• 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 only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Simvastatin Rosemont is and what it is used for
2. What you need to know before you take Simvastatin Rosemont
3. How to take Simvastatin Rosemont
4. Possible side effects
5. How to store Simvastatin Rosemont
6. Contents of the pack and other information

• you are allergic to simvastatin or any of the other ingredients of this medicine (listed in section 6). An allergic reaction can include a rash, itching or shortness of breath
• you have liver problems
• you are pregnant or breast-feeding (see section below ‘Pregnancy and breast-feeding’)
• you are taking antifungal drugs such as itraconazole, ketoconazole, posaconazole or voriconazole
• you are taking antibiotics such as erythromycin, clarithromycin or telithromycin
• you are taking medicines to treat HIV infections such as indinavir, nelfinavir, ritonavir or saquinavir
• you are taking boceprevir or telaprevir, used to treat hepatitis C virus
• you are taking a medicine to treat depression called nefazodone
• you are taking cobicistat
• you are taking a medicine to lower cholesterol called gemfibrozil
• you are taking ciclosporin (a medicine often used in transplant patients)
• you are taking danazol (a man-made hormone used to treat endometriosis)
• you are taking or have taken in the last 7 days a medicine called fusidic acid, (a medicine for bacterial infection) orally or by injection. The combination of fusidic acid and simvastatin can lead to serious muscle problems (rhabdomyolysis).

Do not take more than 40 mg simvastatin if you are taking lomitapide (used to treat a serious and rare genetic cholesterol condition).

Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor before taking simvastatin.

Talk to your doctor or pharmacist before taking simvastatin if:

• you have an existing medical condition including allergies
• you drink large amounts of alcohol
• you have a history of liver disease. Your doctor may give you some blood tests to check your liver before and after starting treatment
• you have kidney problems
• you have severe lung disease (respiratory failure)
• you are due to have an operation, you may need to stop taking simvastatin for a short time
• you are Asian, because a different dose may be applicable to you
• you have or have had myasthenia (a disease with general muscle weakness including in some cases muscles used when breathing), or ocular myasthenia (a disease causing eye muscle weakness) as statins may sometimes aggravate the condition or lead to the occurrence of myasthenia (see section 4).

Your doctor should do a blood test before you start taking simvastatin and if you have any symptoms of liver problems while you take simvastatin. This is to check how well your liver is working.

Your doctor may also want you to have blood tests to check how well your liver is working after you start taking simvastatin.

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.

Tell your doctor if you have severe lung disease.

Contact your doctor immediately if you experience unexplained muscle pain, tenderness or weakness. This is because on rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare deaths have occurred.

The risk of muscle breakdown is greater at higher doses of simvastatin, particularly the 80 mg dose. The risk of muscle breakdown is also greater in certain patients. Talk with your doctor if any of the following applies:

• you drink large amounts of alcohol
• you have kidney problems
• you have thyroid problems
• you are 65 years or older
• you are female
• you have ever had muscle problems during treatment with cholesterol-lowering medicines called “statins” or fibrates
• you or a close family member have a hereditary muscle disorder.

Also tell your doctor or pharmacist if you have a muscle weakness that is constant. Additional tests and medicines may be needed to diagnose and treat this.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking simvastatin.

It is particularly important to tell your doctor if you are taking any of the following medicines. Taking simvastatin with any of these medicines can increase the risk of muscle problems (some of these have already been listed in the above section ‘Do not take Simvastatin’):

• If you need to take oral fusidic acid to treat a bacterial infection you will need to temporarily stop using this medicine. Your doctor will tell you when it is safe to restart simvastatin.
  Taking simvastatin with fusidic acid may rarely lead to muscle weakness, tenderness or pain (rhabdomyolysis). See more information regarding rhabdomyolysis in section 4.
• ciclosporin, used to dampen the immune system
• danazol, a steroid used to treat endometriosis and breast cysts in women
• medicines to treat fungal infections such as itraconazole, ketoconazole, fluconazole, posaconazole or voriconazole
• medicines to lower cholesterol called fibrates (such as gemfibrozil or bezafibrate)
• antibiotics, such as erythromycin, clarithromycin or telithromycin
• medicines to treat HIV infections such as indinavir, nelfinavir, ritonavir or saquinavir
• boceprevir, telaprevir, elbasvir or grazoprevir used to treat hepatitis C virus infection
• nefazodone, used to treat depression
• medicines with the active ingredient cobicistat
• amiodarone, used to treat irregular heart beats
• verapamil, diltiazem or amlodipine, used to treat heart conditions
• lomitapide (used to treat a serious and rare genetic cholesterol condition)
• daptomycin (a drug used to treat complicated skin and skin structure infections and bacteraemia). It is possible that side effects affecting the muscles may be higher when this medicine is taken during treatment with simvastatin. Your doctor may decide that you stop taking Simvastatin for a while
• colchicines, used to treat gout
• ticagrelor (antiplatelet medicine).

