первичная гиперхолестеринемия IIа и IIb типа (при неэффективности диетотерапии у пациентов с повышенным риском развития коронарного атеросклероза), комбинированная гиперхолестеринемия и гипертриглицеридемия, гиперлипопротеинемия, не поддающаяся коррекции специальной диетой и физической нагрузкой.
профилактика инфаркта миокарда (для замедления прогрессирования коронарного атеросклероза), инсульта и преходящих нарушений мозгового кровообращения.
Гиполипидемический препарат, получаемый синтетическим путем из продукта ферментации Aspergillus terreus. Является неактивным лактоном, в организме подвергается гидролизу с образованием гидроксикислотного производного. Активный метаболит ингибирует 3-гидрокси-3-метил-глутарил-КоА-редуктазу (ГМГ-КоA-редуктазу), фермент, катализирующий начальную реакцию образования мевалоната из ГМГ-КоА. Поскольку превращение ГМГ-КоA в мевалонат представляет собой ранний этап синтеза холестерина (Хс), то применение симвастатина не вызывает накопления в организме потенциально токсичных стеролов. ГМГ-КоA легко метаболизируется до ацетил-КоА, который участвует во многих процессах синтеза в организме.
Снижает концентрацию ТГ, ЛПНП, ЛПОНП и общего холестерина (Хс) в плазме (в случаях гетерозиготной семейной и несемейной форм гиперхолестеринемии, при смешанной гиперлипидемии, когда повышение содержания Хс является фактором риска). Уменьшает соотношение ЛПНП/ЛПВП и общий Хс/ЛПВП. Начало действия - через 2 нед. от начала приема, максимальный терапевтический эффект - через 4-6 нед. Действие сохраняется при продолжении лечения; при прекращении терапии содержание Хс возвращается к исходному уровню (до начала лечения).
Фармакокинетика
Всасывание и распределение
После приема внутрь симавстатин в высокой степени абсорбируется из ЖКТ. После приема внутрь Сmax достигается через 1.3-2.4 ч и снижается на 90% через 12 ч. Связывание с белками плазмы крови составляет 95%.
Метаболизм и выведение
Симвастатин подвергается эффекту "первого прохождения" через печень. Гидролизируется в основном в свою активную форму бета-гидроксикислоту. Обнаружены также другие активные и неактивные метаболиты. Метаболизм осуществляется при участии изоферментов CYP3A4, CYP3A5 и CYP3A7. Т1/2 активных метаболитов составляет 1.9 ч. Выводится в основном с каловыми массами (60%) в виде метаболитов. Около 10-15% выводится почками в неактивной форме.
Показания к применению
первичная гиперхолестеринемия IIа и IIb типа (при неэффективности диетотерапии у пациентов с повышенным риском развития коронарного атеросклероза), комбинированная гиперхолестеринемия и гипертриглицеридемия, гиперлипопротеинемия, не поддающаяся коррекции специальной диетой и физической нагрузкой.
профилактика инфаркта миокарда (для замедления прогрессирования коронарного атеросклероза), инсульта и преходящих нарушений мозгового кровообращения.
Препарат противопоказан при печеночной недостаточности; острых заболеваниях печени и при повышении активности печеночных трансаминаз неясного генеза.
Противопоказания
печеночная недостаточность;
острые заболевания печени;
повышение активности печеночных трансаминаз неясного генеза;
возраст до 18 лет (безопасность и эффективность применения не установлены);
беременность;
период лактации (грудного вскармливания);
повышенная чувствительность к компонентам препарата;
повышенная чувствительность к другим препаратам статинового ряда (ингибиторам ГМГ-КоА-редуктазы) в анамнезе.
С осторожностью
С осторожностью назначают лицам, злоупотребляющим алкоголем и/или имеющим в анамнезе заболевания печени; пациентам после трансплантации органов, которым производится терапия иммунодепрессантами (в связи с повышенным риском возникновения рабдомиолиза и почечной недостаточности); при состояниях, которые могут привести к развитию выраженной недостаточности функции почек (артериальная гипотензия, острые инфекционные заболевания тяжелого течения, выраженные метаболические и эндокринные нарушения, нарушения водно-электролитного баланса, хирургические вмешательства /в т.ч. стоматологические/, травмы); пациентам с пониженным или повышенным тонусом мышц неясной этиологии; при эпилепсии.
