Simvastatin use has declined over time due to more potent statins being available and due to numerous drug interactions.

Grapefruit juice can inhibit CYP3A4 which will increase the concentrations of simvastatin.

Genetic variations in SLCO1B1 can lead to patients being more susceptible to simvastatin toxicity.

Simvastatin is a lipophilic statin. I discuss why this is important and how it might impact clinical decisions.