Loading...



Shopping cart processing ...
0
Your cart0
Products 0
Price $0.00
Bestsellers Pill categories
Customer Support 24/7
usa canada USA
uk UK
au AU
Live Chat 24/7
Menu
Customer Support 24/7
USA/Canada Toll Free USA
UK UK
AUS AU
Customer Support 24/7
usacanada USA
uk UK
au AU
We accept
  • Visa
  • MasterCard
  • Amex
  • JCB
Currency
USD
Your cart: $0.00 (0 items)
Checkout

Categories list

Choosing us you get:

  • Reliable supplier
  • Low Internet prices
  • Free bonus pills
  • Discount on all future orders
  • Discreet package
  • SSL secure orders
Worldwide Shipping!

Testimonials:

  • Arnold Wallis Hamilton, Australia
    I recommend your on-line pharmacy without any hesitation as it is about three months when I take necessary pills and my life gets more comfortable and full, Thank you, my friends.
More info »

Zocor

Zocor
Zocor is a cholesterol- lowering medication prescribed to inhibit the production of cholesterol by the liver.

Brand: Simvastatin

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: May 2024
View product image
Package Price Per pill Save Order
Zocor 40 mg
180 pills - 40 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$276.95 $1.54 $214.63 Add to cart
120 pills - 40 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$199.99 $1.67 $127.73 Add to cart
90 pills - 40 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$159.91 $1.78 $85.88 Add to cart
60 pills - 40 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$121.95 $2.03 $41.91 Add to cart
30 pills - 40 mg $81.93 $2.73 No Add to cart
Zocor 20 mg
270 pills - 20 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$273.95 $1.01 $85.96 Add to cart
180 pills - 20 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$187.93 $1.04 $52.01 Add to cart
120 pills - 20 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$129.99 $1.08 $29.97 Add to cart
90 pills - 20 mg $99.99 $1.11 $19.98 Add to cart
60 pills - 20 mg $70.91 $1.18 $9.07 Add to cart
30 pills - 20 mg $39.99 $1.33 No Add to cart
Zocor 10 mg
270 pills - 10 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$209.99 $0.78 $104.56 Add to cart
180 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$144.55 $0.80 $65.15 Add to cart
120 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$100.93 $0.84 $38.87 Add to cart
90 pills - 10 mg $79.93 $0.89 $24.92 Add to cart
60 pills - 10 mg $58.99 $0.98 $10.91 Add to cart
30 pills - 10 mg $34.95 $1.17 No Add to cart
Zocor 5 mg
270 pills - 5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$199.99 $0.74 $105.92 Add to cart
180 pills - 5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$139.97 $0.78 $63.97 Add to cart
120 pills - 5 mg $95.93 $0.80 $40.03 Add to cart
90 pills - 5 mg $75.91 $0.84 $26.06 Add to cart
60 pills - 5 mg $55.95 $0.93 $12.03 Add to cart
30 pills - 5 mg $33.99 $1.13 No Add to cart

Product description

Drug title

Zocor (Simvastatin)

Pharmacological action

After oral administration simvastatin, which is inactive lactone, undergoes hydrolysis in liver to form active beta-hydroxy acid derivative, which is main metabolite with high inhibitory activity against HMG-CoA (3-hydroxy-3-methylglutaryl-Coenzyme A) reductase, enzyme that catalyzes initial and most important step of cholesterol biosynthesis. Clinical studies have demonstrated the effectiveness of Zocor in reducing total plasma cholesterol (X), low-density lipoproteins (LDL), triglycerides (TG) and very-low-density lipoproteins (VLDL), and increase high density lipoproteins (HDL) in patients with heterozygous familial and non-familial forms of hypercholesterolemia, as well as mixed hyperlipidemia in cases where elevated cholesterol is a risk factor and diet therapy alone is not enough. Noticeable therapeutic effect was achieved within 2 weeks of taking the drug, the maximum therapeutic effect - after 4-6 weeks of treatment. The effect is maintained during the continuation of treatment. When discontinuing simvastatin therapy, total cholesterol content returns to the baseline level observed before the start of treatment.


