Fluvastatin

Brand names

• Lescol

Usage

To treat high cholesterol. Usually prescribed after first lines of treatment - including diet, weight loss, and exercise - fail to reduce total and low-density lipoprotein (LDL) cholesterol to acceptable levels.

How it works

Fluvastatin blocks the action of an enzyme required for the manufacture of cholesterol, thereby interfering with its formation. By lowering the amount of cholesterol in the liver cells, fluvastatin increases the formation of receptors for LDL, and thereby reduces blood levels of total and LDL cholesterol. In addition to lowering LDL cholesterol, fluvastatin also modestly reduces triglyceride levels and raises HDL (the so-called "good" cholesterol) levels.

Side effects

Serious

Fever and unusual or unexplained muscle aches and tenderness.

Common

Side effects occur in only 1 % to 2% of patients. These include constipation or diarrhea, dizziness or lightheadedness, bloating or gas, heartburn, nausea, skin rash, stomach pain, rise in liver enzymes.

Less common

Sleeping difficulty.

Possible interactions

Other medicaments:

Fluvastatin may increase the effects of:

• digoxin (Lanoxin).
• warfarin (Coumadin); more frequent testing of INR (prothrombin time) will be needed.

Fluvastatin taken concurrently with:



• amprenavir (Agenerase) and ritonavir (Norvir) and perhaps other protease inhibitors may increase fluvastatin levels and the risk of muscle damage (myopathy).
• clofibrate (Atromid-S) or other fibrate compounds may result in increased risk of serious muscle toxicity.
• cyclosporine (Sandimmune) can result in kidney failure and myopathy.
• erythromycin and perhaps other macrolide antibiotics may increase risk of muscle damage (myopathy or rhabdomyolysis).
• fluconazole (Diflucan), itraconazole (Sporanox) or ketoconazole (Nizoral) increases myopathy or rhabdomyolysis risk.
• gemfibrozil (Lopid) may alter the absorption and excretion of fluvastatin; these medicaments should not be taken concurrently.
• levothyroxine (various) may blunt the effects of levothyroxine.
• medicines that change cytochrome P450 3A4 (inhibitors will increase fluvastatin levels and inducers will blunt atorvastatin therapeutic effects).
• niacin may cause an increased frequency of muscle problems (myopathy) when combined with a related medicine (lovastatin). Caution is advised. Niacin may also increase homocysteine levels-a risk factor for heart disease.
• omeprazole (Prilosec) may increase fluvastatin levels and lead to toxicity.
• quinupristin/dalfopristin (Synercid) may increase the risk for myopathy by increasing cerivastatin blood levels.
• ranitidine (Zantac) may increase peak blood levels of fluvastatin.
• ritonavir (Norvir) may lead to fluvastatin toxicity.
• sildenafil (Viagra) may change levels of either medicament as they both use CYP3A4 to be removed from the body.

The following medicament may decrease the effects of fluvastatin:



• cholestyramine (Questran), by possibly reducing absorption of fluvastatin; take fluvastatin 1 hour before or 4 hours after cholestyramine.

Foods:

Follow a standard low-cholesterol diet.

Herbal medicines or minerals:

No data exist from well-designed clinical studies about garlic and fluvastatin combinations and can not presently be recommended. Additionally, garlic may inhibit blood clotting (platelet) aggregation-something to consider if you are already taking a platelet inhibitor. The FDA will allow one dietary supplement called Cholestin to be sold. Because this product actually contains lovastatin, and the use of two HMGCo-A inhibitors may increase risk of rhabdomyolysis or myopathy, the combination is advised. Some products containing plant sterols (Benecol) may be useful as complimentary care to lower total and LDL cholesterol. Substituting soy for some of the meat in your diet can help avoid cardiovascular problems. Lastly, because this medicine can deplete coenzyme Q10, supplementation may be needed.

Discontinuation:

Do not stop this medicament without your physician's knowledge and guidance. There may be significant increase in blood cholesterol levels following discontinuation of this medicament.