Lovastatin (Oral)

Taken orally, Lovastatin is a HMG-CoA reductase inhibitor and is used to lower levels of cholesterol and triglycerides in the blood.

Overview

Also known as a lipid, cholesterol is a fatty substance which is necessary for the body to function normally. Produced by the liver, cholesterol is crucial to the functioning of cells and the production of vitamin D, bile and some hormones. Although cholesterol is needed for the body to work effectively, too much cholesterol can be harmful.

When cholesterol is transported in the blood, it is carried with either low density or high density lipoprotein. (LDL and HDL). Whilst HDL can have a protective effect on the body, too much LDL can be extremely harmful to the patient. Excess cholesterol can adhere to the walls of the blood vessels and cause blockages, which may prevent blood from getting around the body properly. Whilst this alone can cause serious health problems, patients can suffer further complications if a blockage breaks away from the blood vessel and travels to the heart or brain.

Unless treated, high cholesterol levels increase the patient's risk of experiencing serious medical events, such as heart attacks, strokes and atherosclerosis.

Similarly, high levels of triglycerides in the blood can also cause patients to develop life-threatening medical conditions. Stored in the body's fat cells, triglycerides are fatty deposits. If the patient's triglyceride levels are too high, it can cause narrowing of the arterial walls. As a result, blood is unable to flow through the arteries at the appropriate rate, which places extra pressure on the heart.

Although high cholesterol levels can sometimes be caused by inherited conditions, the majority of patients can lower their cholesterol levels by adopting healthier lifestyles. In addition to this, medication can be used to lower cholesterol and triglyceride levels. For example, Lovastatin is a HMG-CoA reductase inhibitor and works by preventing HMG-CoA from being converted into mevalonate.

Mevalonate is vital to the production of cholesterol and, without it, the body is not able to produce cholesterol in such large amounts. As a result, Lovastatin is able to lower the amount of cholesterol and triglycerides produced by the patient's body. Once the patient's triglyceride and cholesterol levels are within a normal range, their risk of experiencing further health complications should also be reduced.

Whilst Lovastatin is effective in treating high cholesterol and triglyceride levels, it is normally prescribed in conjunction with lifestyle and dietary changes. Often, physicians will advise patients to engage in more exercise and to adopt a healthier diet whilst taking Lovastatin.

Conditions Treated

High levels of cholesterol in the blood

High levels of triglycerides in the blood

Type Of Medicine

HMG-CoA reductase inhibitor (Statin)

Side Effects

Like most medications, Lovastatin can sometimes cause patients to develop side effects. Whilst patients may experience side effects when they first start using Lovastatin, these will often decrease over time.

If the following side effects are fairly mild, patients may not require medical intervention:

  • Sour or acid stomach
  • Rash on the skin
  • Belching
  • Full or bloated feeling
  • Stomach pain, upset or discomfort
  • Blurred vision
  • Passing gas
  • Diarrhea
  • Nausea
  • Difficulty having a bowel movement (stool)
  • Loss or lack or strength
  • Dizziness
  • Indigestion
  • Excess gas or air in the intestines or stomach
  • Heartburn

Although the above side effects may not necessarily require further medical treatment, patients should obtain medical advice if they are severe and/or on-going.

Patients will also need to obtain immediate medical assistance if they experience the following adverse effects whilst taking Lovastatin:

  • Bladder pain
  • Swollen joints
  • Cloudy or bloody urine
  • Runny or stuffy nose
  • Chest tightness
  • Tenderness or pain around the cheekbones or eyes
  • Cough
  • Muscle weakness, tenderness or pain
  • Dark-colored urine
  • Painful, burning or difficult urination
  • Muscle stiffness, spasms, cramps or aching
  • Difficulty with moving
  • Pain in the lower back or side
  • Fever
  • Pain in the joints
  • Frequent urge to urinate
  • Trouble with breathing
  • Headache
  • Unusual weakness or tiredness

Dosage

When patients are treated with Lovastatin for high cholesterol and high triglyceride levels, they may be prescribed standard tablets or extended-release tablets. If adult patients are given standard tablets, they are usually advised to take 20mg once per day, usually with their evening meal. If necessary, the dose can be increased but patients are not normally prescribed more than 80mg per day. Alternatively, if children between the ages of 10 and 17 years are prescribed standard Lovastatin tablets, they are usually instructed to take 10mg per day, with their evening meal. Although their dose may be increased, patients of this age are not normally given more than 40mg of Lovastatin per day.

If extended-release Lovastatin tablets are prescribed, adult patients are usually instructed to take 20-60mg per day, usually in the evening. Due to safety concerns, pediatric patients are not usually treated with Lovastatin in extended-release form.

Although this is a standard dosing regime for treatment with Lovastatin, patients should follow their physician's instructions when taking Lovastatin. In some cases, the patient's dose may be modified or altered, particularly if they are taken with any other medications.

If patients are taking Lovastatin in conjunction with Danazol, Verapamil, Diltiazem or Dronedarone, for example, they will not usually be prescribed more than 20mg of Lovastatin per day. Similarly, if patients are taking this medication alongside Amiodarone, the maximum dose is normally 40mg per day. If higher doses of Lovastatin are taken with the medicines, the patient's risk of developing kidney disease and/or muscle injury is increased.

Generally, the standard Lovastatin tablets should be taken with food, whereas the extended-release tablets are usually taken without food. It is important that patients swallow the extended-release tablet whole and do not attempt to break or crush it.

When taking Lovastatin, patients may also be advised to stick to a specific diet plan. Usually, patients will need to adhere to a low cholesterol, low fat and low carbohydrate diet as this can help to reduce their cholesterol and triglyceride levels.

Before taking Lovastatin, patients should tell their doctor if they consume grapefruit juice. Drinking more than one quart of grapefruit juice per day when taking Lovastatin could increase the patient's risk of suffering from kidney disease and/or muscle injury. Due to this, patients may be advised to reduce their consumption or cut grapefruit and grapefruit juice out of their diet altogether.

Patients should not consume or drink a large amount of alcohol when taking Lovastatin as it could have unwanted and serious effects on the liver.

If patients forget to take a dose of Lovastatin, they should take it as soon as they remember to. However, if their next dose is almost due, patients should skip the missed dose and continue taking their medication at the usual time. Patients should not attempt to take a double dose of Lovastatin, even if an earlier dose has been missed.

If patients are unsure how or when to take Lovastatin, they should seek help from their physician or pharmacist.

Potential Drug Interactions

Due to the risk of a drug interaction occurring, Lovastatin is not prescribed in conjunction with the following medicines:

  • Amprenavir
  • Mifepristone
  • Atazanavir
  • Nefazodone
  • Boceprevir
  • Nelfinavir
  • Lopinavir
  • Clarithromycin
  • Mibefradil
  • Cobicistat
  • Telithromycin
  • Darunavir
  • Telaprevir
  • Erythromycin
  • Saquinavir
  • Fosamprenavir
  • Posaconazole
  • Idelalisib
  • Ritonavir
  • Indinavir
  • Tipranavir
  • Itraconazole
  • Voriconazole
  • Ketoconazole

Similarly, taking Lovastatin alongside the following medicines is not usually advisable:

  • Amiodarone
  • Lumacaftor
  • Bezafibrate
  • Lomitapide
  • Dronedarone
  • Ceritinib
  • Quinupristin
  • Ciprofibrate
  • Niacin
  • Diltiazem
  • Clofibrate
  • Fluconazole
  • Delavirdine
  • Colchicine
  • Gemfibrozil
  • Conivaptan
  • Fenofibrate
  • Cyclosporine
  • Ranolazine
  • Dalfopristin
  • Fenofibric Acid
  • Danazol
  • Verapamil
  • Daptomycin

In some cases, however, doctors may decide it is in the patient's best interests to prescribe Lovastatin in conjunction with one of the medicines listed above. If so, the patient's dose of Lovastatin is likely to be modified and they may be instructed to take their medications at specific times as this can help to reduce the risk of an interaction occurring.

If patients take Lovastatin alongside the following medications, they may have an increased risk of developing side effects:

  • Azithromycin
  • Oat Bran
  • Bosentan
  • Pectin
  • Clopidogrel
  • St John's Wort

If patients do exhibit troublesome side effects when taking Lovastatin alongside the above medicines, they should consult their physician. It may be possible for their treatment to be modified so that the adverse effects caused by the medications are reduced.

Lovastatin can also interact with the following food and drink:

  • Grapefruit, grapefruit juice and any other products containing grapefruit

Due to this, patients should remove these items from their diet completely or ask their doctor how much they can safely consume whilst taking Lovastatin.

Before patients start taking Lovastatin, they should tell their doctor if they are taking any other prescription medicines, over-the-counter medications, supplements or vitamins. In addition to this, patients should obtain medical advice before taking any new medicines, vitamins or supplements once they have begun treatment with Lovastatin.

Warnings

If patients have any other medical problems, they should notify their physician before they start taking Lovastatin. Similarly, patients should disclose their medical history to their doctor before they take any medications. There are some conditions which could affect treatment with Lovastatin and these may include:

  • Electrolyte disorder
  • Alcohol abuse
  • Endocrine disorder
  • Diabetes
  • Liver disease
  • Underactive thyroid (Hypothyroidism)
  • Low blood pressure (Hypotension)
  • Epilepsy and/or seizures
  • Metabolic disorder
  • Kidney disease
  • Sepsis
  • High levels of cholesterol caused by familial homozygous (Hypercholesterolemia)
  • Elevated liver enzymes

Although pediatric patients can be prescribed Lovastatin, the effects of the extended-release tablets have not been specifically studied on younger patients. Due to this, only standard Lovastatin is used to treat children. Similarly, the effects of standard Lovastatin tablets have not been tested on people under the age of 10 years. Whilst standard Lovastatin tablets may be used to treat patients between the ages of 10 and 17 years, Lovastatin is not usually prescribed to patients under this age.

