Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
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
coronary artery 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.
PRESCRIPTION: Yes
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 staring 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), and protease inhibitors such as indinavir (Crixivan) and
ritonavir (Norvir). Large quantities of grape fruit juice (>1 quart daily) also
will increase blood levels of lovastatin.
Amiodarone (Cordarone), verapamil (Calan, Verelan, Isoptin),
danazol
(Danocrine), cyclosporine
(Gengraf, Neoral), niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil
(Lopid) and fenofibrate (Tricor) also may increase the risk of muscle toxicity
when combined with lovastatin. Patients taking amiodarone (Cordarone) or verapamil
(Calan, Verelan, Isoptin) should
not take more than 40 mg of lovastatin. Patients taking niacin (greater than or
equal to 1 g/day), gemfibrozil (Lopid), fenofibrate (Tricor) or cyclosporine
(Gengraf, Neoral) should not take more
than 20 mg of lovastatin.
Lovastatin may increase the effect of warfarin (Coumadin), a blood thinner.
Patients taking lovastatin and warfarin (Coumadin) should be monitored carefully for toxic
effects of warfarin.
PREGNANCY: Pregnant women should not use lovastatin because the developing
fetus requires cholesterol for development, and lovastatin reduces the
production of cholesterol. Lovastatin should only be administered to women of
child bearing age if they are not likely to become pregnant.
NURSING MOTHERS: Because of the risk of adverse effects to the developing
infant, lovastatin should not be administered to
nursing mothers.
SIDE EFFECTS: The most common side effects of lovastatin are headache,
nausea,
vomiting, diarrhea, abdominal pain, muscle pain, and
abnormal liver
tests. Hypersensitivity reactions have also been reported. The most serious
potential side effects are liver damage and muscle inflammation or breakdown.
Lovastatin is a statin. Therefore it shares side effects, such as liver and
muscle damage associated with all statins. Serious liver damage caused by
statins is rare. More often, statins cause abnormalities of liver tests, and,
therefore, periodic measurement of liver tests in the blood is recommended
during treatment with all statins. Abnormal tests usually return to normal even
if a statin is continued, but if the abnormal test value is greater than three
times the upper limit of normal, the statin usually is stopped. Liver tests
should be measured before lovastatin is started, at 6 and 12 weeks after
initiation of therapy, with an increase in dose, and periodically thereafter or
if there is a medical concern about liver damage.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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