Применение при беременности и в период грудного вскармливания
Препарат противопоказан к применению при беременности.
В связи с тем, что ингибиторы ГМГ-КоА-редуктазы тормозят синтез холестерина, а холестерин и другие продукты его синтеза играют существенную роль в развитии плода, включая синтез стероидов и клеточных мембран, симвастатин может оказывать неблагоприятное воздействие на плод при назначении при беременности (женщины репродуктивного возраста должны избегать зачатия). Если в процессе лечения возникает беременность, препарат должен быть отменен, а женщина предупреждена о возможной опасности для плода.
Отмена гиполипидемических средств при беременности не оказывает существенного влияния на результаты длительного лечения первичной гиперхолестеринемии.
При необходимости назначения препарата в период лактации следует решить вопрос о прекращении грудного вскармливания.
Способ применения и дозы
Таблетки принимают внутрь, 1 раз/сут вечером.
При легкой или умеренной гиперхолестеринемии начальная доза составляет 5 мг/сут; при выраженной гиперхолестеринемии - 10 мг/сут. При необходимости возможно повышение дозы не ранее чем через 4 нед. Максимальная суточная доза - 80 мг.
При ишемической болезни сердца начальная доза - 20 мг; при необходимости дозу постепенно увеличивают через каждые 4 нед. до 40 мг. Если концентрация ЛПНП менее 75 мг/дл (1.94 ммоль/л), концентрация общего холестерина менее 140 мг/дл (3.6 ммоль/л), дозу препарата необходимо уменьшить.
У пациентов с хронической почечной недостаточностью (КК менее 30 мл/мин) или при одновременном применении фибратов, никотиновой кислоты (или никотинамида) начальная доза - 5 мг, максимальная суточная доза - 10 мг.
На фоне иммунодепрессивной терапии (например, циклоспорин) рекомендуемая начальная доза 5 мг/сут. Максимальная суточная доза составляет 5 мг.
В случае пропуска текущей дозы препарат необходимо принять как можно скорее. Если наступило время следующей дозы, дозу не удваивать.
Побочное действие
Со стороны пищеварительной системы: диспепсия (тошнота, рвота, гастралгия, боли в животе, запор, диарея, метеоризм), гепатит, желтуха, повышение активности печеночных трансаминаз, ЩФ, КФК; редко - острый панкреатит.
Со стороны ЦНС и периферической нервной системы: астенический синдром, головокружение, головная боль, бессонница, судороги, парестезии, периферическая невропатия, расплывчатость зрения, нарушение вкусовых ощущений.
Со стороны костно-мышечной системы: миопатия, миалгия, мышечная слабость; редко - рабдомиолиз.
Дерматологические реакции: кожная сыпь, зуд, алопеция.
Прочие: анемия, сердцебиение, острая почечная недостаточность (вследствие рабдомиолиза), снижение потенции.
Передозировка
Лечение: следует вызвать рвоту, принять активированный уголь; показано проведение симптоматической терапии. Следует контролировать функции печени и почек, содержание КФК в сыворотке крови.
Взаимодействие с другими лекарственными средствами
При совместном применении симвастатин усиливает действие непрямых антикоагулянтов и увеличивает риск возникновения кровотечений.
При совместном применении с симвастатином цитостатики, противогрибковые препараты (кетоконазол, итраконазол), фибраты, никотиновая кислота в высоких дозах, иммунодепрессанты, эритромицин, кларитромицин, ингибиторы протеаз повышают риск развития рабдомиолиза.
При совместном применении симвастатин способствует повышению концентрации дигоксина в плазме крови.
При одновременном приеме колестирамин и колестипол снижают биодоступность симвастатина (прием симвастатина возможен через 4 ч после приема указанных лекарственных средств, при этом отмечается аддитивный эффект
Особые указания
У пациентов с хронической почечной недостаточностью (КК менее 30 мл/мин) начальная доза - 5 мг, максимальная суточная доза - 10 мг.