The active form of simvastatin is a specific inhibitor of HMG-CoA reductase, the enzyme that catalyzes the reaction of mevalonate formation from HMG-CoA. Because the conversion of HMG-CoA to mevalonate represents an early step in cholesterol biosynthesis, it is believed that use of Zocor should not cause accumulation of potentially toxic sterols in the body. In addition, HMG-CoA is also readily metabolized back to acetyl-CoA, which is involved in many biosynthesis processes in the body.


In the Scandinavian Study of the Effects of Simvastatin on Survival (4S), the effect of Zocor therapy on overall mortality (median patient participation time 5.4 years) was evaluated in 4444 patients with coronary heart disease (CHD) and baseline total cholesterol levels of 212-309 mg/dL (5.5-8.0 mmol/L). In this multicenter, randomized, double-blind, placebo-controlled trial, Zocor reduced the risk of overall mortality by 30%, CHD mortality by 42%, and the incidence of nonfatal myocardial infarctions confirmed in hospital settings by 37%. Zocor also reduced the risk of undergoing surgeries to restore blood flow (aorto-coronary bypass or percutaneous transluminal coronary angioplasty) by 37%. In patients with diabetes the risk of severe coronary complications was reduced by 55%. Moreover, Zocor significantly (by 28%) reduced the risk of fatal and nonfatal cerebrovascular events (strokes and transient cerebrovascular events).


In a 5-year, multicenter, randomized, double-blind, placebo-controlled Heart Protection Study (HeartProtectionStudy- HPS), the efficacy of Zocor therapy was demonstrated in 20536 patients with or without hyperlipidemia who were at high risk for CHD and comorbidities such as diabetes, stroke, other vascular disease. 33% of patients had LDL levels below 116 mg/dL, 25% had LDL levels between 116 mg/dL and 135 mg/dL, and 42% had LDL levels above 135 mg/dL.

In this study, simvastatin at a dose of 40 mg/day compared with placebo reduced the risk of overall mortality by 13%, CHD-related mortality by 18%, and the risk of serious coronary complications (including nonfatal myocardial infarction or CHD-related death) by 27%, the need for surgical interventions to restore coronary blood flow (including aorto-coronary bypass and percutaneous transluminal angioplasty) as well as peripheral blood flow and other types of noncoronary revascularization by 30% and 16%, respectively, and the risk of stroke by 25%. The frequency of hospitalizations for heart failure (HF) was reduced by 17%. The risk of serious coronary and vascular complications was reduced by 25% in patients with or without CHD, including patients with diabetes mellitus and patients with cardiovascular disease, including peripheral circulatory disorders. In patients with diabetes mellitus, Zocor® reduced the risk of serious vascular complications by 21%, including the need for surgery to restore peripheral blood flow (surgical or angioplasty), lower extremity amputation, and the occurrence of trophic ulcers.


In another multicenter, placebo-controlled study involving 404 patients using coronary angiography coronary blood flow quantification, Zocor® slowed the progression of coronary atherosclerosis and the development of both new lesions and new total occlusions, whereas patients who received standard therapy for 4 years showed a steady progression of atherosclerotic coronary artery lesions.


A subgroup analysis of 2 studies that included 147 patients with hypercholesterolemia (Fredrickson type IV hyperlipidemia) showed that Zocor® in dose from 20 to 80 mg/day reduced triglycerides to 21-39% (in placebo group 11-13%), LDL to 23-35% (in placebo group 1-3%), all lipoproteins other than HDL to 26-43% (in placebo group 1-3%) and increased HDL to 9-14% (in placebo group - to 3%).


In 7 patients with dysbetalipoproteinemia (Fredrickson type III hyperlipidemia), Zocor® at a dose of 80 mg/day reduced LDL, including LDL to 51% (in the placebo group to 8%) with LDL and LDL to 60% (in the placebo group to 4%).

