Lovastatin

Lovastatin is a cholesterol-lowering medication called a statin prescribed to treat elevated blood cholesterol levels.

Lovastatin should be used in addition to dietary modifications as part of a treatment plan to lower cholesterol levels when the response to diet and other non-pharmacological measures alone have been inadequate to reduce cardiovascular risk.

Lovastatin is available under the following different brand names: Mevacor, and Altoprev.

Dosage Forms and Strengths

Tablets, extended-release

• 10mg
• 20mg
• 40mg
• 60mg

Tablets

• 10mg
• 20mg
• 40mg

Dosage Considerations – Should be Given as Follows:

Hypercholesterolemia

Mevacor (immediate-release): 20 mg orally once/day with evening meal initially, or may divide daily dose twice daily; adjust dose at 4-week intervals if increase required; not to exceed 80 mg/day

Altoprev (extended-release): 10-60 mg orally at bedtime

Heterozygous Familial Hypercholesterolemia, Pediatric

Children 10-17 years: 20-40 mg orally once/day; not to exceed 40 mg/day

Initiate with 10 mg/day if patient requires smaller LDL-C reduction

Dosing Considerations

Co-administration with danazol, diltiazem, or verapamil: Do not exceed 20 mg lovastatin daily

Co-administration with amiodarone: Do not exceed 40 mg lovastatin daily

Avoid large quantities of grapefruit juice (greater than 1 quart/day)

Overdose management

Adverse drug reactions from overdose may include peripheral neuropathy, diarrhea, increased potassium, myopathy, rhabdomyolysis, acute renal failure, elevated liver function tests, eye lens opacities Treatment is supportive

Dosing Modifications

Renal impairment (severe; CrCl less than 30 mL/minute): Doses greater than 20 mg/day should be carefully considered and, if deemed necessary, implemented cautiously

Common side effects of lovastatin include:

• Creatine phosphokinase (CPK) elevation
• Gas (flatulence)
• Abdominal/stomach pain
• Stomach upset
• Constipation
• Diarrhea
• Muscle pain/tenderness
• Nausea
• Indigestion
• Heartburn
• Weakness
• Blurred vision
• Rash
• Muscle cramps
• Dizziness
• Headache
• Joint pain
• Back pain
• Bloating
• Sleep problems (insomnia)

Less common side effects of lovastatin include:

• Dermatomyositis
• Increased liver function tests
• Liver damage
• Muscle disease
• Muscle wasting (rhabdomyolysis) (rare)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Lovastatin has severe/serious/moderate/mild interactions with at least 34 different drugs.
• Lovastatin has severe/serious/moderate/mild interactions with at least 77 different drugs.
• Lovastatin has severe/serious/moderate/mild interactions with at least 79 different drugs.
• Mild Interactions of lovastatin include:
  • alvimopan
  • coenzyme Q10
  • colestipol
  • exenatide injectable solution
  • exenatide injectable suspension
  • fexofenadine
  • isradipine
  • liraglutide
  • loratadine
  • orlistat
  • ruxolitinib
  • trazodone

 This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains lovastatin. Do not take Mevacor or Altoprev if you are allergic to lovastatin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Hypersensitivity to lovastatin or other components

Active liver disease, or unexplained elevated transaminases

Pregnancy, lactation

Concomitant administration with strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, cobicistat, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, and nefazodone)

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Lovastatin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Lovastatin?"

Cautions

• Non-serious and reversible cognitive side effects may occur.
• Increased blood sugar and glycosylated hemoglobin (HbA1c) levels reported with statin intake.
• Rhabdomyolysis, risk of myopathy: Risk increased by co-administration CYP3A4 inhibitors or other drugs that cause myopathy.
• Avoid co-administration with cyclosporine or gemfibrozil; caution with other fibrates or lipid-lowering doses of niacin (1 g/day or more) because of increased risk for myopathy.
• Heavy alcohol use, history of liver disease, renal failure.
• Discontinue if markedly elevated creatine phosphokinase (CPK) levels occur or myopathy is diagnosed or suspected; also, temporarily withhold in any patient experiencing an acute or serious condition predisposing to the development of renal failure secondary to rhabdomyolysis (egg, sepsis; hypotension; major surgery; trauma; severe metabolic, endocrine, or electrolyte disorders; uncontrolled epilepsy).
• Rare reports of immune-mediated necrotizing myopathy (IMNM), characterized by increased serum creatine kinase that persists despite discontinuation of statin.
• Obtain baseline liver enzyme tests before initiating and then periodically thereafter.
• Brand Altocor renamed Altoprev due to confusion with Advicor.

Pregnancy and Lactation

• Do not use lovastatin in pregnancy. The risks involved outweigh potential benefits. Safer alternatives exist.
• Lovastatin is contraindicated in lactation; it is unsafe for use while breastfeeding.