При возникновении миалгии, миастении и/или при выраженном повышении активности КФК лечение препаратом прекращают.
Атеростат (как и другие ингибиторы ГМГ-КоA-редуктазы) не следует применять при повышенном риске возникновения рабдомиолиза и почечной недостаточности (вследствие тяжелой острой инфекции, артериальной гипотензии, большой хирургической операции, травмы, тяжелых метаболических нарушений).
Атеростат не показан в тех случаях, когда имеется гипертриглицеридемия I, IV и V типов. Препарат эффективен как в виде монотерапии, так и в сочетании с секвестрантами желчных кислот.
До начала и во время курса лечения пациент должен находиться на гипохолестериновой диете.
Пациентам рекомендуется немедленно сообщать о необъяснимых болях в мышцах, вялости или слабости, особенно если это сопровождается недомоганием или лихорадкой.
Контроль лабораторных показателей
Перед началом лечения необходимо провести исследование функции печени, а затем контролировать активность печеночных трансаминаз каждые 6 нед в течение первых 3 мес, далее каждые 8 нед в течение оставшегося первого года и затем 1 раз в полгода. Пациентам, получающим симвастатин в суточной дозе 80 мг, функцию печени контролируют 1 раз в 3 мес. В тех случаях, когда активность печеночных трансаминаз нарастает (превышение в 3 раза ВГН), препарат отменяют.
Пациентам с почечной недостаточностью тяжелой степени лечение проводят под контролем функции почек.
Условия хранения
Препарат следует хранить в сухом, недоступном месте при температуре не выше 30°С.
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гипромеллоза, гидроксипропилцеллюлоза, титана диоксид, краситель красный кислотный."}}]},{"id":8,"name":"Фармакотерапевтическая группа","slug":"","body":[{"type":"paragraph","data":{"text":"\u003ca href=\"https://www.vidal.ru/drugs/pharm-group/209\"\u003eГиполипидемическое средство ГМГ-КоА редуктазы ингибитор\u003c/a\u003e."}}]},{"id":9,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Гиполипидемический препарат, получаемый синтетическим путем из продукта ферментации Aspergillus terreus. Является неактивным лактоном, в организме подвергается гидролизу с образованием гидроксикислотного производного. Активный метаболит ингибирует 3-гидрокси-3-метил-глутарил-КоА-редуктазу (ГМГ-КоA-редуктазу), фермент, катализирующий начальную реакцию образования мевалоната из ГМГ-КоА. Поскольку превращение ГМГ-КоA в мевалонат представляет собой ранний этап синтеза холестерина (Хс), то применение симвастатина не вызывает накопления в организме потенциально токсичных стеролов. ГМГ-КоA легко метаболизируется до ацетил-КоА, который участвует во многих процессах синтеза в организме."}},{"type":"paragraph","data":{"text":"Снижает концентрацию ТГ, ЛПНП, ЛПОНП и общего холестерина (Хс) в плазме (в случаях гетерозиготной семейной и несемейной форм гиперхолестеринемии, при смешанной гиперлипидемии, когда повышение содержания Хс является фактором риска). Уменьшает соотношение ЛПНП/ЛПВП и общий Хс/ЛПВП. Начало действия - через 2 нед. от начала приема, максимальный терапевтический эффект - через 4-6 нед. Действие сохраняется при продолжении лечения; при прекращении терапии содержание Хс возвращается к исходному уровню (до начала лечения)."}},{"type":"header","data":{"text":"Фармакокинетика","level":4}},{"type":"paragraph","data":{"text":"\u003ci\u003eВсасывание и распределение\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"После приема внутрь симавстатин в высокой степени абсорбируется из ЖКТ. После приема внутрь С\u003csub\u003emax\u003c/sub\u003e достигается через 1.3-2.4 ч и снижается на 90% через 12 ч. Связывание с белками плазмы крови составляет 95%."