Dosing Simvastatin:
New 2011 FDA Recommendation

Chief Complaint: "I need refills."

History of Present Illness
FR is a 67-year-old Hispanic male who presents to see the cardiologist, Dr. B, for a follow-up visit. FR was last seen in clinic on 1/20/12, at which time the simvastatin dose was increased to 80 mg daily to better control his dyslipidemia. The patient has no new complaints today and states that he is feeling "great." FR requests refills on his medications. You are the newly hired PharmD in this clinic, and the cardiologist asks your opinion regarding this patient's case.

Past Medical History Type 2 diabetes mellitus × 4 years Hypertension × 6 years Dyslipidemia × 2 years Constipation Medication List Lantus 10 units QHS (started 3/18/11) Glipizide XL 7.5 mg (started 9/24/10) ASA 81 mg (started 9/24/10) Lisinopril 10 mg (started 7/22/09) Hydrochlorothiazide 12.5 mg     (started 7/12/11) Simvastatin 80 mg (started 1/20/12) Docusate 100 mg PRN     (started 2/15/08) Allergies No known drug allergies

Family and Social History Father died at age 82 from     myocardial infarction Mother died at age 61;     medical history unknown Patient is married with two children Denies current alcohol and tobacco use Fasting lipid profile rechecked today at 8 AM Total cholesterol: 248 mg/dL Triglycerides: 320 mg/dL HDL: 66 mg/dL LDL: 143 mg/dL Liver function tests from 8/11/11     are within normal limits. Vital Signs BP: 124/76, P: 89, RR: 18, T: 37.2°C, Wt: 94 kg, Ht: 5'8"

What is your recommendation for Dr. B regarding this patient's dyslipidemia management?

Anna Markel Vaysman, PharmD, BCPS
Clinical Pharmacist, Clinical Assistant Professor
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois