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Doctors' Answers to "Frequently Asked Questions" - Zocor


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/23/2000]
Question: Is Zocor more effective when taken sublingually (rather than orally)?

Answer: I don't have any info on sublingual, but I would expect the oral to be a better absorption and hence more effective.

[posted 09/14/2000]
Question: My doctor recently prescribed Zocor to help lower my LDL cholesterol levels, and he told me it has recently been identified as being an inhibitor to the development of osteoporosis. Is this true?

Answer: Possibly, but early data.

[posted 07/30/2000]
Question: I just started taking Zocor because my cholesteral is high. I also use Nizoral Shampoo (ketoconazole) 2% about once a week. I saw in the Zocor warnings not to take Ketoconazole. Does this apply only to tablets and not to shampoo. thanks

Answer: Tablets only.

[posted 08/5/2000]
Question: Within 12 hours of taking my first dose of Zocor, I felt less friction in my joints (knees). Is this a result of lower cholesterol?

Answer: No.

[posted 06/12/2000]
Question:
I have been taking Zocor (20 mg) for high cholesterol since 7/95 and now my insurance company tells me I have to take a generic brand. My choice is either Lipitor or Pravachol. My questions is will there be any type of drug reaction with the change in medication for my cholesterol condition. Other medications I am taking are Armour Thyroid for underactive thyroid (105 mg), Premarin (.3 mg), clonazepam (.50 mg), plus vitamin E (400 i.u.).

Several years ago I had an adverse drug reaction when the doctor tried to change my thyroid medication (Armour) to Synthroid. I was extremely sick for several years with severe head pain, balance problems, a change in vision and other problems and finally went to the Lahey-Clinic in Burlington, MA where the psychopharmacologist placed me on clonazepam to help with the problems.

I am not familiar with either Lipitor or Pravachol and am rather hesitant about this change in medication. Any help you can give would be greatly appreciated.

Answer: They are more alike than different. Lipitor is structurally closer than Pravachol, but I doubt that you will see any difference with these two versus Zocor.

[posted 06/7/2000]
Question: I just started on the cholestrol reducing drug Zocor. For the last 10 years I started my day with a glass of grapefruit juice. Zorcor indicates not to drink grapefruit juice while taking it, due to interactions. What is the connection with Zocor and grapefruit juice, and why not any other citrus juice?

Thank you for your time in answering my question.

Answer: Grapefruit is thought to affect the p450 system of the liver which is responsible for the degradation of zocor, hence affecting your blood levels of the drug.

[posted 05/15/2000]
Question: I have been taking Zocor for several years, and have begun experiencing a continuous pain in the area of my trigeminal nerve. A friend of mine, also taking Zocor for high cholesterol, has had similar experiences. She has gone off the medication and the pain subsided. I recently stopped taking the Zocor and the pain has been lessened substantially. Can Zocor can be the cause of this problem, or is it possibly unrelated? What recommendations can you make for a substitute medication?

Answer: I'm not aware of this side effect. Depending on your level of cholesterol Triclor, Lopid, Questran would be the other drugs, but they tend not to be as efficient as Zocor. I would suspect that any of the drugs in the class of HMG Co A Reductase Drugs would have this effect, but Pravachol might be an option since it tends to be more lipid soluble.

[posted 04/28/2000]
Question: I am 31 years old and have high cholesterol. My doctor just put me on Zocor. I still want to have kids and I brought up that concern with my doctor. The doctor says when your ready will just take you off the medicine. I see all of these warning signs don't get pregnant and they are starting to scare me. I want to know what harm if any this will bring to myself or the baby if I become pregnant while on Zocor or even if I stop taking the medicine and then get pregnant.

Any help would be appreciated,

Kim

Answer: Probably not a major risk if you check closely. We do stop the medication when someone is pregnant and there is no absolute information on human risk(all animal studies)but, the first 6 weeks or so is probably a minor risk.

[posted 04/5/2000]
Question: I have recently heard/read that large doses of Vitamin C,
taken daily with Zocor (40 mg), will cancel the positive
effects of Zocor in reducing cholesterol. I have recently
been taking 8000 mg of C every day. Any thoughts or
suggestions? Thanks.

