Names and pronunciation
(pit′a-va-stat′-in) Livalo, Zypitamag
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Drug reference
(pit′a-va-stat′-in) Livalo, Zypitamag
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Func. class.: Antilipidemic
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Chem. class.: HMG-CoA reductase inhibitor
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Do not confuse: pitavastatin/pravastatin
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ACTION: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis; high doses lead to plaque regression
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USES: As an adjunct for primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyc eride levels, prevention of CV disease by reduction of heart risk in those with mildly elevated cholesterol
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Unlabeled uses: Atherosclerosis
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CONTRAINDICATIONS: Preg nancy, breastfeeding, hypersensitivity, active hepatic disease, cholestasis Precautions: Past hepatic disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalance, seizures, sur- gery, organ transplant, endocrine dis- ease, females, hypotension, renal disease
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SIDE EFFECTS CNS: Headache GI: Constipation, diarrhea INTEG: Rash, pruritus, alopecia MS: Arthralgia, myalgia, rhabdomyolysis RESP: Pharyngitis
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INTERACTIONS Increase: risk for possible rhabdomyoly- sis—azole antifungals, cycloSPORINE, erythromycin, niacin, gemfibrozil, clofibrate Increase: levels of pitavastatin— erythromycin Drug/Herb Increase: pitavastatin—red yeast rice Drug/Lab Test Increase: bilirubin, alk phos, ALT, AST Interference: thyroid function tests
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DOSAGE AND ROUTES • Adult: PO 2 mg/day, usual range 1-4, max 4 mg/day Renal dose • Adult: PO CCr 30-<60 mL/min, 1 mg daily, max 2 mg daily; CCr <30 mL/min on hemodialysis, 1 mg daily, max 2 mg daily; CCr <30 mL/min, not recom- mended Atherosclerosis (unlabeled) • Adult: PO 4 mg/day
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Available forms: Calcium tablets 1, 2, 4 mg magnesium tablet 1, 2, 4 mg
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Administer: • Total daily dose any time of day without regard to meals • Store in cool environment in tight con- tainer protected from light
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Assess: • Diet: obtain diet history including fat, cholesterol in diet • Cholesterol, triglyceride levels periodi- cally during treatment; check lipid panel 6 wk after changing dose • Hepatic studies baseline and when clinically indicated; if AST >3× normal, reduce or discontinue; AST, ALT, LFTs may be increased • Renal studies in patients with compro- mised renal system: BUN, I&O ratio, cre- atinine • Rhabdomyolysis: muscle pain, ten- derness; obtain CPK if clinically indicated; if markedly increased, product may need to be discontinued • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: decrease in cholesterol to desired level after 6 wk
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blood work will be necessary dur- ing treatment • To report blurred vision, severe GI symptoms, headache, muscle pain, weak- ness, tenderness • That previously prescribed regimen will continue: low-cholesterol diet, exer- cise program, smoking cessation • That product may increase blood glu- cose level • Not to take product if pregnant or if pregnancy is planned or suspected (notify prescriber); to avoid breastfeeding
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PHARMACOKINETICS Peak 1 hr; metabolized in liver, excreted in urine, feces; half-life 12 hr; protein binding 99%; concentrations lower in healthy African Americans
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• Adult: PO 2 mg/day, usual range 1-4, max 4 mg/day Renal dose
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• Adult: PO CCr 30-<60 mL/min, 1 mg daily, max 2 mg daily; CCr <30 mL/min on hemodialysis, 1 mg daily, max 2 mg daily; CCr <30 mL/min, not recom- mended Atherosclerosis (unlabeled)
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• Adult: PO 4 mg/day
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