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lovastatin (mevinolin)
Mevacor

Pregnancy Risk Category X

How supplied
Tablets:
10 mg, 20 mg, 40 mg

Action
Inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is an early (and rate-limiting) step in the synthetic pathway of cholesterol.

Indications & dosage
Reduction of low-density lipoprotein and total cholesterol levels in patients with primary hypercholesterolemia (types IIa and IIb), to slow the progression of coronary atherosclerosis associated with coronary artery disease
--
Adults:
initially, 20 mg P.O. once daily with evening meal. Recommended dosage range is 10 to 80 mg daily in one or two divided doses.
Adjust-a-dose:
For patients receiving immunosuppressants, initially 10 mg P.O. daily. Maximum daily dose is 20 mg.
NEW INDICATION:
Primary prevention of coronary heart disease in patients without symptomatic cardiovascular disease, average to moderately elevated total cholesterol and low-density lipoprotein cholesterol, and below average high-density lipoprotein cholesterol--
Adults:
initially, 20 mg P.O. once daily with evening meal. Recommended dosage range is 10 to 80 mg daily in one or two divided doses.

Adverse reactions
CNS:
headache, dizziness, peripheral neuropathy, insomnia.
CV:
chest pain.
EENT:
blurred vision.
GI:
constipation, diarrhea, dyspepsia, flatulence, abdominal pain or cramps, heartburn, nausea, vomiting.
Hepatic:
elevated serum CK or serum transaminase levels.
Musculoskeletal:
muscle cramps, myalgia, myositis, rhabdomyolysis.
Skin:
rash, pruritus, alopecia.

Interactions
Drug-drug.
Azole antifungals, clarithromycin, cyclosporine or other immunosuppressants, erythromycin, gemfibrozil, nefazodone, niacin: possible increased risk of polymyositis and rhabdomyolysis (maximum recommended lovastatin dose is 20 mg daily); monitor patient closely.
Oral anticoagulants:
lovastatin may enhance the clinical effects of oral anticoagulants. Monitor patient closely.
Drug-lifestyle.
Alcohol use: increased risk of hepatotoxicity. Avoid concomitant use.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with active liver disease or conditions associated with unexplained persistent elevations of serum transaminase levels; also contraindicated in pregnant and breast-feeding women, in women of childbearing age unless there is no risk of pregnancy, and in patients taking mibefradil.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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