Pharmacokinetics

Metabolism


The main active metabolites of simvastatin in blood plasma are betahydroxyacid and its 6'-hydroxy, 6'-hydroxymethyl, and 6'-exomethylene derivatives. Cmax in blood plasma of simvastatin metabolites is reached in 1.3-2.4 hours after a single dose. There is data about reaching Cmax of simvastatin and its metabolites in period up to 4 h and its slow decrease after 12 h by about 10%. When receiving simvastatin in recommended therapeutic doses (5-80 mg/day) a linear character of AUC profile of active metabolites in total blood flow is preserved. Linear dependence is preserved when increasing the dose up to 120 mg.


Simvastatin is an inactive lactone that is readily hydrolyzed to B-hydroxyacid, L-654,969, a potent HMG-CoA reductase inhibitor. The metabolite L-654,969 and 4 other active metabolites are present in plasma. HMG-CoA reductase inhibition underlies all pharmacokinetic studies of B-hydroxyacid metabolites (active inhibitors) and, following the basis of hydrolysis, active with latent inhibitors (all inhibitors). Both are determined in blood plasma when prescribing simvastatin.


About 85% of the oral dose of simvastatin undergoes absorption.


Distribution


After oral administration, higher concentrations of simvastatin are detected in the liver than in other tissues.


Content of active form of simvastatin L-654,969 in systemic blood flow is less than 5% of the orally taken dose, 95% of this amount is in protein-bound state. Active metabolism of simvastatin in liver (more than 60% in men) results in its low content in general blood flow.


The possibility of simvastatin penetration through the blood-brain barrier and the blood-placental barrier has not been studied.


Excretion


During the first passage through the hepatic bloodstream, simvastatin is metabolized with subsequent excretion of the drug and its metabolites with bile.


In the study, 100 mg of the drug was administered in capsules (5 x 20 mg), labeled simvastatin C14 accumulated in blood, urine and feces. About 60% of the labeled drug was detected in feces and only about 13% in urine.


The coefficient of variation of AUC in the total bloodstream was independent of the simvastatin dose. In this study, patients took oral simvastatin tablets at doses of 5, 10, 20, 60, 90, and 120 mg. Food intake (within standard hypocholesterol diet) immediately after simvastatin intake does not violate pharmacokinetic profile of the drug. Pharmacokinetic parameters when taking a single dose and long-term treatment with simvastatin show that simvastatin does not accumulate in tissues during long-term treatment. Cmax of inhibitors in blood plasma is reached within 1.3-2.4 h after drug administration.


In a study in patients with severe renal insufficiency (cratinine clearance less than 30 ml/min) after a single dose of the drug, plasma concentrations of total HMG-CoA reductase inhibitors were approximately 2 times higher than in healthy volunteers.

Contraindications to use

  • active phase of liver disease or persistent elevation of plasma transaminases of unknown etiology;
  • pregnancy;
  • period of lactation;
  • Hypersensitivity to any component of the drug.

Caution:


  • many of the patients who underwent rhabdomyolysis during simvastatin therapy had a complicated history, including renal failure, usually due to diabetes mellitus. Such patients require more careful monitoring. Simvastatin therapy should be temporarily discontinued in such patients a few days before major surgical interventions, as well as in the postoperative period;
  • patients with persistently elevated levels of serum transaminases, exceeding 3 times the upper limit of normal, the drug should be discontinued;
  • in patients with severe renal insufficiency (creatinine clearance less than 30 ml/min), the appropriateness of prescribing the drug in doses greater than 10 mg/day should be carefully weighed. If such doses are considered necessary, they should be administered with caution;
  • abuse of alcohol prior to treatment.

Use in pregnancy and lactation

Zocor is contraindicated and should not be administered to pregnant women or women who are expecting or planning to become pregnant.


Since the safety for pregnant women is not proven and there is no data that Zocor treatment during pregnancy is more beneficial than the risk for the fetus, the drug should be stopped immediately at the onset of pregnancy. If pregnancy occurs during treatment with Zocor, the drug should be withdrawn and the woman should be warned about the possible risk to the fetus.