As well as the medicines listed above, tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines bought without a prescription, including herbal medicines.

In particular tell your doctor if you are taking any of the following medicines:

• medicines that stop blood clots from forming such as warfarin, phenprocoumon or acenocoumarol (anticoagulants)
• fenofibrate (another medicine for lowering cholesterol)
• niacin (nicotinic acid, another medicine for lowering cholesterol)
• rifamapicin (used to treat tuberculosis).

Also tell your doctor if you are taking niacin (nicotinic acid) or a niacin-containing product and are Chinese.

Also tell any doctor who is prescribing a new medicine for you that you are taking simvastatin.

If you are going to have an operation, tell the doctor that you are taking simvastatin as it should be stopped a few days before.

Grapefruit juice contains one or more components that alter how the body uses some medicinal products, including simvastatin. Consuming grapefruit juice should be avoided.

Do not use simvastatin if you are pregnant or planning to become pregnant. If you become pregnant while on this medicine, stop taking it and talk to your doctor straight away.

Do not use simvastatin if you are breast-feeding, because it is not known if the medicine is passed into breast milk.

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 Simvastatin Rosemont). Simvastatin has not been studied in children under the age of 10 years. For more information, talk to your doctor.

This medicine should not affect your ability to drive or operate machinery. However, this medicine may cause dizziness. If you feel this, take extra care when driving or using tools or machines.

• Methyl parahydroxybenzoate (E218), ethyl parahydroxybenzoate (E214) and propyl parahydroxybenzoate (E216). These may cause an allergic reaction. This allergy may happen some time after starting the medicine.
• less than 1 mmol sodium (23 mg) per 1ml, that is to say essentially ‘sodium-free’.
• propylene glycol (E1520) (17.2mg in a 1ml) – if you are pregnant, breast-feeding or suffer from a liver or kidney disease, do not take this medicine unless recommended by your doctor. Your doctor may carry out extra checks while you are taking this medicine. If your child is less than 5 years old, talk to your doctor or pharmacist before giving them this medicine, in particular if they use other medicines that contain propylene glycol or alcohol.

• This medicine contains 4mg of simvastatin in each 1ml, (20mg of simvastatin in each 5ml).
• Take this medicine by mouth using the double-sided measuring spoon provided. The measuring spoon is graduated to deliver a 1.25ml, 2.5ml or 5ml dose as prescribed by your doctor or pharmacist.
• This medicine can also be administered via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes. There is further information in the SmPC, ask your doctor, pharmacist or nurse for this information.
• Do not use with a tube which is made of latex.
• Instructions for use via NG or PEG tube:
  1. Ensure the tube is clear before taking the medicine
  2. Flush the tube with sufficient amount of water to remove any feed left in the tube
  3. Administer the medicine into the tube, with a suitable measuring device
  4. Flush the tube again with 10ml of water.
• Shake the bottle well before use.
• If you feel that the effect of your medicine is too strong or too weak, do not change the dose yourself, but talk to your doctor or pharmacist.

The usual doses are given below. Your doctor may change these.

The usual dose range is 5mg to 80mg each day. The 80mg dose is only recommended in patients with very high cholesterol levels and at high risk of heart disease problems. The dose will be decided by your doctor depending upon what you are being treated for.

This product strength is the most suitable presentation when doses of 20mg or below are required. For higher doses use the 40mg/5ml strength presentation.

• The usual starting dose is 10mg (2.5ml) to 20mg (5ml) each day.
  This may be increased gradually by your doctor up to 40mg (10ml) each day.
• Take this dose in the evening.

• The usual dose is 40mg (10ml) in the evening, or
• 20mg (5ml) in the morning, 20mg (5ml) at lunch time and 40mg (10ml) in the evening.

