Indications for Lovastatin Tablets:
To reduce risk of MI, unstable angina, and coronary revascularization procedures in patients without symptomatic cardiovascular disease (CVD), average to moderately elevated total-C and LDL-C, and below average HDL-C. Primary hypercholesterolemia (Types IIa and IIb) to reduce elevated total-C and LDL-C when response to nondrug therapy is inadequate. To slow progression of coronary atherosclerosis in patients with coronary heart disease to lower total-C and LDL-C. Adjunct to nondrug therapy to reduce total-C, LDL-C and apo B in patients 10–17yrs of age (≥1yr post-menarche) with heterozygous familial hypercholesterolemia if LDL-C remains >189mg/dL, or if LDL-C remains >160mg/dL with either family history of premature cardiovascular disease (CVD) or if patient has at least 2 other CVD risk factors.
Give with evening meal. ≥17yrs: initially 10–20mg once daily, may increase at 4 week intervals; max 80mg/day in single or divided doses. Concomitant danazol, diltiazem, dronedarone, verapamil: initially 10mg/day; max 20mg/day. Concomitant amiodarone: max 40mg/day. Severe renal insufficiency (CrCl<30mL/min): 20mg/day; caution with dose increases.
<10yrs: not recommended. 10–17yrs: initially 10–20mg once daily, may increase at 4 week intervals. Usual range: 10–40mg/day; max 40mg/day.
Active liver disease. Unexplained, persistent elevated serum transaminases. Concomitant strong CYP3A4 inhibitors (eg, itraconazole, ketoconazole, posaconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone). Pregnancy (Cat.X). Nursing mothers.
Discontinue if myopathy, elevated CPK levels occur; suspend if a predisposition to development of renal failure secondary to rhabdomyolysis develops. Monitor liver function before starting therapy and repeat as clinically indicated. History of liver disease. Alcoholism. Homozygous familial hypercholesterolemia.
HMG-CoA reductase inhibitor.
See Contraindications. Increased risk of myopathy with strong CYP3A4 inhibitors, danazol, diltiazem, dronedarone, verapamil, amiodarone. May be potentiated by voriconazole, ranolazine; consider dose adjustment of lovastatin. Avoid gemfibrozil, cyclosporine, grapefruit juice >1 quart daily. Caution with, other fibrates, macrolides, niacin (≥1g/day), colchicine. Monitor oral anticoagulants. Inhibition of endogenous steroid production with spironolactone, ketoconazole, cimetidine.
GI upset, headache, rash, pruritus, myalgia, dizziness, blurred vision, elevated serum transaminases, myopathy, rhabdomyolysis with renal dysfunction; increased HbA1c and fasting serum glucose, cognitive impairment; rare: immune-mediated necrotizing myopathy.