lovastatin

Dosage Forms & Strengths

Hypercholesterolemia

Mevacor (immediate-release): 20 mg PO qDay with evening meal initially, or may divide daily dose BID; adjust dose at 4-week intervals if increase required; not to exceed 80 mg/day

Altoprev (extended-release): 10-60 mg PO qHS

Dosing Considerations

Coadministration with danazol, diltiazem, or verapamil: Do not exceed 20 mg lovastatin daily

Coadministration with amiodarone: Do not exceed 40 mg lovastatin daily

Avoid large quantities of grapefruit juice (>1 qt/day)

Overdose management

Adverse drug reactions from overdose may include peripheral neuropathy, diarrhea, increased K+, myopathy, rhabdomyolysis, acute renal failure, elevated LFTs, eye lens opacities
Treatment is supportive

Dosing Modifications

Renal impairment (severe; CrCl <30 mL/min): Doses >20 mg/day should be carefully considered and, if deemed necessary, implemented cautiously

Contraindicated (34)

atazanavir
boceprevir
clarithromycin
cobicistat
conivaptan
darunavir
delavirdine
elvitegravir/cobicistat/emtricitabine/tenofovir df
erythromycin base
erythromycin ethylsuccinate
erythromycin lactobionate
erythromycin stearate
fosamprenavir
idelalisib
indinavir
isoniazid
itraconazole
ketoconazole
lopinavir
mifepristone
nefazodone
nelfinavir
nicardipine
ombitasvir/paritaprevir/ritonavir
ombitasvir/paritaprevir/ritonavir & dasabuvir
posaconazole
quinidine
red yeast rice
ritonavir
saquinavir
telaprevir
telithromycin
tipranavir
voriconazole

Serious - Use Alternative (78)

afatinib
amiodarone
aprepitant
armodafinil
artemether/lumefantrine
bezafibrate
bosentan
butabarbital
butalbital
carbamazepine
cimetidine
clobetasone
colchicine
cyclosporine
darifenacin
dasatinib
deflazacort
dexamethasone
diltiazem
efavirenz
eluxadoline
eslicarbazepine acetate
ethotoin
etravirine
eucalyptus
everolimus
fenofibrate
fenofibrate micronized
fenofibric acid
fluconazole
fluvoxamine
fosphenytoin
gemfibrozil
grapefruit
griseofulvin
hexobarbital
hydrocortisone
ivacaftor
lapatinib
lomitapide
lumefantrine
marijuana
mephobarbital
mesterolone
methylprednisolone
metronidazole
mibefradil
miconazole vaginal
modafinil
nafcillin
nevirapine
niacin
nifedipine
nilotinib
oxcarbazepine
oxiconazole
pentobarbital
phenobarbital
phenytoin
pomalidomide
prednisolone
prednisone
primidone
quinidine
quinupristin/dalfopristin
rifabutin
rifampin
rifapentine
riociguat
rufinamide
secobarbital
sitaxentan
st john's wort
topiramate
troglitazone
troleandomycin
verapamil
zafirlukast

Significant - Monitor Closely (79)

amiodarone
atorvastatin
axitinib
azithromycin
bazedoxifene/conjugated estrogens
bosutinib
ceritinib
cholestyramine
cholic acid
clobetasone
clotrimazole
colchicine
conjugated estrogens
conjugated estrogens, vaginal
crizotinib
crofelemer
dabrafenib
daclatasvir
daclizumab
daptomycin
deferasirox
deflazacort
dexamethasone
docetaxel
dronedarone
elbasvir/grazoprevir
eliglustat
erythromycin base
erythromycin ethylsuccinate
erythromycin lactobionate
erythromycin stearate
estradiol
flibanserin
hydrocortisone
iloperidone
imatinib
ivermectin
ketoconazole
lanthanum carbonate
lapatinib
lomitapide
loperamide
maraviroc
mipomersen
mitotane
nefazodone
netilmicin
nicardipine
nifedipine
nilotinib
ombitasvir/paritaprevir/ritonavir
paclitaxel
paclitaxel protein bound
paliperidone
phenobarbital
ponatinib
quercetin
ranolazine
reserpine
rifampin
sacubitril/valsartan
silodosin
simeprevir
simvastatin
sirolimus
spironolactone
st john's wort
tacrolimus
ticagrelor
tolvaptan
trazodone
valsartan
vemurafenib
verapamil
vinblastine
vincristine
vincristine liposomal
vismodegib
warfarin

Minor (12)

alvimopan
coenzyme q10
colestipol
exenatide injectable solution
exenatide injectable suspension
fexofenadine
isradipine
liraglutide
loratadine
orlistat
ruxolitinib
trazodone

Adverse Effects

>10%

CPK elevation (11%)

1-10%

Flatulence (4-5%)

Abdominal pain (2-3%)

Constipation (2-3%)

Diarrhea (2-3%)

Myalgia (2-3%)

Nausea (2-3%)

Dyspepsia (1-2%)

Weakness (1-2%)

Blurred vision (0.8-1%)

Rash (0.8-1%)

Muscle cramps (0.6-1%)

Dizziness (0.5-1%)

<1%

Dermatomyositis

Increased LFTs

Hepatotoxicity

Myopathy

Rhabdomyolysis

Warnings

Contraindications

Hypersensitivity to lovastatin or other components

Active liver disease, or unexplained elevated transaminases

Pregnancy, lactation

Concomitant administration with strong CYP3A4 inhibitors (eg, itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, cobicistat, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, and nefazodone)

Cautions

Nonserious and reversible cognitive side effects may occur

Increased blood sugar and glycosylated hemoglobin (HbA1c) levels reported with statin intake

Rhabdomyolysis, risk of myopathy: Risk increased by coadministration CYP3A4 inhibitors or other drugs that cause myopathy

Avoid coadministration with cyclosporine or gemfibrozil; caution with other fibrates or lipid-lowering doses of niacin (≥1 g/day) because of increased risk for myopathy

Heavy alcohol use, history of liver disease, renal failure

Discontinue if markedly elevated CPK levels occur or myopathy is diagnosed or suspected; also, temporarily withhold in any patient experiencing an acute or serious condition predisposing to the development of renal failure secondary to rhabdomyolysis (eg, sepsis; hypotension; major surgery; trauma; severe metabolic, endocrine, or electrolyte disorders; uncontrolled epilepsy)

Rare reports of immune-mediated necrotizing myopathy (IMNM), characterized by increased serum creatine kinase that persists despite discontinuation of statin

Obtain baseline liver enzyme tests before initiating and then periodically thereafter

Brand Altocor renamed Altoprev due to confusion with Advicor

Pregnancy & Lactation

Pregnancy category: X

Lactation: Contraindicated; unsafe