Drug Name
Generic Name : lovastatin (mevinolin)
Brand Name: Altoprev, Apo-Lovastatin (CAN), Co-Lovastatin (CAN), Gen-Lovastatin (CAN), Mevacor, Nu-Lovastatin (CAN), ratio-Lovastatin (CAN), PMS-Lovastatin (CAN)
Classification: Antihyperlipidemic, HMG-CoA reductase inhibitor
Pregnancy Category X
Dosage & Route
Available forms : Tablets—10, 20, 40 mg; ER tablets—10, 20, 40, 60 mg
ADULTS
- Initially, 20 mg/day PO given in the evening with meals. Maintenance dose range, 20–80 mg/day PO single or divided doses. Do not exceed 80 mg/day. For ER tablets, 10–60 mg/day as single dose PO, taken in the evening. Adjust at intervals of 4 wk or more. Patients receiving cyclosporine should start at 10 mg daily and not exceed 20 mg daily. May be combined with bile acid sequestrants. If combined with fibrates or niacin, do not exceed 20 mg daily.
PEDIATRIC PATIENTS
- Adolescent boys and post-menarchal girls, age 10–17 yr: 10–20 mg/day PO; may increase to a maximum of 40 mg/day.
PATIENTS WITH RENAL IMPAIRMENT
- For creatinine clearance < 30 mL/min, use doses > 20 mg/day with caution.
Therapeutic actions
- Lovastatin reduces cholesterol synthesis by inhibiting the rate-limiting step catalysed by HMG-CoA reductase.
Indications
- Treatment of familial hypercholesterolemia
- Adjunctive treatment of type II hyperlipidemia (ER only)
- To slow the progression of atherosclerosis in patients with CAD
- Primary prevention of coronary heart disease in patients without symptomatic disease; average to moderately elevated total cholesterol and LDL cholesterol, and low HDLs
- As adjunct to diet to reduce total cholesterol, LDLs, apolipoprotein B levels in adolescent boys and girls who are at least 1 yr post-menarche who have heterozygous familial hypercholesterolemia
Adverse effects
- Increased creatine phosphokinase; flatulence, nausea, dyspepsia, constipation or diarrhoea, abdominal pain; muscle cramps, myalgia, weakness; blurred vision; headache, dizziness; rash.
- Potentially Fatal: Rhabdomyolysis and acute renal failure.
Contraindications
- Active liver disease; unexplained persistently elevated serum transaminases. Pregnancy and lactation.
Nursing considerations
Assessment
- History: Allergy to lovastatin, impaired hepatic function, cataracts, pregnancy, lactation
- Physical: Orientation, affect, ophthalmologic examination; liver evaluation; lipid studies, LFTs
Interventions
- Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM
- Arrange for regular checkups.
- Advise patient that this drug cannot be taken during pregnancy; urge the use of barrier contraceptives
- Arrange for periodic ophthalmologic examinations to check for cataract development, and liver function studies q 4–6 wk during first 15 mo and then periodically.
- Administer only when diet restricted in cholesterol and saturated fats fails to lower cholesterol and lipids adequately.
Teaching points
- Take drug in the evening. Continue following a cholesterol-lowering diet while taking this medication. Avoid drinking grapefruit juice while taking this drug.
- Do not cut, crush, or chew extended-release tablets.
- Use a barrier contraceptive while you are taking this drug; if you think you are pregnant or wish to become pregnant, consult your health care provider.
- Have periodic ophthalmologic examinations.
- You may experience these side effects: Nausea (eat frequent small meals), headache, muscle and joint aches and pains (may lessen).
- Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine, or light-colored stools, severe muscle pain, soreness.