Zocor

[simvastatin]

Additional Info
General Recommendations

Prior to initiating therapy with simvastatin, secondary causes for hypercholesterolemia (e. g., hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, alcoholism) should be excluded, and a lipid profile performed to measure total-C, HDL-C, and TG. For patients with TG less than 400 mg/ dL (< 4.5 mmol/ L), LDL-C can be estimated using the following equation:
LDL-C = total-C – [( 0.20 x TG) + HDL-C] For TG levels > 400 mg/ dL (> 4.5 mmol/ L), this equation is less accurate and LDL-C concentrations should be determined by ultracentrifugation. In many hypertriglyceridemic patients, LDL-C may be low or normal despite elevated total-C. In such cases, ZOCOR is not indicated. Lipid determinations should be performed at intervals of no less than four weeks and dosage adjusted according to the patient's response to therapy. The NCEP Treatment Guidelines are summarized in Table 6:

TABLE 6
NCEP Treatment Guidelines:
LDL-C Goals and Cutpoints for Therapeutic Lifestyle Changes and Drug Therapy in Different Risk Categories

Text Continues Below

---

Risk Category LDL Goal (mg/ dL)

LDL Level at Which to Initiate Therapeutic Lifestyle Changes (mg/ dL)

LDL Level at Which to Consider Drug Therapy (mg/ dL)

CHD * or CHD risk equivalents
(10-year risk >20%)

2+ Risk factors
(10 year risk 20%)

0-1 Risk factor §

<100
<130
<160

100
130
160

130 (100-129: drug optional) *
10-year risk 10-20%: 130
10-year risk < 10%: 160

190 (160-189: LDL-lowering drug
optional)

* CHD, coronary heart disease
* Some authorities recommend use of LDL-lowering drugs in this category if an LDL-C level of <100 mg/ dL cannot be achieved by therapeutic lifestyle
changes. Others prefer use of drugs that primarily modify triglycerides and HDL-C, e. g., nicotinic acid or fibrate. Clinical judgment also may call for
deferring drug therapy in this subcategory.
§ Almost all people with 0-1 risk factor have a 10-year risk <10%; thus, 10-year risk assessment in people with 0-1 risk factor is not necessary.

Page:  1 | 2 | Next >>