Adult Dosing
Hypercholesterolemia
- 1-2 tabs PO qhs
- Initial dose: 20 mg/500 mg PO qhs for 4 wks
- May increase by not >500 mg/day q 4wks based on extended release niacin
- Max dose: 40 mg/2 gm /day
Mixed dyslipidemia
- 1-2 tabs PO qhs
- Initial dose: 20 mg/500 mg PO qhs for 4 wks
- May increase by not >500 mg/day q 4wks based on extended release niacin
- Max dose: 40 mg/2 gm /day
Dual niacin/lovastatin treatment
- 1-2 tabs PO qhs
- Initial dose: 20 mg/500 mg PO qhs for 4 wks
- May increase by not >500 mg/day q 4wks based on extended release niacin
- Max dose: 40 mg/2 gm /day
Note:
- Initial dose of 500 mg PO niacin if switching from niacin IR
- Convert with same niacin dose when switching from niacin ER
- Convert with same lovastatin dose when switching from lovastatin monotherapy
- Retitrate if treatment interrupted for >7 days
- Administering 325 mg aspirin 30mins before dose to reduce flushing
- Administer with food
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- CrCl >30mL/min: Use with caution
- CrCl <30mL/min: Consider lovastatin dose >20 mg/day carefully, if necessary, use cautiously
Hepatic Dose Adjustment
- Active hepatic disease/unexplained elevated LFTs: Contraindicated
See Supplemental Patient Information
- Avoid using as a substitute for equivalent doses of immediate-release niacin
- For patients switching from immediate-release (crystalline) niacin to extended release niacin initiate therapy with lower doses (i.e. 500 mg PO qd Hs ) and titrate the extended release niacin dose to the desired therapeutic response
- Severe hepatic toxicity, including fulminant hepatic necrosis have occurred in patients who have substituted modified-release, niacin products for immediate-release (crystalline) niacin at equivalent doses
- Reversible transaminase elevations have occurred
- On persistent elevation of transaminase levels to 3 times ULN and association with symptoms of nausea, fever, and/or malaise drug should be discontinued
- Rare occasions of rhabdomyolysis, with or without acute renal failure secondary to myoglobinuria have occurred
- Myopathy manifested as muscle pain or weakness associated with grossly elevated creatine kinase (> 10 times ULN) have occurred. Risk of myopathy increases with concomitant use of potent inhibitors of CYP3A4
- 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
- Assess potential benefits to risk ratio before initiating therapy with combination drug. Carefully monitor patients for any signs and symptoms of myopathy particularly during the initial month of treatment or during upward dosage titration of either drug
- Advise patients about the risk of myopathy
- Discontinue therapy on suspected/diagnosed myopathy
- Avoid concomitant use of gemfibrozil, particularly with higher doses of lovastatin as it increases risk of myopathy; do not exceed dose of lovastatin >20 mg day
- Avoid use in combination with fibrates unless potential benefits will be outweighing risk
- Avoid doses >20 mg/1gm in patients taking concomitant cyclosporine, danazol or fibrates
- Consider interruption of therapy with a systemic antifungal/azole/macrolide antibiotic/ketolide antibiotic
- Monitor Cr at baseline
- Monitor fasting glucose frequently if diabetes or risk of diabetes
- Monitor PO4 if risk of hypophosphatemia
- Monitor prothrombin time, Plt if surgery. Consider CK periodically
- Monitor LFTs at baseline, then q 6-12wk x6mo, then periodically. Carefully supervise patients with elevated serum transaminase levels. Perform LFTs; promptly repeat these measurements if confirmed then perform more frequently
Cautions: Use cautiously in:
- History of liver disease
- Preexisting renal insufficiency
- Alcohol abuse
- Elective major surgery
- Major acute medical/surgical condition
- History of jaundice
- Hepatobiliary disease
- Peptic ulcer
- Diabetic or potentially diabetic patients
- Unstable angina
- MI
- Gout
- Concomitant use with vasoactive drugs
Supplemental Patient Information
- Advise patients to report to clinician on unexplained muscle pain, tenderness, or weakness
- Instruct patients to avoid cutting/crushing/chewing the formulation
- Inform patients that flushing is a common side effect of the therapy, and usually subsides by itself after a few weeks of use
Pregnancy Category:X
Breastfeeding: Literature on use of lovastatin during breastfeeding unavailable. As lovastatin can cause disruption of infant lipid metabolism, breastfeeding is not recommended. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 10 December 2010). Lovastatin/niacin has a potential for serious adverse reactions in nursing infants due to lipid-altering doses of niacin and lovastatin. Niacin is excreted in human milk. Unknown whether lovastatin is excreted in milk. Manufacturer advises to avoid use of lovastatin/niacin drug during breastfeeding.
US Trade Name(s)
US Availability
Advicor (lovastatin/niacin)
- ETABS:
- 20 mg/500 mg
- 20 mg/750 mg
- 20 mg/1 g
- 40 mg/1 g
Canadian Trade Name(s)
Canadian Availability
Advicor (lovastatin/niacin)
- ETABS:
- 20 mg/500 mg
- 20 mg/750 mg
- 20 mg/1 g
- 40 mg/1 g
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Advicor 750-20 MG TB24 [Bottle] (ABBOTT)
60 mg = $276
180 mg = $815.99 - Advicor 1000-40 MG TB24 [Bottle] (ABBOTT)
90 mg = $477.99
180 mg = $950.92 - Advicor 1000-20 MG TB24 [Bottle] (ABBOTT)
60 mg = $296
180 mg = $855.95 - Advicor 500-20 MG TB24 [Bottle] (ABBOTT)
90 mg = $385
180 mg = $756.95
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.