Adult Dosing
Primary hypercholesterolemia
- Immediate Release:
- Start 10 - 20 mg PO Daily with evening meal; 20 mg PO if LDL reduction goal > 20%
- Range: 10-80 mg/day PO divided Daily-bid
- Max: 80 mg/day
- If taking cyclosporine/danazol concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 40 mg/day
- Extended Release:
- 10-60 mg PO Daily with evening meal
- Individualize dose according to goal of therapy
- For patients requiring a small reduction in cholesterol levels, start 10 mfg PO Daily
- Max: 60 mg/day
- If taking cyclosporine concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 20 mg/day
- If taking concomitant lipid lowering therapy: Max: 20 mg/day
Cardiovascular event risk reduction
- Immediate Release:
- Start 10 - 20 mg PO Daily with evening meal
- Range: 10-80 mg/day PO divided Daily-bid
- Max: 80 mg/day
- If taking cyclosporine/danazol concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 40 mg/day
- Extended Release:
- 10-60 mg PO Daily with evening meal
- Individualize dose according to goal of therapy
- For patients requiring a small reduction in cholesterol levels, start 10 mg PO Daily
- Max: 60 mg/day
- If taking cyclosporine concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 20 mg/day
- If taking concomitant lipid lowering therapy: Max: 20 mg/day
Coronary atherosclerosis (slowing down progression)
- Immediate Release:
- Start 10 - 20 mg PO Daily with evening meal
- Range: 10-80 mg/day PO divided Daily-bid
- Max: 80 mg/day
- If taking cyclosporine/danazol concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 40 mg/day
- Extended Release:
- 10-60 mg PO Daily with evening meal
- Individualize dose according to goal of therapy
- For patients requiring a small reduction in cholesterol levels, start 10 mg PO Daily
- Max: 60 mg/day
- If taking cyclosporine concomitantly: Start 10 mg/day. Max: 20 mg/day
- If taking amiodarone/verapamil: Max: 20 mg/day
- If taking concomitant lipid lowering therapy: Max: 20 mg/day
Pediatric Dosing
Heterozygous familial hypercholesterolemia
10-17 yrs
- Immediate Release:
- Start 10 mg PO Daily with evening meal; 20 mg PO if LDL reduction goal > 20%
- Max: 40 mg/day
- If taking gemfibrozil, other nitrates or niacin: Max: 20 mg/day
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <30 mL/min: Use with caution if dose >20 mg/day
- HD: Not defined
Hepatic Dose Adjustment
- Active liver disease or persistent unexplained increases in LFTs: Contraindicated
- Therapy may cause myopathy manifested as muscle pain, tenderness or weakness with creatine kinase (CK) above 10 times the upper limit of normal (ULN). Therapy should be discontinued immediately if myopathy is diagnosed or suspected
- Increase risk of myopathy and rhabdomyolysis in elderly, with higher doses and in renal insufficiency
- Immune-mediated necrotizing myopathy (IMNM) characterized by proximal muscle weakness and elevated serum creatine kinase has been reported with statin use, and may persist despite discontinuation of statin treatment
- Concomitant use of therapy with the potent CYP3A4 inhibitors itraconazole, ketoconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone, or large quantities of grapefruit juice (>1 quart daily)should be avoided
- In patients receiving concomitant medication with cyclosporine or danazol the dose of lovastatin should not exceed 20 mg daily
- In patients receiving concomitant medication with amiodarone or verapamil the dose of lovastatin should not exceed 40 mg daily
- Chronic use of therapy may cause increase in serum transaminases leading to liver dysfunction
- Therapy may elevate creatine phosphokinase and transaminase levels which should be considered in the differential diagnosis of chest pain in a patient on therapy with lovastatin
- Persistent elevations > 3 times the upper normal limits in serum transaminases have occurred. Monitor closely for signs of hepatotoxicity. Perform liver enzyme tests before starting treatment, at 6 and 12 wks after start/ dose increases and periodically thereafter (at least semianually)
- Preexisting ALS may cause functional decline increase with statin therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Alcohol abuse
- Concurrent potent CYP3A4 inhibitors (increased risk of myopathy)
- Concurrent gemfibrozil, niacin, amiodarone, verapamil
Pregnancy Category:X
Breastfeeding: Since lovastatin can cause disruption of infant lipid metabolism, breastfeeding is not recommended. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 March 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Lovastatin 20 MG TABS [Bottle] (ACTAVIS ELIZABETH)
30 mg = $22.99
90 mg = $59.99 - Lovastatin 10 MG TABS [Bottle] (ACTAVIS ELIZABETH)
45 mg = $47.99
90 mg = $55.96 - Mevacor 40 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $146
90 mg = $409.95 - Lovastatin 40 MG TABS [Bottle] (ACTAVIS ELIZABETH)
30 mg = $35.99
90 mg = $98.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