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМетаболизм и выведение\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Симвастатин подвергается эффекту \"первого прохождения\" через печень. Гидролизируется в основном в свою активную форму бета-гидроксикислоту. Обнаружены также другие активные и неактивные метаболиты. Метаболизм осуществляется при участии изоферментов CYP3A4, CYP3A5 и CYP3A7. Т\u003csub\u003e1/2\u003c/sub\u003e активных метаболитов составляет 1.9 ч. Выводится в основном с каловыми массами (60%) в виде метаболитов. Около 10-15% выводится почками в неактивной форме."}}]},{"id":10,"name":"Показания к применению","slug":"indications","body":[{"type":"list","data":{"style":"ordered","items":["первичная гиперхолестеринемия IIа и IIb типа (при неэффективности диетотерапии у пациентов с повышенным риском развития коронарного атеросклероза), комбинированная гиперхолестеринемия и гипертриглицеридемия, гиперлипопротеинемия, не поддающаяся коррекции специальной диетой и физической нагрузкой.","профилактика инфаркта миокарда (для замедления прогрессирования коронарного атеросклероза), инсульта и преходящих нарушений мозгового кровообращения."]}},{"type":"paragraph","data":{"text":"Препарат противопоказан при печеночной недостаточности; острых заболеваниях печени и при повышении активности печеночных трансаминаз неясного генеза."}}]},{"id":11,"name":"Противопоказания","slug":"contraindications","body":[{"type":"list","data":{"style":"ordered","items":["печеночная недостаточность;","острые заболевания печени;","повышение активности печеночных трансаминаз неясного генеза;","возраст до 18 лет (безопасность и эффективность применения не установлены);","беременность;","период лактации (грудного вскармливания);","повышенная чувствительность к компонентам препарата;","повышенная чувствительность к другим препаратам статинового ряда (ингибиторам ГМГ-КоА-редуктазы) в анамнезе."]}}]},{"id":12,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eС осторожностью\u003c/i\u003e назначают лицам, злоупотребляющим алкоголем и/или имеющим в анамнезе заболевания печени; пациентам после трансплантации органов, которым производится терапия иммунодепрессантами (в связи с повышенным риском возникновения рабдомиолиза и почечной недостаточности); при состояниях, которые могут привести к развитию выраженной недостаточности функции почек (артериальная гипотензия, острые инфекционные заболевания тяжелого течения, выраженные метаболические и эндокринные нарушения, нарушения водно-электролитного баланса, хирургические вмешательства /в т.ч. стоматологические/, травмы); пациентам с пониженным или повышенным тонусом мышц неясной этиологии; при эпилепсии. "}}]},{"id":13,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Препарат противопоказан к применению при беременности."}},{"type":"paragraph","data":{"text":"В связи с тем, что ингибиторы ГМГ-КоА-редуктазы тормозят синтез холестерина, а холестерин и другие продукты его синтеза играют существенную роль в развитии плода, включая синтез стероидов и клеточных мембран, симвастатин может оказывать неблагоприятное воздействие на плод при назначении при беременности (женщины репродуктивного возраста должны избегать зачатия). Если в процессе лечения возникает беременность, препарат должен быть отменен, а женщина предупреждена о возможной опасности для плода."}},{"type":"paragraph","data":{"text":"Отмена гиполипидемических средств при беременности не оказывает существенного влияния на результаты длительного лечения первичной гиперхолестеринемии."}},{"type":"paragraph","data":{"text":"При необходимости назначения препарата в период лактации следует решить вопрос о прекращении грудного вскармливания."}}]},{"id":14,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Таблетки принимают внутрь, 1 раз/сут вечером."}},{"type":"paragraph","data":{"text":"При \u003ci\u003eлегкой или умеренной гиперхолестеринемии\u003c/i\u003e начальная доза составляет 5 мг/сут; при \u003ci\u003eвыраженной гиперхолестеринемии\u003c/i\u003e - 10 мг/сут. При необходимости возможно повышение дозы не ранее чем через 4 нед. Максимальная суточная доза - 80 мг."