FLUVASTATIN
(flu-vah-stat'in)
Lescol, Lescol XL
Classifications: cardiovascular agent; antilipemic; hmg-coa reductase inhibitor (statin)
Prototype: Lovastatin
Pregnancy Category: X

Availability

20 mg, 40 mg capsules; 80 mg extended release tablet

Actions

Inhibits therapeutic reductase 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA), which is essential to hepatic production of cholesterol. Cholesterol-lowering effect triggers induction of LDL receptors, which promotes removal of LDL and VLDL remnants (precursors of LDL) from plasma.

Therapeutic Effects

Results in an increase in plasma HDL concentration. HDLs collect excess cholesterol from body cells and transport it to the liver for excretion.

Uses

Adjunct to diet for the reduction of elevated total LDL cholesterol in patients with primary hypercholesterolemia (Types IIa and IIb).

Unlabeled Uses

Other types of hyperlipidemias.

Contraindications

Hypersensitivity to fluvastatin, lovastatin, pravastatin, or simvastatin; active liver disease or unexplained persistent elevated liver function tests; pregnancy (category X), lactation.

Cautious Use

Patients who consume substantial quantities of alcohol; history of liver disease; renal impairment.

Route & Dosage

Hypercholesterolemia
Adult: PO 20 mg h.s., may increase up to 80 mg/d in 1–2 doses

Administration

Oral

Give at bedtime.
Ensure the extended release tablet is not chewed or crushed. It must be swallowed whole.
Separate doses of this drug and bile-acid resin (e.g., cholestyramine) by at least 2 h when given concomitantly.
Note: Dosage adjustments may be required in patients with significant renal or hepatic impairment.
Store at room temperature, 15°–30° C (59°–86° F).

Adverse Effects (1%)

CNS: Headache, fatigue. Body as a Whole: Myalgia. GI: Dyspepsia, diarrhea, abdominal pain. Skin: Rash.

Interactions

Drug: May increase risk of bleeding with warfarin; cholestyramine decreases fluvastatin absorption; rifampin increases metabolism of fluvastatin; may increase risk of myopathy and rhabdomyolysis with gemfibrozil, fenofibrate, clofibrate.

Pharmacokinetics

Absorption: Readily absorbed from GI tract; about 24% reaches systemic circulation after first-pass metabolism Onset: 3–6 wk. Peak: Serum level 0.5–1 h. Distribution: 98% protein bound; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: 95% excreted in bile; 5% excreted in urine. Half-Life: 0.5–1 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Monitor lipoprotein levels; maximal lipid-lowering effect occurs in 4–6 wk. Monitor serum transaminase and CPK levels every 3–4 mo for the first year and periodically thereafter.
Monitor PT & INR in patients on concurrent warfarin therapy; PT & INR may be prolonged.

Patient & Family Education

Take fluvastatin at bedtime.
Be alert & report signs of bleeding immediately when also taking warfarin.
Notify physician immediately of the following: Fever; rash; muscle pain, weakness, tenderness, or cramping.
Reduce or eliminate alcohol consumption while taking fluvastatin.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug