II. Indications
- See Hyperlipidemia Management for formal criteria
- See Statin
- Hyperlipidemia
- Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
III. Contraindications
- See Statin
- Drug Interactions
- Pregnancy (Teratogen)
- Acute Liver Failure or decompensated Cirrhosis
IV. Mechanism
- See Statin
V. Efficacy
- See Statin
- Lovastatin 10 mg lowers LDL 21%
- Lovastatin 20 mg lowers LDL 24 to 29% (recommended starting dose)
- Lovastatin 40 mg lowers LDL 30 to 31%
- Lovastatin 80 mg lowers LDL 40 to 48%
VI. Adverse Effects
- See Statin
- See Statin-Induced Myopathy
VII. Safety
- Pregnancy Category X
- Contraindicated in Lactation
VIII. Pharmacokinetics
- See Statin
- Undergoes first pass metabolism as with most Statins (except Pravastatin)
-
Protein binding
- As with most Statins (except Pravastatin), Lovastatin is 90% Protein bound
- Cytochrome P450 Metabolism
IX. Dosing: Adult
- Specific LDL and HDL targets have been replaced with high-intensity Statin if 10 year Cardiovascular Risk >20%
- Low intensity Statin (age >75 years, or Statin intolerant)
- Lovastatin 20 to 40 mg orally daily (maximum 80 mg/day)
X. Dosing: Child
- Approved for children over age 10 to 17 years old with Heterozygous familial Hyperlipidemia
- Start 10 mg orally daily
- Maximum: 40 mg/day
XI. Monitoring
XII. Drug Interactions (See Contraindications above)
- See Statin
-
CYP3A4 Inhibitors
- Azole Antifungals (Intraconazole, Ketoconazole - 10-20 fold increase in Statin serum levels)
- Increased risk of Statin Myopathy (esp. with age >65, Obesity, renal or liver Impairment)
- Avoid with Lovastatin
- Calcium Channel Blocker
- Grapefruit juice increases some Statin levels
- Lovastatin is among the drugs most affected
- Avoid with any Grapefruit juice (or minimal use)
- References
- (2016) Presc Lett 23(3):18
- Reamy (2007) Am Fam Physician 76:190-1 [PubMed]
- Lovastatin is among the drugs most affected
- Azole Antifungals (Intraconazole, Ketoconazole - 10-20 fold increase in Statin serum levels)
-
CYP3A4/organic anion transporting polypeptide inhibitors
- Cyclosporine (10-20 fold increase in Statin serum levels)
- Avoid with Lovastatin over 20 mg daily
- Macrolides (Erythromycin, Clarithromycin - 6-10 fold increase in Statin serum levels)
- Avoid while on Lovastatin (or stop Statin while on Macrolide)
- Azithromycin appears to be safe with Statins
- Protease inibitors (Atazanavir, Ritonavir, Lopinavir/Ritonavir)
- Avoid with Lovastatin
- Cyclosporine (10-20 fold increase in Statin serum levels)
-
CYP3A4/CYP2C9 Inhibitor
- Amiodarone
- Increased risk of Statin Myopathy (esp. with age >65, Obesity, renal or liver Impairment)
- Avoid with Lovastatin over 40 mg daily
- Warfarin (Increased INR and bleeding risk)
- Among the highest risk with Lovastatin
- Amiodarone
-
CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Avoid with Lovastatin over 20 mg daily
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Other interactions
- Mibefradil (Posicor)
- Niacin
- Alcohol
- Increases risk of liver enzyme elevations
XIII. Resources
- See Statin
- Lovastatin Extended Release (DailyMed)
- Lovastatin Regular Release (DailyMed)
XIV. References
- (2017) Presc Lett 24(11): 62
- (2012) Presc Lett 19(5): 25
- (2012) Presc Lett, Characteristics of Various Statins, #280502
- Carpenter (2019) Am Fam Physician 99(9):558-64 [PubMed]
- Chong (2001) Am J Med 111:390-400 [PubMed]
- Crouch (2001) Am Fam Physician 63(2):309-20 [PubMed]
- Gillett (2011) Am Fam Physician 83(6): 711-6 [PubMed]
- Jones (1998) Am J Cardiol 81:582-7 [PubMed]
- Sasaki (1998) Clin Ther 20:539-48 [PubMed]
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Related Studies
| lovastatin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| LOVASTATIN 10 MG TABLET | Generic | $0.05 each |
| LOVASTATIN 20 MG TABLET | Generic | $0.05 each |
| LOVASTATIN 40 MG TABLET | Generic | $0.06 each |