FLUVASTATIN (flu-vah-stat'in)
Lescol, Lescol XL Classifications: hmg-coa reductase inhibitor (statin); antilipemic agent; Therapeutic: cholesterol-lowering agent (statin) Prototype: Lovastatin Pregnancy Category: X
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Availability
20 mg, 40 mg capsules; 80 mg extended release tablet
Action
Inhibits reductase 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) that 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 Effect
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; children ≤10 y.
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 12 doses
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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 from GI tract; about 24% reaches systemic circulation after first-pass
metabolism.
Onset: 36 wk.
Peak: Serum level 0.51 h.
Distribution: 98% protein bound; distributed into breast milk.
Metabolism: In liver.
Elimination: 95% in bile; 5% in urine.
Half-Life: 0.51 h.
Nursing Implications
Assessment & Drug Effects
- Lab tests: Monitor lipoprotein levels; maximal lipid-lowering effect occurs in 46 wk. Monitor serum transaminase and
CPK levels every 34 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.