There are no data on excretion of simvastatin into milk, but since a small amount of other drugs of this class is excreted into women's milk, women taking Zocor are not recommended to breastfeed due to the possibility of serious adverse reactions in children.


Use in liver dysfunction

In patients with persistently elevated serum transaminase levels exceeding 3 times the upper limit of normal, the drug should be discontinued.


Contraindicated:


  • Liver disease in the active phase or persistent elevation of plasma transaminases of unclear etiology.

Effect on the liver


In clinical trials, several adult patients receiving simvastatin have experienced sustained elevation of liver enzymes (more than 3 times the upper limit of normal). On discontinuation or interruption of the drug, transaminase activity usually gradually returns to baseline levels. Elevated transaminase levels are not associated with jaundice or other clinical symptomatology, but may be associated with deviations in the results of functional liver tests and/or alcohol abuse before the start of treatment. No hypersensitivity reactions were identified.


In the 4S study, the number of patients with more than one increase in serum transaminases (more than 3 times the upper limit of normal) did not differ significantly between the groups taking simvastatin and placebo 0.7% and 0.6%. Elevated serum transaminases caused discontinuation of treatment in 8 patients (out of 2221) in simvastatin group and in 5 patients (out of 2223) in placebo group. All patients in this study received a starting dose of 20 mg of simvastatin; in 37% the dose was increased to 40 mg.


In 2 controlled clinical trials in 1105 patients, drug-related persistent increases in transaminase levels were observed in 0.7% and 1.8% of cases when receiving 40 mg and 80 mg of the drug, respectively.


In the HPS study of 20536 patients with Zocor at a dose of 40 mg/day, the increase in serum transaminases (more than 3 times the upper limit of normal) was 0.21% (n=21) and 0.09% (n=9) in the simvastatin and placebo groups, respectively.


Liver function tests are recommended for all patients before treatment and thereafter according to clinical indications. Patients who plan to increase the dose of simvastatin to 80 mg/day should have additional liver function tests performed before switching to the indicated dosage, 3 months after starting treatment and periodically thereafter (e.g., once/half a year) during the first year of treatment. Special attention should be paid to patients with elevated serum transaminases. These patients should be repeated as soon as possible and thereafter regularly until their serum transaminase levels normalize. In cases where the level of transaminases increases, especially when they persistently exceed 3 times the upper limit of normal, the drug should be discontinued.


During treatment with simvastatin, as well as during treatment with other hypolipidemic agents, a moderate (less than 3 times the upper limit of normal) increase in serum transaminase activity was observed. These changes appeared soon after the start of treatment, were often transient, were not accompanied by any symptoms and did not require interruption of treatment.

Administration in renal impairment

As Zocor is excreted by kidneys in small amount, it is not necessary to change the dosage in patients with moderate renal insufficiency. In patients with severe renal insufficiency (creatinine clearance less than 30 ml/min), it is necessary to weigh up carefully the expediency of prescribing the preparation in dosages higher than 10 mg/day. If such doses are considered necessary, they should be prescribed with caution.


In severe renal insufficiency (creatinine clearance less than 30 ml/min), the appropriateness of prescribing the drug in doses greater than 10 mg/day should be carefully weighed. If such doses are considered necessary, they should be prescribed with caution.


Use in elderly patients

In patients over 65 years of age, the efficacy of Zocor, as assessed by the reduction in total and LDL cholesterol, is the same as in the general population, no significant increase in the incidence of clinical or laboratory adverse effects has been observed.


Indications of Zocor

In patients at high risk for CHD (with or without hyperlipidemia), such as patients with diabetes mellitus, patients with a history of stroke or other cerebrovascular disease, patients with peripheral vascular disease, or patients with CHD or predisposition to CHD, Zocor is indicated to


  • reduce the risk of overall mortality by reducing mortality due to CHD;
  • reducing the risk of serious vascular and coronary complications: nonfatal myocardial infarction, coronary death, stroke
  • revascularization surgery;
  • reducing the risk of the need for operations to restore coronary blood flow (such as aorto-coronary bypass and percutaneous transluminal coronary angioplasty);
  • reducing the risk of the need for surgical intervention to restore peripheral blood flow and other types of non-coronary revascularization;
  • reducing the risk of hospitalization for angina attacks.

