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PACKAGE LEAFLET: INFORMATION FOR THE USER
SIMZAL 10 mg, 20 mg & 40 mg FILM-COATED TABLETS
Read all of this leaflet carefully before you start taking this medicine.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even
if their symptoms are the same as yours.
• If any of the side effects get serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
IN THIS LEAFLET:
1. What Simzal is and what it is used for
2. Before you take Simzal
3. How to take Simzal
4. Possible side effects
5. How to store Simzal
6. Further information
WHAT SIMZAL IS AND WHAT IT IS USED FOR
Simzal belongs to a group of drugs called HMG-CoA reductase inhibitors. These reduce the amount
of cholesterol and triglycerides (fatty substances) in your blood.
Simzal is used:
to reduce your risk in the future of developing coronary heart disease or having a heart attack or
stroke, if you have raised levels of cholesterol but do not have coronary heart disease
to reduce your risk of having a further heart attack or stroke, if you have already had a heart
attack or have unstable angina
to reduce increased lipid levels, if you have had an organ transplant and are taking medication to
stop your body rejecting the transplant.
Some further information:
• While cholesterol is vital for the normal functioning of the body, if the level in the blood
becomes too high it can build up on the walls of the arteries. Eventually blood vessels can
become blocked. Only a small amount of cholesterol comes from our diet, the majority is made
by our own livers. The body produces most cholesterol at night.
• Even though you may be on a low fat diet, your doctor has done some blood tests which show
that you still have too much fat (including cholesterol) in your blood. A high cholesterol level is
generally recognised as adding to the risk of heart disease. Additional factors such as existing
heart disease, high blood pressure, diabetes, being overweight, lack of exercise and smoking can
also greatly increase the risk of the development or progression of heart disease.
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BEFORE YOU TAKE SIMZAL
Do NOT take Simzal if you:
• are allergic (hypersensitive) to simvastatin or any of the other ingredients of this medicine
• have liver disease
• are pregnant or breast-feeding (see Pregnancy and breast-feeding section).
• are taking any of the medicines listed under Taking other medicines, DO not take Simzal in
Take special care with Simzal
Tell your doctor before you start to take this medicine if you:
• have kidney problems
• are over 70 years of age
• have a history of liver problems
• have an underactive thyroid gland
• have an hereditary muscular disorder, or a family history of such problems.
• have previously suffered from side effects affecting your muscles when taking another
cholesterol lowering medicine such as a statin or a fibrate e.g. gemfibrozil
• have problems with alcohol abuse (regularly drinking large amounts of alcohol).
• have severe respiratory failure
While you are on this medicine your doctor will monitor you closely if you have diabetes or are at
risk of developing diabetes. You are likely to be at risk of developing diabetes if you have high
levels of sugars and fats in your blood, are overweight and have high blood pressure.
If you have suffered from any of these problems, your doctor will need to carry out a blood test
before and possibly during Simzal treatment to assess your risk of developing muscle-related side
Taking other medicines
Do NOT take Simzal in combination with:
• itraconazole , ketoconazole, fluconazole or posaconazole (used to treat fungal infections)
• HIV protease inhibitors e.g. nelfinavir, ritonavir or indinavir (used for treatment of HIV
• erythromycin, clarithromycin or telithromycin (used to treat infections)
• nefazodone (an antidepressant).
Talk to your doctor if you are taking any of the following:
• other drugs to lower your lipid (fat) levels e.g. gemfibrozil, bezafibrate, fenofibrate or large
doses (more than 1 g per day) of niacin or nicotinic acid
• drugs known as bile acid sequestrants (a class of drugs that prevents bile acids being reabsorbed
from the digestive system, so promoting conversion of cholesterol into bile acids) e.g.
colestyramine, colestipol. (Please see section 3, Taking in combination with a bile acid
• ciclosporin (an immunosuppressant used after an organ transplant)
• amiodarone, verapamil or diltiazem (used to treat abnormal heart rhythms)
• coumarin derivatives e.g. warfarin (used to stop the blood clotting)
• danazol (used to correct hormonal imbalances)
• amlodipine (used to treat high blood pressure and chest pain)
• fusidic acid (used to treat infections)
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colchicine (used to treat gout)
rifampicin (used to treat tuberculosis)
digoxin (to treat heart conditions).
