lovastatin, Mevacor, Altoprev (cont.)
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:
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.
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 also have been reported.
The most serious potential side effects are liver damage and muscle inflammation or breakdown. Lovastatin 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. 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 function tests should be performed at the beginning of treatment and then as needed thereafter. Inflammation of the muscles caused by statins can lead to a serious breakdown of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood. Myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than 1% of patients. To prevent the development of rhabdomyolysis, patients taking lovastatin should contact their healthcare provider immediately if they develop unexplained muscle pain, weakness, or muscle tenderness.
Statins have been associated with increases in HbA1c and fasting serum glucose levels as are seen in diabetes. There are also post-marketing reports of memory loss, forgetfulness, amnesia, confusion, and memory impairment. Symptoms may start one day to years after starting treatment and resolve within a median of three weeks after stopping the statin.
Reference: FDA Prescribing Information
Last Editorial Review: 5/31/2012
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