Hello there from Dr. K, your War on Diabetes pharmacist. Today we are going to continue our discussion about cholesterol medications. We have been covering the most common class of cholesterol meds, known as statins, and the statin for today is…drum roll please…lovastatin. So without further ado, let’s get started!
How does it lower cholesterol: Lovastatin (or its brand name Mevacor or extended release Altoprev) is an HMG-CoA reductase inhibitor (more commonly known as a “statin”). HMG-CoA reductase is an enzyme in the body that is used in the process of making cholesterol. Our bodies need some cholesterol for important cellular functions, but too much cholesterol can lead to problems including heart disease, stroke, chest pain, heart attack, and death. Simvastatin works by stopping HMG-CoA reductase from working, which stops the body from making cholesterol. Also, simvastatin helps to remove cholesterol from the body.
The effect on your numbers: The primary effect of lovastatin is on your bad cholesterol, or LDL. As I’ve discussed in previous posts, medications like lovastatin cause greater increases in cholesterol as we increase the dose, but this only happens up to a certain dose and then the effects plateau. At that point, we don’t see very much added benefit, but we do see more side effects. So if your cholesterol is not coming down low enough at doses around 40 mg, maybe another medication would be a better option for you.
For reference, this is an approximation of the effectiveness of lovastatin, per dose:
Lovastatin 10 mg – lowers LDL by about 21%
Lovastatin 20 mg – lowers LDL by about 24-27%
Lovastatin 40 mg – lowers LDL by about 30-31%
Lovastatin 80 mg – lowers LDL by about 40-42%
Dosing: Dosing is based on how high your LDL is and how much it needs to be lowered (see the list above), side effects, and other medications you are on. Just like with simvastatin, if you are taking certain medications along with lovastatin your dose might need to be adjusted. Medications on this list include amiodarone, cyclosporine, danazol, diltiazem, gemfibrozil, niacin, and verapamil. Ask your doctor or local pharmacist if you have any questions or if you are taking these medications currently with lovastatin.
Generally, lovastatin is started at a dose of 20 mg taken at bedtime (our bodies produce cholesterol while we sleep, so you should always take your statins at bedtime so that they can work while cholesterol is being made). You should be on the medication for at least four weeks before your dose is adjusted, to determine the effectiveness of the current dose. For the extended release lovastatin, known as Altoprev, the initial dose for diabetic patients is 20 mg and any increases should be done very cautiously.
Side effects: There are very few side effects that are attributed to lovastatin, and they will generally go away as your body becomes used to the medication. The most common ones are constipation (up to 3.5% of patients), abdominal pain (up to 2.5% of patients), and muscle pain (5 to 6% of patients). There have also been a small amount of patients that have experienced severe side effects with lovastatin use – liver problems, skin rashes, autoimmune disease, lupus, muscle disorders, and tendon rupture. These were not considered to be common side effects, but they still need to be mentioned. If you are concerned about them, please talk with your doctor to determine your risk for these side effects.
The FDA has put out a consumer update in regards to liver and muscle problems with statins, as well as addressing other safety issues that have been reported to them involving memory loss and increased blood sugars potentially caused by statins. I will provide a link to this information for you, but will summarize the report very briefly. There have been a small number of patients that have experienced “fuzzy or unfocused thinking,” which was not severe and stopped when the statin was stopped. Also, a small risk of increased blood sugars and development of type 2 diabetes has been found for some people when placed on statins. However, the FDA is quick to say that both of these instances are very rare and minor, and should not be used as reasons for discontinuing your statins. Statins have been shown to be extremely beneficial in reducing the risk of heart disease, stroke, and death and the benefits of this far outweigh the potential risks of these rare side effects. If you are at all concerned about these risks, do not stop taking your medication without talking with your local physician.
Who should not take lovastatin: Patients with active liver disease, pregnant women, and breastfeeding mothers should not take lovastatin. There are also other conditions and characteristics that can make you more susceptible to muscle damage/weakness or liver problems while on lovastatin, so you should talk to your doctor if you have any concerns. Some of these instances include ALS, age greater than 65, female gender, Chinese descent patients also taking niacin, sepsis, hypotension, uncontrolled epilepsy, surgery or trauma, uncontrolled hypothyroidism, liver or kidney disease, and substantial use of alcohol.
Drug interactions: Earlier I talked about how patients on certain medications should be on lower doses of lovastatin. Well, there is another list of medications that should not be used at all with lovastatin, because they can cause you to be at increased risk of the major side effects I just mentioned. Those medications include:
- HIV protease inhibitors (atazanavir/Reyataz, darunavir/Prezista, fosamprenavir/Lexia, indinavir/Crixivan, nelfinavir/Viracept, ritonavir/Norvir, saquinavir/Invirase, tipranavir/Aptivus)
As I mentioned in my simvastatin post, if you are an avid fan of grapefruit juice, limit yourself to no more than one quart daily when you are taking statins because grapefruit and grapefruit juice will affect how the medication works in your body. Here is a refresher chart talking about this:
There are other medications that are known to interact with lovastatin. If you have questions, please contact your local doctor or pharmacist.
If you would like to read more about lovastatin, here is another good website: http://www.webmd.com/drugs/mono-92-LOVASTATIN+-+ORAL.aspx?drugid=11594&drugname=lovastatin+Oral