Names and pronunciation
(loh-vah-stat′in) Altoprev, Mevacor
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Drug reference
(loh-vah-stat′in) Altoprev, Mevacor
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Func. class.: Antilipemic
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Chem. class.: HMG-CoA reductase inhibitor
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Do not confuse: Mevacor/Benicor
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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 IIa, IIb), atherosclerosis; heterozygous familial hypercholesterolemia (adolescents)
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity, active hepatic disease Precautions: Children, past hepatic dis- ease, alcoholism, severe acute infections, trauma, hypotension, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalances, visual disorder
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SIDE EFFECTS CNS: Dizziness, headache, tremor, insomnia, paresthesia EENT: Blurred vision, lens opacities GI: Flatus, nausea, constipation, diarrhea, dyspepsia, abdominal pain, heartburn, dysfunction, vomiting, acid hepatic regurgitation, dry mouth, dysgeusia HEMA: Thrombocytopenia, hemolytic anemia, leukopenia INTEG: Rash, pruritus, photosensitivity MS: Muscle cramps, myalgia, myositis, rhabdomyolysis; leg, shoulder, or local- ized pain
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INTERACTIONS Increase: myalgia, myositis, rhabdomy olysis—azole antifungals, clarithromycin, clofibrate, cycloSPORINE, danazol, diltia zem, erythromycin, gemfibrozil, niacin, protease inhibitors, quinupristin-dalfo pristin, telithromycin, verapamil; avoid concurrent use Increase: bleeding—warfarin Increase: lovastatin effects—diltiazem Decrease: effects of lovastatin—bile acid sequestrants, exenatide, bosentan Decrease: lovastatin metabolism, avoid combining with >40 mg/day amioda- rone Drug/Herb Decrease: effect—pectin, St. John’s wort Increase: adverse reactions—red yeast rice Drug/Food • Possible toxicity: grapefruit juice Increase: levels of lovastatin with food; must be taken with food Decrease: absorption—oat bran Drug/Lab Test Increase: CK, LFTs Interference: T3, T4, T7, TSH
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DOSAGE AND ROUTES To prevent/treat CAD, hyperlipidemia • Adult: PO 20 mg/day with evening meal; may increase to 20-80 mg/day in single or divided doses at 4-wk intervals, max 80 mg/day; EXT REL 20-60 mg/day at bedtime, max 60 mg/day Heterozygous familial hypercholesterolemia • Adolescent 10-17 yr: PO 10-40 mg with evening meal Primary prevention of CV disease • Adult 40-75 yr with type 1 or 2 diabe- tes: PO 40 mg immediate release daily Secondary prevention of CV disease • Adult >75 yr (not candidate for high- intensity use): PO 40 mg immediate re- lease daily Renal dose • Adult: PO CCr <30 mg/min, max 20 mg/day unless titrated
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Available forms: Tabs 10, 20, 40 mg; ext rel tab 20, 40, 60 mg
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Administer: • In evening with meal; if dose is in- creased, take with breakfast and evening meal (immediate release); use at bed- time (extended release) • Altroprev is not equivalent to Mevacor • Do not crush, chew ext rel tab • Store in cool environment in airtight, light-resistant container
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Assess: • Diet: obtain diet history including fat, cholesterol in diet • Fasting cholesterol, LDL, HDL, triglyc- erides periodically during treatment • Hepatic studies at initiation, 6 wk, 12 wk after initiation or change in dose, periodi- cally thereafter; AST, ALT, LFTs may increase • Renal function in patients with com- promised renal system: BUN, creatinine, I&O ratio • Pregnancy/breastfeeding: not to be used in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: decreased tri- glycerides, sLDL, total cholesterol; in- creased HDL; slowing CAD
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blood work, ophthalmic exam L will be necessary during treatment • To report blurred vision, severe GI symptoms, dizziness, headache, muscle pain, weakness • To use sunscreen or to stay out of the sun to prevent photosensitivity • That previously prescribed regimen will continue: low-cholesterol diet, exer- cise program, smoking cessation • That product should be taken with food; not to crush, chew ext rel product; to take immediate-release product in the AM, PM if used bid; to take ext rel product at bedtime • Not to use with grapefruit juice, large amounts of alcohol • To protect product from light and moisture • Pregnancy/breastfeeding: to report suspected pregnancy; not to breastfeed
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PHARMACOKINETICS PO: Peak 2 hr; peak response 4-6 wk, ext rel peak 14 hr; metabolized in liver (metabolites); highly protein bound; excreted in urine 10%, feces 83%; crosses blood-brain barrier, placenta; excreted in breast milk; half-life 1 hr
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• Adolescent 10-17 yr: PO 10-40 mg with evening meal Primary prevention of CV disease
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