Answer: I haven't heard this. Vitamin C is an antioxidant and has been studied repeatedly in coronary artery disease. This has usually been as a preventive, and the studies have been equivical with no major advantage (or disadvantage) so I suspect there is no interaction. You can call the manufacturer, they may have more information, Merck 800-672-6372.

[posted 03/31/2000]
Question: I am currently taking 10mg of Lipitor. My last cholesteral count was 189. However, due to insurance coverage, my doctor wants to switch me to Zocor, but says that I will need to take 20mg of Zocor to equal the 10mg of Lipitor. Does this seem right --- a higher dosage of Zocor?

Answer: That's what the recommendations are. Zocor is less efficient per milligram than Lipitor.

[posted 03/23/2000]
Question: I have beeen having some side effects from Zocor, such as the swelling of my legs. Do you suggest a different medication for me?

Answer: This isn't a usual problem with Zocor, I would look for other causes. However, Lopid or Triclor would be ok, depending on your cholesterol level.

[posted 03/23/2000]
Question: I have beeen having some side effects from Zocor, such as the swelling of my legs. Do you suggest a different medication for me?

Answer: This isn't a usual problem with Zocor, I would look for other causes. However, Lopid or Triclor would be ok, depending on your cholesterol level.

[posted 03/10/2000]
Question: Good morning,

I have been taking Zocor (40mg) for years. I lately discovered that I was 3 weeks pregnant and immediately stopped taking the medication. Prior to those 3 weeks, I was off Zocor for two months in order to run some tests.

My doctor tells me I have little to worry regarding the health of my baby (birth defects) for taking the medication only 3 weeks. I am looking for a second opinion.

Thank you,
France Landreville

Answer: Zocor is not to be used in pregnancy. Studies in rats and mice have shown no teratogenic potential of the drug and as far as I can tell it has to do with the necessity of cholesterol for development of the neurologic system. The PDR recommends cessation as soon as you are known to be pregnant which you did. I would doubt that there is much risk at this point.

[posted 02/1/2000]
Question: I am currently taking Zocor. Have seen a warning that I should not drink grapefruit juice while taking this medication. What is your opinion?

Answer: Grapefruit juice is thought to enhance the p450 enzyme system in the liver, responsible for metabolism of zocor(among others). It may reduce its effectiveness by enhancing its degradation, I have not seen specific studies on zocor, but theorectically true. You can check with Merck for more data, 800-672-6372.

[posted 01/30/2000]
Question: My daughter, Anne, is taking Zocor for an inherited cholestrol problem (total cholestrol-441), which is working well. Her father died at age 42. However, she has developed painful morning arthritic-type symptoms in all of her joints, which subsides during the day but is still there. She is presently waiting for blood-test results from a rheumatoligist to see what is wrong. The onset of symptoms came after switching from 10mg to 20mg of Zocor. I took her off of Zocor 3 days ago to eliminate the possibility of drug-interaction. I am going to take her to a lipid specialist, too (our family doctor prescribed Zocor). How long does it take for Zocor to be elimiated from the system?
Would you send a copy of your answer to my office email, that I usually look at throughout the day?
email copy: Carol_Cortino@nps.gov
Thank you,
Carol Cortino

Answer: The zocor will be biologically absent in 24-36 hours. However, if there is some inflammation due to the zocor, it may take a couple of weeks. There is a lot of muscle inflammation with this class of drug(1% or patients)but, joint findings would be very,very unusual. However, it does no harm to stop it for few weeks. Rather than a lipid specialist, I would suggest a Rheumatologist for her joints.

[posted 01/12/2000]
Question: My doctor has me on zocor and zestril. When is the best time to take them. I currently take them at lunch with my vitamins. Do they counteract with any vitamins (A, E, any B's)? Should they be taken at different times of day for max benefit?

Answer: The cholesterol lowering drugs are best taken at bedtime, but hard to know if it really makes a difference. Zestril is not quite a 24 hour drug. Most recommend it a night, but, watch your blood pressure. If ok in the am and pm, it probably doesn't matter. I'm not aware of any conflicts with vitamins. There is no reason to take them apart per se.

[posted 11/12/1999]
Question: I've been taking Hydrochlorothiazide (for elevated blood pressure) for about half a year.
I then started Zocor (for colosterol) and in about three weeks became depressed.
Not incapacitated, but I have all of the following to a certain degree: loss of appetite, insomnia, general apathy, anxiety, fits of crying.
It's slowly improving but I was woundering if you know of drug interactions with these medications?
Thank you for any help.