If teenage patients are prescribed Lovastatin, they should be warned about the effects of this medication during pregnancy and offered effective forms of birth control.

Lovastatin may be prescribed to geriatric patients, providing they do not have any age-related conditions which could affect the use of this medication. Older patients are more likely to suffer from kidney disease, for example, and this may mean that their dose of Lovastatin needs to be modified.

When taking Lovastatin, patients should have regular check-ups with their physician and routine blood tests may also be carried out. This will confirm whether the patient's dose of Lovastatin needs to be changed and that the medication isn't having any unwanted effects.

Lovastatin can increase the patient's risk of developing serious muscle problems, such as immune-mediated necrotizing myopathy (IMNM) or myopathy. If patients experience the following symptoms when taking Lovastatin, they should obtain immediate medical help:

  • Unexplained muscle weakness, tenderness or pain
  • Fever
  • Unusual tiredness

Patients could also experience a muscle problem known as rhabdomyolysis when taking Lovastatin and this could result in kidney problems. If patients exhibit the following symptoms when taking this medicine, they should access immediate medical treatment:

  • Muscle stiffness or pain
  • Diarrhea
  • Muscle spasms or cramps
  • Fever
  • Weakness or tiredness

When taking Lovastatin, patients could experience liver damage and should obtain medical advice if they develop the following symptoms:

  • Stomach pain
  • Dark colored urine
  • Vomiting
  • Loss of appetite
  • Headache
  • Weight loss
  • Light colored stools
  • Pain in the upper right of the stomach
  • Yellowing of the skin or eyes
  • General feeling of weakness or tiredness

If patients are due to undergo any medical tests or procedures, they must tell the relevant healthcare practitioners that they are taking Lovastatin. Patients should also inform their dentist that they are taking this medication. If patients are due to have major surgery or develop certain other medical conditions, they may be advised to stop taking Lovastatin.

Lovastatin should not be used during pregnancy under any circumstances. If this medication is taken by patients who are pregnant, it could cause serious harm to the fetus. Patients must inform their doctor if they are pregnant before Lovastatin is prescribed and patients should not take Lovastatin during a pregnancy. As safer alternatives are available, patients may be prescribed an alternative medication during and following their pregnancy.

Whilst taking Lovastatin, patients should use an effective form of birth control. If patients are planning to have children, they should discuss this with their physician before trying to conceive. If necessary, the patient's treatment with Lovastatin can be discontinued and an alternative medication prescribed.

If patients become pregnant when using Lovastatin, they should inform their physician immediately.

It is not safe for patients to breastfeed whilst taking Lovastatin. As the medication could be excreted in breastmilk, it could cause harm to a nursing infant. Patients should never breastfeed whilst taking Lovastatin and should not breastfeed soon after taking their last dose as the medication may remain in their system for some time.

Before using Lovastatin, patients should tell their doctor if they have any existing allergies. This includes allergies to medicines, preservatives, dyes, animals, foods and other substances. In rare cases, patients may develop an allergic reaction when taking Lovastatin and, if so, they will require emergency medical treatment. The symptoms of an allergic reaction can include:

  • Itching
  • Rash on the skin
  • Hives
  • Difficulty breathing
  • Hoarseness
  • Shortness of breath
  • Difficulty swallowing
  • Swelling of the face, hands, throat, tongue, mouth or lips

Storage

As patients are usually advised to take Lovastatin on a daily basis, they will need to keep a supply of medication at home. However, it's important that Lovastatin is kept in an appropriate location and that children and/or pets cannot gain access to it.

In most cases, Lovastatin can be kept at room temperature but should be protected from heat, light and moisture. Patients should also keep Lovastatin in a closed container at all times. In order to store the medicine properly, patients should follow the manufacturer's instructions.

If patients are advised to stop taking Lovastatin or if the medicine reaches its expiration date, patients should dispose of it carefully. Old or out-of-date medicines should not be kept in the home due to the risks they pose. However, medicines should not be thrown out with regular household waste either. Instead, patients should contact their physician's office or pharmacist and make use of a specialist medicine disposal service.

Summary

Although patients may not exhibit symptoms of high cholesterol and high triglyceride levels, these conditions pose serious health risks. If patients have too much cholesterol or triglycerides in their blood, they have a significantly higher risk of developing cardiovascular disease and could suffer a stroke or heart attack at any time.

As both of these substances adhere to the walls of the blood vessels, they cause the vessels to narrow and harden. As a result, blood cannot be pumped around the body appropriately and the patient's heart has to work harder in order to keep their circulation going. Over time, this can have detrimental consequences and patients may suffer serious medical events as a result of high triglyceride and cholesterol levels.

By using Lovastatin, however, patients can reduce the amount of triglycerides and cholesterol in their blood and, therefore, reduce their risk of suffering further health problems. Providing patients take Lovastatin and make appropriate dietary and lifestyle changes, their triglyceride and cholesterol levels can be reduced and maintained within a normal range.