 January 2013 (UTC)

Thanks for the heads up. Fortunately I have found sources which state this and have added it to the article. I also found some other things which are stated to be contraindicated and will be adding those sometime.OakRunner (talk) 06:55, 15 January 2013 (UTC)

Addition Helpful Information

Information regarding side effects, as well as route of administration would be helpful if included as well. This is general information that patients currently taking, or potential future consumers would most likely be interested in. Mbdy222 (talk) 03:27, 11 December 2013 (UTC)

Keeping the lead in easier to understand En

Have summarized "and to reduce the risk of coronary heart disease-related death, heart attack, stroke, or requiring cardiac revascularization procedures in people at high risk" as " It is also used to decrease the risk of heart problems in those at high risk."

Have left the body more specific and complicated. Doc James (talk · contribs · email) 06:43, 29 November 2015 (UTC)

Indication

@Doc James:

Your point is a good one, and I have to say that the description of the drug's indications in the package insert is awfully legalistic and cumbersome. I'm not thrilled with the language currently used in the body of the article, but dunno if something like "prevention of atherosclerosis-related complications such as stroke and heart attack" is taking too much liberty with the source.

If you have any thoughts on some language that captures the gist of this without sounding like it came out of a legal document, please go ahead and plug it in.

Thanks 73.162.132.47 (talk) 13:50, 29 November 2015 (UTC)

Sure have adjusted the body of the text to "The primary uses of simvastin are to treat high blood lipid levels and to prevent atherosclerosis-related complications such as stroke and heart attacks in those who are at high risk." Let me know what you think? Doc James (talk · contribs · email) 13:54, 29 November 2015 (UTC)

Thanks, this is great! 2601:643:8100:8AF4:F4BB:DF2E:D0E4:58CF (talk) 13:23, 30 November 2015 (UTC)

Statins in people with unknown lipids

We use them all the time in those post MI without checking lipid levels.

Others appear to view it the same "Statins also have benefits above and beyond cholesterol lowering. We have long known that statins lower the risk of premature death, heart attack, and stroke, even among individuals with relatively normal cholesterol levels—who are not exempt from having heart attacks or stroke."

This book agrees[2] Doc James (talk · contribs · email) 01:20, 23 July 2016 (UTC)

Lipophilic

Having read this (and other top google hits), I'm unclear if S is lipophilic (fat-binding) or hydrophiliac, another sort of statin. Re the recent Chinese study. Anyone? Johnbod (talk) 14:00, 3 June 2017 (UTC)

In depth discussion

Of its relatively low cost. https://www.sciencedirect.com/science/article/pii/S0735109717417827#undfig2

Doc James (talk · contribs · email) 03:31, 30 March 2020 (UTC)

Per the recommendation of the closer this "The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014.

"Simvastatin" (PDF). International Drug Price Indicator Guide. Retrieved 28 November 2015.{{cite web}}: CS1 maint: url-status (link)

Requires no interpretation. Doc James (talk · contribs · email) 19:42, 30 March 2020 (UTC)

Choosing to describe the prices published by two suppliers as "The wholesale cost in some LMIC" is a matter of interpretation. WhatamIdoing (talk) 21:07, 30 March 2020 (UTC)

Sorry no you are incorrect. You will notice the price by IDA Foundation aswell which applies to more than 130 countries. Doc James (talk · contribs · email) 21:19, 30 March 2020 (UTC)

Clarification of RfC

Should we state " Simvastatin is relatively low cost." at the end of the 4 paragraph of the simvastatin article?

Based on this 2012 article which states

Simvastatin... is a universally accepted and relatively inexpensive drug.