Answer: None that I am aware of.

Lipitor vs. Zocor [posted 1/13/99]
Question: What are the pros and cons on Lipitor vs. Zocor? Is one preferred over the other?

Answer: They're pretty similar. Lipitor is somewhat more potent mg for mg, but they have similar side effects and lowering of cholesterol. I use them interchangeably.

Zocor [posted 1/13/99]
Question: Do you have any information on Zocor?

Answer: Zocor is a HMG Co A Reductase drug used to lower cholesterol by inhibiting an enzyme in the liver responsible for cholesterol metabolism. Usually fairly symptom free, but will need ongoing liver function tests and regular medical evaluations.

Zocor vs. Lipitor [posted 12/10/98]
Question: I have been taking Zocor for aprox. two years now and it has dramatically lowered my cholesterol level. Recently my health care provider has informed me that they will no longer pay for the Zocor and has suggested other drugs. My doctor now has me taking Lipitor instead. I am now experiencing depression and sore muscles. Is there a big difference between the two drugs?

Answer: Lipitor is a little more potent and I have some patients who have side effects with Lipitor who do not on Zocor. Usually, if your doctor documents this they will make an exception. Also, you can basically cut your cost in 1/2 by buying double your dosage and cutting them in 1/2 with a pill splitter available in any pharmacy.

Zocor Reaction [posted 8/12/98]
Question: I have been taking Zocor now for four days and have experienced tremendous insomnia. I was told by my pharmacists to take the one pill a day the last thing after eating before bedtime. I have followed those instructions and I get wide awake, with no desire to sleep. Last night I stayed awake until 4:30 a.m. before ever dropping off to sleep. Has any one else had such a reaction?

Answer: Not a common effect. Try taking it first thing in the morning. Theoretically, taking it at night will have a better effect on cholesterol, but if your sleep is involved, try the early morning.

Zocor Side Effect? [posted 8/11/98]
Question: Are there any reports on Zocor as a contributor to so called floppy valves?

Answer: No.

Zocor and Impotence [posted 8/11/98]
Question: Can Zocor cause impotence as a side effect?

Answer: I have had two patients who complain of this. However, it is hard to know if it is the medication or hardening of the arteries (the reason you take the drug in the first place). If you stop the drug it would clearly be gone by 1-2 weeks. If you see no difference, it is not the drug. In general, I do not see this problem with the drug.

Zocor Side Effects [posted 7/31/98]
Question: I would like to know if stomach problems can occur while taking zocor. I have been taking zocor fro 3 months. The last couple of weeks I have been have gastro problems. When I eat a meal, I immediately start to burp and feel terrible. Sometimes it starts at breakfast and sometimes it doesn't bother me at all. I also take vitamins and I have stopped most of my vitamins to see if it is the zocor that is doing it. I also take 10 grams of prinivil a day.

Answer: Very uncommon on zocor unless it is liver toxicity. Have your liver functions been checked?

Zocor Side Effect [posted 7/30/98]
Question: Can there be side effects from Zocor that could cause impotency?

Answer: Uncommon to rare.

Zocor - Effect on Liver [posted 7/23/98]
Question: What can you tell me about the drug zocor? I am concerned about side effects to my liver.

Answer: Zocor belongs to a class of drugs called HMG-Co A Reductase drugs. This is a class which inhibits one of the enzymes in the liver responsible for regulation of cholesterol metabolism. In effect, the switch that turns cholesterol metabolism on and off. Since 85% or so of your cholesterol is made by your liver this is a powerful drug. Zocor is one of the more efficient drugs in this class and is used extensively. Occasional patients (one in 300 or so) will experience liver problems and the drug will need to be stopped. This will necessitate liver monitoring (blood tests). However, if the liver enzymes rise, the drug can be stopped before any damage occurs. I monitor my patients every 3-4 months the first year and about every 6 months after that. In the lower dosing necessary for most patients (40 mg a day or less), the drug is incredibly safe. You will need monitoring, but the risk is almost nil.

Zocor
Question: It has been recommended by my doctor that I take zocor to lower my cholesterol level. However, since being diagnosed with fibromyalgia I have been taking arthrotec and paxil. Would there be any adverse effects? Muscle and joint pain are already being experienced, before taking zocor.

