Pitavastatin

About Pitavastatin

Pitavastatin blocks HMG-CoA reductase, the enzyme the liver uses to make cholesterol, so the liver clears more LDL from the blood. It is approved alongside diet for adults with primary hyperlipidemia, and Livalo also for children 8 and older with heterozygous familial hypercholesterolemia. The usual dose is 2 to 4 mg once a day, with or without food, and LDL can be rechecked as early as four weeks after starting.

It is cleared mainly by glucuronidation, with only minimal cytochrome P450 metabolism. Cyclosporine must not be taken with it, and moderate or severe kidney disease, including dialysis, means starting at 1 mg with a 2 mg maximum.

Muscle pain, constipation, diarrhea, back pain and limb pain are the most common side effects. Statins can rarely cause serious muscle breakdown, more likely at 65 or older, with uncontrolled hypothyroidism, kidney disease, some other lipid-lowering drugs and higher doses. Liver tests may be done before starting, and blood sugar and HbA1c can rise. It is contraindicated in acute liver failure or decompensated cirrhosis, stopped when pregnancy is recognized, and not recommended while breastfeeding; there is no boxed warning.

Zypitamag, pitavastatin magnesium in 2 and 4 mg tablets, was approved under its own application and is not rated therapeutically equivalent to Livalo, so a pharmacist cannot swap it with generic pitavastatin calcium or Livalo; a change goes through the prescriber.

Taking Pitavastatin

How to take it

Once a day at about the same time, with or without food. Keep taking it even if you feel well, alongside the diet and exercise your prescriber recommends.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for your next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in the original container, protected from light, excess heat and moisture (so not in a bathroom), and out of reach of children.

Interactions to know about

Cyclosporine must not be taken with it, and gemfibrozil is avoided; erythromycin and rifampin limit the dose; other fibrates, niacin and colchicine raise the risk of muscle problems. Report unexplained muscle pain, tenderness or weakness, especially with fever or tiredness, and dark urine or yellowing skin. Tell your prescriber at once if you become pregnant.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Pitavastatin differs from pharmacy to pharmacy

Generic pitavastatin calcium comes from several manufacturers, and pharmacies pay different amounts depending on their supplier, so generic quotes vary; Livalo and Zypitamag are brands and are usually priced above it. A prescription for Zypitamag can only be filled with Zypitamag, while one for pitavastatin, or for Livalo with substitution allowed, can be filled with the generic.

Livalo comes in bottles of 90 and statins are usually long-term, so a ninety-day fill spreads the dispensing fee.

Ways to pay less for Pitavastatin without insurance

• Ask the prescriber to write for pitavastatin, or for Livalo with substitution allowed, so the generic can be dispensed.
• If Zypitamag was prescribed, ask whether generic pitavastatin calcium would suit you; the pharmacy cannot make that switch itself.
• Ask for a ninety-day supply once your dose is settled.
• If cost is still a barrier, ask the prescriber about an older generic statin.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Pitavastatin

1. 1.Is this generic pitavastatin, Livalo or Zypitamag?
2. 2.Do my antibiotics, gout medicines or other cholesterol drugs interact with it?
3. 3.Is my dose right for my kidney function?
4. 4.Which muscle symptoms should I report?
5. 5.When will my cholesterol be checked again?

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