}},{"type":"paragraph","data":{"text":"При \u003ci\u003eишемической болезни сердца\u003c/i\u003e начальная доза - 20 мг; при необходимости дозу постепенно увеличивают через каждые 4 нед. до 40 мг. Если концентрация ЛПНП менее 75 мг/дл (1.94 ммоль/л), концентрация общего холестерина менее 140 мг/дл (3.6 ммоль/л), дозу препарата необходимо уменьшить."}},{"type":"paragraph","data":{"text":"У \u003cb\u003eпациентов с хронической почечной недостаточностью (КК менее 30 мл/мин)\u003c/b\u003e или при одновременном применении фибратов, никотиновой кислоты (или никотинамида) начальная доза - 5 мг, максимальная суточная доза - 10 мг."}},{"type":"paragraph","data":{"text":"На фоне иммунодепрессивной терапии (например, циклоспорин) рекомендуемая начальная доза 5 мг/сут. Максимальная суточная доза составляет 5 мг."}},{"type":"paragraph","data":{"text":"В случае пропуска текущей дозы препарат необходимо принять как можно скорее. Если наступило время следующей дозы, дозу не удваивать."}}]},{"id":15,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны пищеварительной системы:\u003c/i\u003e диспепсия (тошнота, рвота, гастралгия, боли в животе, запор, диарея, метеоризм), гепатит, желтуха, повышение активности печеночных трансаминаз, ЩФ, КФК; редко - острый панкреатит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны ЦНС и периферической нервной системы\u003c/i\u003e: астенический синдром, головокружение, головная боль, бессонница, судороги, парестезии, периферическая невропатия, расплывчатость зрения, нарушение вкусовых ощущений."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны костно-мышечной системы: \u003c/i\u003eмиопатия, миалгия, мышечная слабость; редко - рабдомиолиз."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАллергические и иммунопатологические реакции:\u003c/i\u003e ангионевротический отек, волчаночноподобный синдром, ревматическая полимиалгия, васкулит, тромбоцитопения, эозинофилия, повышение СОЭ, артрит, артралгия, крапивница, фотосенсибилизация, лихорадка, гиперемия кожи, приливы, одышка."}},{"type":"paragraph","data":{"text":"\u003ci\u003eДерматологические реакции:\u003c/i\u003e кожная сыпь, зуд, алопеция."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПрочие:\u003c/i\u003e анемия, сердцебиение, острая почечная недостаточность (вследствие рабдомиолиза), снижение потенции."}}]},{"id":16,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eЛечение:\u003c/i\u003e следует вызвать рвоту, принять активированный уголь; показано проведение симптоматической терапии. Следует контролировать функции печени и почек, содержание КФК в сыворотке крови."}}]},{"id":17,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При совместном применении симвастатин усиливает действие непрямых антикоагулянтов и увеличивает риск возникновения кровотечений."}},{"type":"paragraph","data":{"text":"При совместном применении с симвастатином цитостатики, противогрибковые препараты (кетоконазол, итраконазол), фибраты, никотиновая кислота в высоких дозах, иммунодепрессанты, эритромицин, кларитромицин, ингибиторы протеаз повышают риск развития рабдомиолиза."}},{"type":"paragraph","data":{"text":"При совместном применении симвастатин способствует повышению концентрации дигоксина в плазме крови."}},{"type":"paragraph","data":{"text":"При одновременном приеме колестирамин и колестипол снижают биодоступность симвастатина (прием симвастатина возможен через 4 ч после приема указанных лекарственных средств, при этом отмечается аддитивный эффект"}}]},{"id":18,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"У \u003cb\u003eпациентов с хронической почечной недостаточностью (КК менее 30 мл/мин)\u003c/b\u003e начальная доза - 5 мг, максимальная суточная доза - 10 мг. "}},{"type":"paragraph","data":{"text":"При возникновении миалгии, миастении и/или при выраженном повышении активности КФК лечение препаратом прекращают."