• The usual dose is 20mg (5ml) to 40mg (10ml) each day.
• Take this dose in the evening.

• The doctor will start you on a lower dose and gradually increase it.

• The recommended usual starting dose is 10mg (2.5ml) a day in the evening.
• The maximum recommended dose is 40mg (10ml) a day.

If you take more of this medicine than you should, talk to your doctor or go to your nearest hospital straight away. Take the medicine pack with you.

• If you forget a dose, take it as soon as you remember. However, if it is nearly time for the next dose, skip the missed dose
• Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

Do not stop taking simvastatin unless your doctor tells you to. It may make your cholesterol levels rise again.

• muscle pain, tenderness, weakness or cramps. On rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare, deaths have occurred
• an allergic reaction including:
  • swelling of the face, tongue and throat which may cause difficulty in breathing (angioedema)
  • severe muscle pain usually in the shoulders and hips
  • rash with weakness of limbs and neck muscles
  • pain or inflammation of the joints (polymyalgia rheumatica)
  • inflammation of the blood vessels (vasculitis)
  • unusual bruising, skin eruptions and swelling (dermatomyositis), hives, skin sensitivity to the sun, fever, flushing
  • shortness of breath (dyspnoea) and feeling unwell
  • lupus-like disease picture (including rash, joint disorders and effects on blood cells)
• inflammation of the liver with yellowing of the skin and eyes, itching, dark-coloured urine or pale-coloured stools, liver failure (very rare)
• inflammation of the pancreas often with severe abdominal pain.

The following very rare serious side effects were reported:

• a serious allergic reaction which causes difficulty in breathing or dizziness (anaphylaxis)
• rash that may occur on the skin or sores in the mouth (lichenoid drug eruptions)
• muscle rupture
• gynecomastia (breast enlargement in men).

The following side effects have also been reported rarely:

• low red blood cell count (anaemia)
• numbness or weakness of the arms and legs
• headache, tingling sensation, feeling dizzy
• blurred vision, impaired vision
• feeling sick (nausea) or being sick (vomiting)
• stomach upset including constipation, diarrhoea, wind, heartburn and stomach pain
• rash, itching, hair loss
• feeling weak
• trouble sleeping (very rare)
• poor memory (very rare), memory loss, confusion.

The following side effects have also been reported but the frequency cannot be estimated from the available information (frequency not known):

• erectile dysfunction
• depression
• breathing problems including persistent cough and/or shortness of breath or fever
• tendon problems, sometimes complicated by rupture of the tendon
• myasthenia gravis (a disease causing general muscle weakness including in some cases muscles used when breathing)
• ocular myasthenia (a disease causing eye muscle weakness).

Talk to your doctor if you experience weakness in your arms or legs that worsens after periods of activity, double vision or drooping of your eyelids, difficulty swallowing, or shortness of breath.

Additional possible side effects reported with some statins:

• sleep disturbances, including nightmares
• 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 medicine
• muscle pain, tenderness, or weakness that is constant that may not go away after stopping simvastatin (frequency not known).

Laboratory Values

Elevations in some laboratory blood tests of liver function and a muscle enzyme (creatine kinase) have been observed.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects you can help provide more information on the safety of this medicine.

United Kingdom

• The active ingredient is simvastatin. Each 1ml contains 4mg simvastatin, (each 5ml contains 20mg simvastatin).
• The other ingredients are methyl parahydroxybenzoate (E218), ethyl parahydroxybenzoate (E214), propyl parahydroxybenzoate (E216), propylene glycol (E1520), aluminium magnesium silicate, carmellose sodium (E466), simeticone emulsion, citric acid monohydrate (E330), disodium hydrogen phosphate anhydrous (E339), sodium laurilsulfate (E470a), acesulfame potassium (E950), butylhydroxyanisole (BHA) strawberry flavour and purified water.

A white to off-white suspension with a flavour and odour of strawberry.

It comes in a brown glass bottle 150ml with HDPE, EPE wadded, tamper evident, child resistant closure. A double-sided dosing spoon is provided to measure 1.25ml, 2.5ml and 5ml doses as prescribed.

This medicinal product is authorised in the Member States of the EEA under the following names:

Greece KYMORAL Πόσιμο εναιώρημα 20 mg/5 ml

United Kingdom Simvastatin Rosemont 20mg/5ml Oral Suspension