Answer: Shouldn't be a problem. In view of the ongoing muscle pain, I'd check CPK values to ensure they don't elevate with zocor. This is an uncommon problem About 1% or less of patients have side effect.

Zocor Reactions
Question: Other than manufacturer information, is there any information dealing with reactions to the cholesterol lowering drug zocor? Specifically, male breast enlargement with associated pain and increased nerve sensitivity.

Answer: Breast enlargement is one of the potential risks. I have about 1-2% of patients with thisproblem. Initially, I was a disbeliever, but I've seen it enough now to understand that it is real. Why it hits some and not others is unclear. You might try other lipid lowering agents like Pravachol. I've had some luck with this.

Zocor Side Effects
Question: I had been taking Zocor for approximately 7 years from 1989 to 1996. While taking the drug I suffered general debility on a number of occasions and definite mood swings. I also suffered quite frequently from digestive related problems and back pains. I also felt that I was very susceptible to any virus I came into contact with, suffering severe flu on a number of occasions. I stopped taking the drug approximately one year ago and after a matter of weeks I felt that I was much fitter in myself and my mental state appeared to be much more stable. In this time I had no days off work due to any sickness. I revisited my local hospital some weeks ago and advised them of the improvement in my health, but despite my protestations the doctor insisted that I recommence treatment with Zocor. Within a matter of days my general health had deteriorated and I contracted a severe bout of flu which I have still not shaken and is now affecting my chest quite severely. My doctor keeps insisting that there is no connection and that any side-effects from Zocor are only very mild digestive related disorders. Any further information on the side-effects of Zocor would be appreciated along with any confirmation as to whether my symptoms are related.

Answer: This is unusual, but if it affects you this way, it does. I suspect that the flu like feeling really is a drug interaction rather than a true infection. That is, your body’s reaction to the drug. Zocor is generally well tolerated, but some individuals will experience the less common side effects. Common side effects include liver toxicity, occasional muscle inflammation, and rash. If it makes you feel crummy stop taking it.

Zocor
Question: I would like to know if there are any side effects to this medicine?

Answer: Zocor(simvastatin) is one of class of cholesterol lowering agents referred to as HMG-CoA reductase inhibitor. This is an enzyme in the liver responsible for the production of cholesterol by the liver. Inhibition of this enzyme will reduce the production of cholesterol by the liver; hence, lowering total cholesterol. Because it is a selective inhibitor of one enzyme, it tends to have few side effects. However, like any medicine it has potential problems. These include potential liver toxicity(necessitating regular liver tests), occasional patients have some sort of reaction with muscle inflammation(occasionally severely so) for unclear reasons. There are other side effects like rashes, but it is usually very well tolerated if liver functions are checked and there is no muscle inflammation.

Zocor vs. Mevacor
Question: My husband is 44 and has a congenital heart valve problem, which throws blood back to the heart and therefore the heart is enlarged. He was taking Mevacor and questran for mildly high cholesterol. His cardiologist suggested that he switch from Mevacor to Zocor because there is less effect on the liver. Our primary physician says this is not the case and that mevacor and zocor are basically the same. Which doctor is correct?

Answer: They both have similar effects on the liver. However, zocor is more effective and will get a lower cholesterol for the same risk.

Irregular Heartbeat
Question: I take zocor and plendil for high blood pressure and have been taking it for about 1yr. with in the last month or so my heart feels like it is skipping beats at times. Also I’ve been getting sore spots on my gums and roof of my mouth that last a few days then clears up and then comes back in awhile. I have had arrhythmia before about 5 yrs ago and it cleared up in about 1 week. My doctor run tests and didn't seem to be to worried about it. I just wonder if it is the medicine that I am taking that could be causing this. Since I’ve been on the medication I just haven't felt right. I’m 45 yrs old if that matters. I’ve been on high blood pressure medicine for about 10 yrs. and zocor for about 2 yrs. thanks for your time

Answer: I suspect if you were going to have a problem it would have been at first. It is unusual to develop these problems in the course of taking them. One exception would be if Zocor is causing liver function abnormalities-easily checked with a blood test. However, depending on your blood pressure stop it for a few days and see what happens with the arrhythmia. This will need to be coordinated with your MD to watch your BP off the medications.




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