20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           :
10 to 20     : mg daily. In severe renal impairment doses above 10 mg should be used with caution (doses up to 40 mg have been used)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
HD                     :Unlikely to be dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anti-arrhythmics: increased risk of myopathy with amiodarone – do not exceed 20 mg of simvastatin.1
Antibacterials: increased risk of myopathy with clarithromycin, daptomycin, telithromycin and erythromycin – avoid concomitant use; increased risk of myopathy with fusidic acid
Anticoagulants: effects of coumarins enhanced
Antifungals: increased risk of myopathy with itraconazole, posaconazole or ketoconazole and possibly miconazole – avoid concomitant use; possibly increased risk of myopathy with imidazoles and triazoles
Antivirals: increased risk of myopathy with atazanavir, indinavir, nelfinavir, ritonavir or saquinavir and possibly amprenavir or lopinavir – avoid concomitant use; concentration reduced by efavirenz
Calcium-channel blockers: increased risk of myopathy with verapamil and possibly diltiazem – do not exceed 20 mg of simvastatin with verapamil or 40 mg with diltiazem.1
Ciclosporin: increased risk of myopathy – do not exceed 10 mg of simvastatin.1Grapefruit: increased risk of myopathy – avoid concomitant useHormone antagonists: possibly increased risk of myopathy with danazol – do not exceed 10 mg of simvastatin.1Lipid-lowering agents: increased risk of myopathy with fibrates – do not exceed 10 mg of simvastatin except with fenofibrate;1 gemfibrozil –avoid; and nicotinic acid