lovastatin, Mevacor, Altoprev
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: lovastatin
BRAND NAME: Mevacor, Altoprev
DRUG CLASS AND MECHANISM: Lovastatin belongs to a class of cholesterol-lowering drugs called HMG-CoA reductase inhibitors, or, more commonly "statins." Other statins include simvastatin (Zocor), atorvastatin (Lipitor), fluvastatin (Lescol), and rosuvastatin (Crestor). Statins reduce cholesterol by inhibiting an enzyme in the liver (HMG-CoA reductase) that is necessary for the production of cholesterol. In the blood, statins lower total cholesterol, low density lipoprotein (LDL) cholesterol ("bad" cholesterol) and triglycerides. LDL cholesterol is believed to be an important cause of atherosclerosis and coronary artery disease (cardiovascular disease). Lowering LDL cholesterol levels slows and may even reverse coronary artery disease. Statins also increase high density lipoprotein (HDL) cholesterol ("good" cholesterol). Raising HDL cholesterol levels, like lowering LDL cholesterol, may slow coronary artery disease. The FDA approved lovastatin in August 1987.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 10, 20 and 40 mg. Extended release tablets: 10, 20, 40, and 60 mg.
STORAGE: Immediate release tablets should be stored between 5-30 C (41-86 F). Extended release tablets should be stored at room temperature, 20-25 C (68-77 F).
PRESCRIBED FOR: Lovastatin is used for reducing total cholesterol and LDL cholesterol, and triglycerides, and for increasing HDL cholesterol in patients with elevated blood cholesterol levels (hypercholesterolemia). Lovastatin is used for reducing the risk of heart attacks, angina, coronary revascularization procedures in individuals without symptomatic cardiovascular disease, average to moderately elevated cholesterol levels and below average HDL cholesterol levels. It also is used for slowing the progression of coronary atherosclerosis in individuals with coronary heart disease.
DOSING: The dose range for lovastatin is 10-80 mg daily given preferably in the evening when it may be most effective. The usual starting dose is 20 mg once daily, and the maximum dose is 80 mg daily. Blood cholesterol determinations are performed at regular intervals during treatment so that adjustments in dosage can be made.
DRUG INTERACTIONS: Decreased elimination of lovastatin could increase the levels of lovastatin in the body and increase the risk of muscle toxicity from lovastatin. Examples of drugs that decrease elimination of lovastatin include erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune), nefazodone (Serzone), boceprevir (Victrelis), telaprevir (incivek), voriconazole (Vfend), and protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir). They should not be combined with lovastatin.
Large quantities of grape fruit juice (>1 quart daily) also will increase blood levels of lovastatin and should be avoided.
Amiodarone (Cordarone), verapamil (Calan, Verelan, Isoptin), diltiazem (Cardizem), danazol (Danocrine), niacin (Niacor, Niaspan, Slo-Niacin), colchicine, ranolazine (Ranexa), gemfibrozil (Lopid), and fenofibrate (Tricor) also may increase the risk of muscle toxicity when combined with lovastatin. Cyclosporine or gemfibrozil should not be combined with lovastatin. Patients taking amiodarone (Cordarone) should not exceed 40 mg daily of lovastatin. Patients taking verapamil, diltiazem, or danazol should start with 10 mg and should not exceed 20 mg of lovastatin daily. Patients taking niacin (greater than or equal to 1 g/day), fenofibrate (Tricor) or cyclosporine (Gengraf, Neoral) should not take more than 20 mg of lovastatin.
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