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines,
including medicines obtained without a prescription.
Taking Simzal with food and drink:
• avoid drinking grapefruit juice as it can affect the way your medicine works
• keep alcohol intake to a minimum
• your doctor will have explained the importance of a low fat diet as well as taking Simzal.
Pregnancy and Breast-feeding
Do not take Simzal if you are pregnant or breast-feeding, or if you are planning to become pregnant.
Ask your doctor or pharmacist for advice before taking any medicine.
Safety and effectiveness have been studied in 10-17 year old boys and in girls who had started their
menstrual period at least one year before (see HOW TO TAKE SIMZAL). Simzal has not been
studied in children under the age of 10 years. For more information talk to your doctor
Driving and using machines
Simzal may cause dizziness if you are affected do not drive or operate machinery.
Important information about some of the ingredients in your medicine
Patients who are intolerant to lactose should note that Simzal film-coated tablets contain a small
amount of lactose. If you have been told by your doctor that you have an intolerance to some
sugars, contact your doctor before taking this medicinal product.
3. HOW TO TAKE SIMZAL
Always take Simzal exactly as your doctor has told you. You should check with your doctor or
pharmacist if you are not sure.
The tablets should be swallowed whole, preferably with a drink of water.
You should stay on a cholesterol-lowering diet while taking Simzal.
The dose is 1 Simzal 5 mg, 10 mg, 20 mg, 40 mg, or 80 mg tablet by mouth once a day.
The 80 mg dose is only recommended in for adult patients with very high cholesterol levels and at
high risk of heart disease problems.
The usual dosage instructions are given below:
Adults (including the elderly)
• High cholesterol (hypercholesterolaemia)
The usual starting dose is 10 – 20 mg daily taken as a single dose each evening. When a large
reduction in cholesterol is required you may be started on 20 - 40 mg daily taken as a single
dose each evening. Your doctor may increase this up to a maximum of 80 mg daily, though this
is only recommended in severe cases of very high cholesterol where there is a high risk of heart
complications. If your dose needs to be adjusted this will be done at intervals of not less than
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Homozygous familial hypercholesterolaemia (an inherited disorder)
The recommended dosage is 40 mg daily in the evening or 80 mg daily in three divided doses of
20 mg, 20 mg and an evening dose of 40 mg.
Prevention of coronary heart disease (CHD)
The usual dose is 20 – 40 mg daily taken as a single dose in the evening.
Taking in combination with a bile acid sequestrant
Simzal may be given in combination with a bile acid sequestrant e.g. colestyramine or
colestipol. Simzal should be taken either 2 hours before or 4 hours after you have taken the bile
acid sequestrant, as the absorption of Simzal can be affected by these medicines if taken too
For patients taking certain other medicines your doctor may prescribe a lower dose of Simzal.
Patient with kidney problems
If you have severe kidney problems, your doctor may prescribe a lower dose.
Children and adolescents
For children (10 -17 years old), the recommended usual starting dose is 10 mg a day in the evening.
The maximum recommended dose is 40 mg a day.
If you take more Simzal than you should
If you (or someone else) swallow a lot of the tablets all together, or if you think a child has
swallowed any of the tablets, contact your nearest hospital casualty department or your doctor
immediately. Please take this leaflet, any remaining tablets and the container with you to the
hospital or doctor so that they know which tablets were consumed.
If you forget to take Simzal
If you forget to take a tablet, take one as soon as you remember, unless it is nearly time to take the
next one. Do not take a double dose to make up for a forgotten tablet.
If you stop taking Simzal
Do not stop taking your medicine without talking to your doctor first even if you feel better.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. POSSIBLE SIDE EFFECTS
Like all medicines, Simzal can cause side effects, although not everybody gets them.