}},{"type":"paragraph","data":{"text":"Атеростат (как и другие ингибиторы ГМГ-КоA-редуктазы) не следует применять при повышенном риске возникновения рабдомиолиза и почечной недостаточности (вследствие тяжелой острой инфекции, артериальной гипотензии, большой хирургической операции, травмы, тяжелых метаболических нарушений)."}},{"type":"paragraph","data":{"text":"Атеростат не показан в тех случаях, когда имеется гипертриглицеридемия I, IV и V типов. Препарат эффективен как в виде монотерапии, так и в сочетании с секвестрантами желчных кислот."}},{"type":"paragraph","data":{"text":"До начала и во время курса лечения пациент должен находиться на гипохолестериновой диете."}},{"type":"paragraph","data":{"text":"Пациентам рекомендуется немедленно сообщать о необъяснимых болях в мышцах, вялости или слабости, особенно если это сопровождается недомоганием или лихорадкой."}},{"type":"paragraph","data":{"text":"\u003ci\u003eКонтроль лабораторных показателей\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Перед началом лечения необходимо провести исследование функции печени, а затем контролировать активность печеночных трансаминаз каждые 6 нед в течение первых 3 мес, далее каждые 8 нед в течение оставшегося первого года и затем 1 раз в полгода. Пациентам, получающим симвастатин в суточной дозе 80 мг, функцию печени контролируют 1 раз в 3 мес. В тех случаях, когда активность печеночных трансаминаз нарастает (превышение в 3 раза ВГН), препарат отменяют."}},{"type":"paragraph","data":{"text":"Пациентам с почечной недостаточностью тяжелой степени лечение проводят под контролем функции почек."}}]},{"id":21,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"Препарат следует хранить в сухом, недоступном месте при температуре не выше 30°С."}}]},{"id":22,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года."}}]},{"id":23,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту."}}]},{"id":24,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\u003ca href=\"https://www.vidal.ru/drugs/firm/3688\"\u003eАВВА РУС, АО\u003c/a\u003e (Россия). "}}]}],"source":{"title":"('Эркафарм/Столетов',)","url":"https://stoletov.ru/"}},"description_toggle":false,"short_description":"Гиполипидемический препарат, получаемый синтетическим путем из продукта ферментации Aspergillus terreus. Является неактивным лактоном, в организме подвергается гидролизу с образованием гидроксикислотного производного. Активный метаболит ингибирует 3-гидрокси-3-метил-глутарил-КоА-редуктазу (ГМГ-КоA-редуктазу), фермент, катализирующий начальную реакцию образования мевалоната из ГМГ-КоА. Поскольку превращение ГМГ-КоA в мевалонат представляет собой ранний этап синтеза холестерина (Хс), то применение симвастатина не вызывает накопления в организме потенциально токсичных стеролов. ГМГ-КоA легко метаболизируется до ацетил-КоА, который участвует во многих процессах синтеза в организме. Снижает концентрацию ТГ, ЛПНП, ЛПОНП и общего холестерина (Хс) в плазме (в случаях гетерозиготной семейной и несемейной форм гиперхолестеринемии, при смешанной гиперлипидемии, когда повышение содержания Хс является фактором риска). Уменьшает соотношение ЛПНП/ЛПВП и общий Хс/ЛПВП. Начало действия - через 2 нед. от начала приема, максимальный терапевтический эффект - через 4-6 нед. Действие сохраняется при продолжении лечения; при прекращении терапии содержание Хс возвращается к исходному уровню (до начала лечения).Всасывание и распределениеПосле приема внутрь симавстатин в высокой степени абсорбируется из ЖКТ. После приема внутрь Сmaxдостигается через 1.3-2.4 ч и снижается на 90% через 12 ч. Связывание с белками плазмы крови составляет 95%.Метаболизм и выведениеСимвастатин подвергается эффекту \"первого прохождения\" через печень. Гидролизируется в основном в свою активную форму бета-гидроксикислоту. Обнаружены также другие активные и неактивные метаболиты. Метаболизм осуществляется при участии изоферментов CYP3A4, CYP3A5 и CYP3A7. Т1/2активных метаболитов составляет 1.9 ч. Выводится в основном с каловыми массами (60%) в виде метаболитов. 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