Hypercholesterolemia - as an adjunct to diet, when the use of diet alone and other non-drug treatments is not enough, to:


  • Lowering elevated levels of total cholesterol, LDL cholesterol, triglycerides. apolipoprotein B (apo B);
  • to increase HDL cholesterol in patients with primary hypercholesterolemia, including heterozygous familial hypercholesterolemia (Fredrickson type IIa hyperlipidemia), or mixed hypercholesterolemia (Fredrickson type IIb hyperlipidemia);
  • reduced ratio of LDL cholesterol to HDL cholesterol and total cholesterol to HDL cholesterol;
  • hypertriglyceridemia (type IV hyperlipidemia according to Fredrickson classification);
  • addition to diet and other treatments for patients with homozygous familial hypercholesterolemia to reduce elevated levels of total cholesterol, LDL cholesterol, and apolipoprotein B;
  • primary dysbetalipoproteinemia (Fredrickson type III hyperlipidemia).

In patients with diabetes mellitus - Zocor reduces the risk of peripheral vascular complications (revascularization operations, amputation of lower limbs, trophic ulcers).


In patients with CHD with elevated cholesterol, Zocor reduces the development of coronary atherosclerosis, including the development of new lesions and complications.


Dosing regimen

Before the start of treatment with Zocor the patient should be prescribed a standard hypocholesterolemic diet, which should be followed during the whole course of treatment.


The recommended doses of Zocor are from 5 to 80 mg, to be taken once daily in the evening. When adjusting the dose of Zocor its adjustment should be made at intervals of not less than 4 weeks. Maximal daily dose is 80 mg.


Patients with coronary heart disease (CHD) or high risk of coronary heart disease


Standard initial dose of Zocor for patients with high risk of coronary heart disease (in combination with hyperlipidemia or without it - patients with diabetes mellitus, patients with stroke or other cerebrovascular disease in anamnesis, patients with peripheral vascular disease) and for patients with coronary heart disease or risk of its development is 40 mg/day 1 time/day in the evening. Drug therapy should be started simultaneously with diet and physical therapy.


Patients with hypercholesterolemia (not included in the above risk categories)


The usual starting dose is 20 mg/day, which is administered once daily in the evening. For patients who need a significant (more than 45%) decrease in LDL levels, the starting dose may be 40 mg once daily in the evening. For patients with mild to moderate hypercholesterolemia, Zocor can be administered in initial dose of 10 mg. Dose adjustment, if necessary, should be made in the manner described above.


Patients with homozygous familial hypercholesterolemia


Zocor is recommended in a dose of 40 mg/day taken once in the evening, or 80 mg/day in 3 doses: 20 mg in the morning, 20 mg in the afternoon and 40 mg in the evening. In such patients, Zocor is used as an adjunct to other cholesterol-lowering treatment (e.g., LDL plasmapheresis) or without other treatment, if it is not available.


Concomitant therapy


Zocor is recommended for use both as monotherapy and in combination with bile acid sequestrants.


In patients taking cyclosporine, danazol, gemfibrozil or other fibrates (except fenofibrate) or lipid-lowering doses (>1 g/day) of niacin together with Zocor the maximum recommended dose of Zocor is 10 mg/day. For patients taking amiodarone or verapamil concomitantly with Zocor the daily dose of Zocor should not exceed 20 mg


In renal failure.


As Zocor® is excreted by kidneys in small amount, it is not necessary to change the dosage in patients with moderate renal insufficiency. In severe renal insufficiency (creatinine clearance less than 30 ml/min), the appropriateness of prescribing the drug in doses higher than 10 mg/day should be carefully weighed. If such doses are considered necessary, they should be prescribed with caution.