Elavarasu, S; Suthanthiran, TK; Naveen, D (August 2012). "Statins: A new era in local drug delivery". Journal of pharmacy & bioallied sciences. 4 (Suppl 2): S248-51. doi:10.4103/0975-7406.100225. PMID 23066263. Simvastatin... is a universally accepted and relatively inexpensive drug.{{cite journal}}: CS1 maint: unflagged free DOI (link) And this 2018 review which states

The U.S. patent for simvastatin held by Merck expired on June 23, 2006, which catalyzed a large generic drug launch, with firms from India and Israel ramping up production (18). Costs fell from $1,200 to $40/patient/year, as priced by the Management Sciences for Health International Medical Products Price Guide (19). This reduction helped make statins cost-effective by WHO standards, and in 2007, statins were added to the EML as a therapeutic class. Given its lower cost and off-patent status, we proposed simvastatin as the representative example of the therapeutic class of statins. In 2007, statins were added to the EML with simvastatin as the representative.

Kishore, Sandeep P.; Blank, Evan; Heller, David J.; Patel, Amisha; Peters, Alexander; Price, Matthew; Vidula, Mahesh; Fuster, Valentin; Onuma, Oyere; Huffman, Mark D.; Vedanthan, Rajesh (February 2018). "Modernizing the World Health Organization List of Essential Medicines for Preventing and Controlling Cardiovascular Diseases". Journal of the American College of Cardiology. 71 (5): 564–574. doi:10.1016/j.jacc.2017.11.056.

Support

• Support as proposer. The 2018 review makes it clear why the relatively low cost of this medication is notable. Doc James (talk · contribs · email) 21:31, 30 March 2020 (UTC)
• support very clear per review--Ozzie10aaaa (talk) 21:51, 30 March 2020 (UTC)

Oppose

• Oppose because the (good) source doesn't say that. Actually, it's not even clear what that sentence is supposed to mean. User:Doc James, when you wrote that the drug is "relatively low cost", is that supposed to mean that:
  1. it's "a kind of mediumly-low cost" ('relatively low' as contrasted with 'actually low'), or
  2. "the cost went down, relative to the price charged at a different time period/under other circumstances", or
  3. "the cost is low, relative to the cost of other drugs"? WhatamIdoing (talk) 22:15, 30 March 2020 (UTC)

Neither

• Wrong RFC. SandyGeorgia (Talk) 21:55, 30 March 2020 (UTC)
• Appears to ignore Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices. --Hipal/Ronz (talk) 21:58, 30 March 2020 (UTC)
• And this edit is nearly identical. --Hipal/Ronz (talk) 22:04, 30 March 2020 (UTC)

Discussion

Everyone is to put their discussion in their own section.

Comments by SandyGeorgia

I saw this discussion at WT:MED, under this discussion about the recently closed RFC on pharmaceutical drug prices.

This (new and immediately second) RFC is premature and malformed for two reasons.

First, there was essentially no prior discussion about what should be in this particular RFC about this particular drug, after the price text was removed per the RFC, [3] and then later reinserted.

Second, the text proposed for discussion does not encompass the full disputed text. [4] Any conclusion reached about that one sentence is not helpful for any purpose, and an RFC to discuss that one sentence is not be likely to yield any useful conclusions.

The full disputed text is more extensive, using again and still the kinds of sources discussed at the recently closed RFC:

• Simvastatin is relatively in expensive. The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014. The defined daily dose is 30 mg per the World Health Organization. The price decreased from roughly US$1,200 to $40 per year of medication following the patent expiring in 2006. In the United States, it costs about US$10 to 20 per month since patent protection ended. In the UK in 2008, the typical per-patient cost to the NHS of simvastatin was about £1.50 per month. (40 mg/day costs UK NHS £1.37/month in 2012) The price in Canada is about $CAD 130 to 160 per year as of 2016.

Sources
References

James, could you please begin to use edit summaries? Editors removing the text per the RFC most kindly used full and descriptive edit summaries about why the text was being removed. Since there are 530 articles to be reviewed, these edit summaries are helpful. When reinstating text already removed once, per the RFC-- knowing the reinstated text is controversial-- an edit summary should be more descriptive than "adjusted". SandyGeorgia (Talk) 22:01, 30 March 2020 (UTC)

Comments by User Doc James

Some like all encompassing RfC. I prefer very narrow ones. We can have more RfCs on other issues later. Doc James (talk · contribs · email) 22:09, 30 March 2020 (UTC)