At the beginning of therapy Simgalom possible transient increase in the level of “liver” enzymes.
Before starting therapy and then regularly liver function tests (to monitor the activity of “liver” enzymes every 6 weeks during the first 3 months., And then every 8 weeks for the remainder of the first year and then every six months 1) and with increasing doses of test should be conducted to determine liver functions. By increasing the dose to 80 mg of the test should be carried out every 3 months. When persistent elevations of transaminases (more than 3 times compared to baseline) reception Simgal should be discontinued.
Simgal, like other inhibitors of masteronreductase inhibitors, should not be applied at an elevated risk of rhabdomyolysis and renal insufficiency (on background severe acute infection, hypotension, planned major surgery, trauma, severe metabolic disorders).
Cancel gipolipidemicheekih agents during pregnancy has no significant effect on the results of long-term therapy of primary hypercholesterolemia.
due to the fact that inhibitors reductase inhibitors inhibit the synthesis cholesterol, and cholesterol and other products of its synthesis plays an important role in fetal development, including synthesis of steroids and cell membranes, simvastatin may have an adverse effect on the fetus in the appointment of his pregnant (women of childbearing age should avoid conception). If in the course of treatment became pregnant, the drug should be withdrawn and the woman warned of the possible danger to the fetus.
Application Simgal not recommended in women of childbearing age, not using contraception.
Patients with thyroid decreased function (hypothyroidism) or the presence of certain diseases kidney (nephrotic syndrome) with an increase in cholesterol levels should first carry out treatment of the underlying disease.
With caution appoint persons who abuse alcohol and / or have a history of liver disease.
Before and during treatment the patient should be on hypolipidemic diet. Simultaneous administration of grapefruit juice may enhance the severity of side effects associated with taking Simgal, so avoid their simultaneous reception.
Simgal not shown in those cases where there is hypertriglyceridemia I, IV and V types.
Treatment  may cause myopathy, leading to rhabdomyolysis and renal failure. The risk of this disease increases in patients receiving simultaneously with masteron one or more of the following drugs: fibrates (gemfibrozil, fenofibrate), cyclosporine, nefazadon, macrolides (erythromycin, clarithromycin), antifungal agents from “azoles” (ketoconazole, itraconazole) and protease inhibitors (ritonavir). The risk of myopathy is also increased in patients with severe renal insufficiency. All patients who start therapy Simgalom, as well as patients who need to increase the dose of the drug should be warned of the possibility of myopathy and need immediate treatment to the doctor in case of unexplained pain, pain in muscle flaccidity or muscle weakness, particularly if accompanied by malaise or fever.Drug therapy should be discontinued immediately if myopathy is diagnosed or suspected. In order to diagnose myopathy is recommended to conduct regular measurements  .

When treating Simgalom may increase the content of serum masteron, which should be considered in the differential diagnosis of chest pain. Drug withdrawal criterion is an increase in serum  more than 10 times the upper limit of normal. Patients with myalgia, myasthenia and / or marked increase  drug treatment is stopped. The drug is effective as a monotherapy, or in combination with bile acid sequestrants. In case of missing the current drug dose must be taken as soon as possible. If it is time for your next dose, do not double the dose. Patients with severe renal insufficiency treatment is carried out under the control of renal function. The duration of the drug is determined by the physician individually.

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