If the following happens, stop taking the tablets and tell your doctor immediately or go to the
casualty department at your nearest hospital:
• an allergic reaction (swelling of the face or neck, muscle and joint pain, hives, fever, flushing,
shortness of breath).
This is a very serious but rare side effect. You may need urgent medical attention or hospitalisation.
Contact your doctor as soon as possible and stop taking Simzal if you develop:
• any unexplained or persistent muscle pain, tenderness, weakness or cramps, especially, if at the
same time you feel unwell or have a high temperature. In rare cases this can progress to become
a serious and potentially life threatening condition, called rhabdomyolysis.
• breathing problems including persistent cough and/or shortness of breath or fever
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The following side effects have been reported at the approximate frequency shown:
Very Rare (affecting fewer than one person in 10,000)
• liver failure
• shortness of breath, dry cough, weight loss, fatigue (Interstitial lung disease)
Rare (affecting fewer than one person in 1,000 but more than one person in 10,000):
• muscle pain, cramp, wasting of the muscles with or without acute kidney failure (diagnosed
by urine or blood tests), swelling of muscles, muscle weakness
• headache, dizziness, lethargy
• constipation, abdominal pain, indigestion, wind, diarrhoea
• feeling sick or being sick
• pins-and-needles or numbness, loss of sensation
• yellowing of the skin and whites of the eyes (jaundice)
• hepatitis (inflammation of the liver)
• anaemia, a reduction of red blood cells, causing unusual tiredness or weakness
• hair loss
• rash, itching
• pancreatitis (inflammation of the pancreas)
• increases in certain enzyme levels in the body
• a hypersensitivity syndrome which includes a number of symptoms together, such as rashes
on various parts of the body including the eyelids, bruise like rashes, blood disorders
(characterised by fever or chills, sore throat, ulcers in the mouth or throat), stiffness in the
muscles and joints, intolerance to light, fever, flushing, difficulty breathing and a general
feeling of being unwell.
Uncommon (affecting fewer than one person in 100 but more than one person in 1000):
• sleep disturbances (including insomnia and nightmare)
• memory loss
• sexual difficulties.
Diabetes. This is more likely if you have high levels of sugars and fats in your blood, are
overweight and have high blood pressure. Your doctor will monitor you while you are taking this
If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please
tell your doctor or pharmacist.
5. HOW TO STORE SIMZAL
Keep out of the reach and sight of children. Do not store above 25°C. Keep container in the outer
carton. Do not transfer to another container. Do not use Simzal after the expiry date shown on the
outer packaging. The expiry date refers to the last day of that month. Medicines should not be
disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines
no longer required. These measures will help to protect the environment.
6. FURTHER INFORMATION
What Simzal tablets contain:
• The active ingredient is Simzal (10 mg, 20 mg or 40 mg).
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The other ingredients are ascorbic acid, butyl hydroxyanisole (E320), citric acid monohydrate,
lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinised maize
starch, hypromellose, macrogol, triacetin, and titanium dioxide (E171).
The 10 mg tablets also contain red, yellow and black iron oxide (E172).
The 20 mg tablets also contain red and yellow iron oxide (E172).
The 40 mg tablets also contain red iron oxide (E172).
What Simzal tablets look like and contents of the pack:
• The10 mg tablets are peach coloured, oval-shaped, film-coated tablets marked “10” on one side,
and plain on the other.
• The 20 mg tablets are tan coloured, oval-shaped, film-coated tablets marked “20” on one side,
and plain on the other.
• The 40 mg tablets are pink coloured, oval-shaped, film-coated tablets marked “40” on one side,
and plain on the other.
The tablets are available in pack sizes of 10, 20, 28, 30, 50, and 100 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
The Marketing Authorisation holder and company responsible for manufacture: TEVA UK Limited,
Eastbourne, BN22 9AG.
The Marketing Authorisation holder: TEVA UK Limited, Eastbourne, BN22 9AG.
Company Responsible for Manufacture: Teva Pharmaceutical Works Co. Limited, Pallagi Street 13,
H-4042, Debrecen, Hungary.
This leaflet was last revised: March 2012
PL 00289/0379- 0381
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.