Class: HMG-CoA Reductase Inhibitor
Dosage Forms. Tablet: 10 mg, 20 mg, 40 mg; Extended-Release Tablet: 20 mg, 40 mg, 60 mg
Common FDA Label Indication, Dosing, and Titration.
1. Coronary arteriosclerosis, hypercholesterolemia, primary and mixed: Initial, 20 mg po daily, maintenance 10-80 mg po daily or in 2 divided doses; max 80 mg/d; Extended-release tablet: 20-60 mg po qhs
2. Familial hypercholesterolemia, heterozygous, in adolescent patients 10-17 y: Children: initial, 10 po daily, maintenance 10-40 mg po daily; max 40 mg/d
1. Diabetes mellitus type 2, secondary hypercholesterolemia: Adults: 10-80 mg po daily
MOA. HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis.
Drug Characteristics: Lovastatin
Medication Safety Issues: Lovastatin
Drug Interactions: Lovastatin
Adverse Reactions: Lovastatin
Efficacy Monitoring Parameters. Reduction in total cholesterol, LDL-cholesterol, and triglyceride levels; increase in HDL-cholesterol levels. Assess at baseline and periodically during treatment.
Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue) or hepatotoxicity. Liver function tests, blood glucose, and HbA1c should be performed at baseline, 6-12 wk after initiation of therapy, and periodically thereafter. Serum creatine kinase should be measured in patients experiencing muscle pain and in those receiving other drugs associated with myopathy.
Key Patient Counseling Points. Immediate-release tablets should be taken with the evening meal. Extended-release tablets should be taken at bedtime. Swallow extended-release tablets whole; do not chew, crush, or cut. Avoid alcohol, grapefruit, and grapefruit juice. Report signs/symptoms of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure. There are multiple significant drug-drug interactions with lovastatin. Consult a healthcare professional prior to starting any new prescription or OTC medications. Lovastatin does not take the place of lifestyle changes (diet, exercise) to lower cholesterol levels.
Clinical Pearls. Safety and efficacy of extended-release tablets not established in pediatric patients. Use increases risk of diabetes, especially in the elderly.