Names and pronunciation
(flu′vah-stay-tin) Lescol XL
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Drug reference
(flu′vah-stay-tin) Lescol XL
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Func. class.: Antilipemic
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Chem. class.: HMG-CoA reductase inhibitor
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Do not confuse: fluvastatin/FLUoxetine
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ACTION: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
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USES: As an adjunct for primary hypercholesterolemia (types Ia, Ib), coronary atherosclerosis in CAD; to reduce the risk for secondary preven- tion of coronary events in patients with CAD; as an adjunct to diet to reduce LDL, total cholesterol, apo B levels in heterozygous familial hypercholester- olemia (LDL-C ≥190 mg/dL or LDL-C ≥160 mg/dL) with history of prema- ture CV disease
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity, active hepatic disease Precautions: Previous hepatic disease, alcoholism, severe acute infections, trauma, hypotension, uncontrolled sei- zure disorders, severe metabolic disor- ders, electrolyte imbalance, myopathy, rhabdomyolysis
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SIDE EFFECTS CNS: Headache, dizziness, insomnia, confusion EENT: Lens opacities GI: Abdominal pain, cramps, nausea, constipation, diarrhea, dyspepsia, fla tus, hepatic dysfunction, pancreatitis HEMA: Thrombocytopenia, hemolytic anemia, leukopenia INTEG: Rash, pruritus MISC: Fatigue, influenza, photosensitivity F MS: Myalgia, myositis, rhabdomyolysis, arthritis, arthralgia
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INTERACTIONS Increase: effects of warfarin, digoxin, phenytoin; monitor closely Increase: myopathy—cycloSPORINE, niacin, colchicine, protease inhibitors, fibric acid derivatives, erythromycin Increase: effects of fluvastatin—alcohol, cimetidine, ranitidine, omeprazole, phe- nytoin, rifampin Increase: adverse reactions—flucon- azole, itraconazole, ketoconazole Decrease: fluvastatin effect—cholestyr- amine, colestipol; separate by ≥4 hr Drug/Herb Increase: adverse reactions—red yeast rice Drug/Lab Test Increase: LFTs, CK Decrease: platelets, WBC
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DOSAGE AND ROUTES • Adult: PO 20-40 mg/day in PM initially, titrate up to 40 mg bid; or 80 mg/day (ext rel) dosage adjustments may be made at ≥4-wk intervals or ext rel 80 mg at bedtime Heterozygous familial hypercholesterolemia • Adolescent ≥1 yr postmenarche (10- 16 yr): PO 20 mg daily at bedtime, may increase q6wk, max 40 mg bid (cap) or 80 mg (ext rel) Renal dose • Adult: PO Max 40 mg/day
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Available forms: Caps 20, 40 mg; ext rel tab 80 mg
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Administer: • Do not break, crush, or chew ext rel tabs, use at any time of day (tab), in the evening (cap) • Bile acid sequestrant should be given at least 2 hr before fluvastatin • Give without regard to food • Store at room temperature, protected from light
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Assess: • Hypercholesterolemia: diet history: fats, protein carbohydrate; nutritional analysis should see dietitian before treat- ment; fasting lipid profile (cholesterol, LDL, HDL, TG) before and q4-6wk, then q3-6mo when stable • Hepatotoxicity/pancreatitis: monitor hepatic studies before, q12wk after dos- age change, then q6mo; AST, ALT, LFTs may be increased • Renal studies in patients with compro- mised renal system: BUN, I&O ratio, cre- atinine • Myopathy, rhabdomyolysis: muscle pain, tenderness; obtain baseline CPK if elevated; if these occur, product should be discontinued • Pregnancy/breastfeeding: do not use in pregnancy/breastfeeding
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Evaluate: • Therapeutic response: decrease in sLDL, VLDL, total cholesterol; increased HDL, decreased triglycerides, slowing of CAD
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blood work will be necessary dur- ing treatment; to take product as pre- scribed; that effect may take ≥4 wk • To report severe GI symptoms, head- ache, muscle pain, weakness, tenderness • That previously prescribed regimen will continue: low-cholesterol diet, exer- cise program, smoking cessation • To report suspected pregnancy; not to use during pregnancy, breastfeeding • To take without regard to meals; to take immediate-release product in the eve- ning; separate by ≥4 hr from bile-acid product, not to cut, break, chew capsule
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PHARMACOKINETICS Peak response 3-4 wk, metabolized in liver, >98% protein bound, excreted pri- marily in feces, enters breast milk, half- life 1.9 hr, steady-state 4-5 wk
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• Adolescent ≥1 yr postmenarche (10- 16 yr): PO 20 mg daily at bedtime, may increase q6wk, max 40 mg bid (cap) or 80 mg (ext rel) Renal dose
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