Lovastatin

About Lovastatin

Lovastatin blocks HMG-CoA reductase, the enzyme the liver uses to make cholesterol, so more LDL is cleared from the blood. Alongside diet it lowers LDL and total cholesterol, cuts the risk of heart attack, unstable angina and artery-opening procedures in people without heart disease symptoms, and slows artery narrowing in people with heart disease. It is also approved for teenagers aged 10 to 17 with inherited high cholesterol.

The usual starting dose is 20 mg once a day with the evening meal, within a range of 10 to 80 mg a day as one dose or two. The extended-release Altoprev is listed as discontinued in the FDA Orange Book, and DailyMed lists no other extended-release lovastatin, so an Altoprev prescription has to be rewritten.

Lovastatin is broken down by the liver enzyme CYP3A4, so its interaction rules are strict. Strong CYP3A4 inhibitors, such as itraconazole, ketoconazole, clarithromycin, erythromycin, HIV protease inhibitors and cobicistat-containing products, are contraindicated, and gemfibrozil and cyclosporine are avoided. With danazol, diltiazem, dronedarone or verapamil the dose is capped at 20 mg a day, and with amiodarone at 40 mg. The label says to avoid grapefruit juice.

Muscle damage that can progress to rhabdomyolysis and kidney failure is the main risk, so unexplained muscle pain, tenderness or weakness, especially with fever, should be reported promptly. Liver tests are done before starting, it is not used in active liver disease, and dark urine or yellowing skin should be reported. MedlinePlus warns it may harm a fetus and should not be taken while breastfeeding.

Taking Lovastatin

How to take it

With meals: once a day with the evening meal, or with two meals if your prescriber splits the dose. Keep taking it even if you feel well.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in a tightly closed, light-resistant container, away from excess heat and moisture, and out of reach of children.

Interactions to know about

Itraconazole, ketoconazole, posaconazole, voriconazole, clarithromycin, erythromycin, telithromycin, HIV protease inhibitors, nefazodone and cobicistat-containing products must not be taken with it. Gemfibrozil and cyclosporine are avoided, danazol and several heart medicines cap the dose, and other fibrates, niacin at lipid-lowering doses, colchicine and ranolazine add to the muscle risk. Avoid grapefruit juice, and tell any new prescriber you take it.

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 Lovastatin differs from pharmacy to pharmacy

Lovastatin is an old generic made by several companies, so pharmacies pay very little for it and the price is mostly the dispensing fee and markup. Many pharmacies put it on a flat-price list; those that price it individually can quote far more for the same tablets.

The largest tablet is 40 mg, so an 80 mg daily dose needs two tablets a day, which matters at a pharmacy that charges per tablet. As a long-term medicine, it suits a ninety-day fill.

Ways to pay less for Lovastatin without insurance

• Ask whether lovastatin is on the pharmacy’s flat-price generic list.
• Ask for a ninety-day supply once your dose is settled.
• If you have an Altoprev prescription, ask your prescriber for a new one; the brand is no longer sold.
• 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 Lovastatin

1. 1.Should I take it with my evening meal, or split the dose between two meals?
2. 2.Do any of my antibiotics, antifungals, heart or HIV medicines interact with it?
3. 3.Is my dose within the limit for my diltiazem, verapamil or amiodarone?
4. 4.Which muscle or liver symptoms should I report?

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