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Pharmacologic class: HMG-CoA reductase inhibitor
Therapeutic class: Antihyperlipidemic
Pregnancy risk category X
Inhibits HMG-CoA reductase, an enzyme crucial to cholesterol synthesis. Decreases total cholesterol and low-density lipoprotein (LDL) levels and increases high-density lipoprotein level.
Tablets: 10 mg, 20 mg, 40 mg
Tablets (extended-release): 10 mg, 20 mg, 40 mg, 60 mg
Indications and dosages
➣ To reduce LDL, total cholesterol, triglyceride, and apolipoprotein B levels
Adults: Initially, 20 mg P.O. daily. May be increased, as needed, at 4-week intervals to a maximum of 80 mg/day as a single dose or in divided doses. Or 20 mg P.O. (extended-release) daily. May be increased, as needed, at 4-week intervals to a maximum daily dosage of 60 mg.
➣ Heterozygous familial hypercholesterolemia in boys and postmenarchal girls ages 10 and older who have high LDL and cholesterol levels despite adequate trial of diet therapy
Adolescents ages 10 to 17: 10 to 40 mg P.O. daily, with adjustments made at 4-week intervals
• Severe renal insufficiency
• High-risk patients with diabetic dyslipidemia, familial dysbetalipoproteinemia, familial combined hyperlipidemia, or nephrotic hyperlipidemia
• Hypersensitivity to drug, its components, or angiotensin-converting enzyme inhibitors
• Active hepatic disease or unexplained persistent hepatic enzyme elevation
• Concurrent gemfibrozil or azole antifungal therapy
• Pregnancy or breastfeeding
Use cautiously in:
• cerebral arteriosclerosis, heart disease, renal impairment, severe acute infection, severe hypotension or hypertension, uncontrolled seizures, myopathy, visual disturbances, major surgery, trauma, alcoholism
• severe metabolic, endocrine, or electrolyte problems
• women of childbearing age
• Give daily dose with evening meal.
• Increase dosage at intervals of 4 weeks or longer, as ordered.
• Don't give with grapefruit juice (may increase drug blood level).
☞ Discontinue if alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level exceeds three times the upper limit of normal.
CNS: headache, dizziness, asthenia
EENT: blurred vision, eye irritation
GI: nausea, vomiting, constipation, diarrhea, abdominal pain or cramps, dyspepsia, flatulence
Musculoskeletal: myalgia, cramps, rhabdomyolysis
Skin: pruritus, rash, photosensitivity
Other: hypersensitivity reaction
Drug-drug. Azole antifungals, cyclosporine, erythromycin, folic acid derivatives, gemfibrozil, niacin: increased risk of myopathy and rhabdomyolysis
Bile acid sequestrants: decreased lovastatin blood level
Isradipine: increased lovastatin clearance
Warfarin: increased prothrombin time, bleeding
Drug-diagnostic tests. ALT, AST: increased levels
Drug-food. Grapefruit juice: increased lovastatin blood level
Drug-herbs. Red yeast rice: increased risk of adverse reactions
Chaparral, comfrey, germander, jin bu huan, kava, pennyroyal, St. John's wort: increased risk of hepatotoxicity
• Obtain liver function tests before starting therapy, 6 and 12 weeks after therapy begins or dosage is increased, and periodically thereafter.
• Tell patient to take immediate-release tablets with evening meal or extended-release tablets at bedtime.
• Instruct patient not to break, crush, or chew extended-release tablets.
• Emphasize importance of cholesterol-lowering diet and other therapies, such as exercise and weight control.
☞ Instruct patient to report unexplained muscle pain, tenderness, or weakness, as well as signs or symptoms of hepatotoxicity (fever, malaise, abdominal pain, yellowing of skin or eyes, clay-colored stools, or tea-colored urine).
☞ Advise patient to contact prescriber immediately if she is breastfeeding or suspects pregnancy.
• Tell patient not to use herbs without consulting prescriber.
• Inform patient that drug may cause photosensitivity. Caution him to avoid excessive sun or heat lamp light.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
ClassificationTherapeutic: lipid lowering agents
Pharmacologic: hmg coa reductase inhibitors
Time/action profile (cholesterol-lowering effect)
|PO, PO-ER||2 wk||4–6 wk||6 wk†|
Adverse Reactions/Side Effects
Central nervous system
- memory loss
Ear, Eye, Nose, Throat
- blurred vision
- abdominal cramps (most frequent)
- constipation (most frequent)
- diarrhea (most frequent)
- flatus (most frequent)
- heartburn (most frequent)
- altered taste
- drug-induced hepatitis
- ↑ liver enzymes
- erectile dysfunction
- rashes (most frequent)
- rhabdomyolysis (life-threatening)
- immune-mediated necrotizing myopathy
- hypersensitivity reactions
Drug-Drug interactionStrong CYP3A4 inhibitors, including ketoconazole, itraconazole, posaonazole, protease inhibitors, boceprevir, telaprevir, clarithromycin, erythromycin, telithromycin, and nefazodone ↑ risk of myopathy; concurrent use contraindicatedCholesterol-lowering effect may be ↑ with cholestyramine andcolestipol, but bioavailability may be ↓.Risk of myopathy is ↑ by concurrent amiodaronecyclosporine,gemfibrozil, diltiazem, verapamil, danazol, and large doses of niacin (concurrent use with gemfibrozil or cyclosporine should be avoided; use ↓ doses with danazol, amiodarone, diltiazem, or verapamil).May ↑ effects of warfarin.St. John's wort may ↓ levels and effectiveness.Grapefruit juice ↑ blood levels and the risk of rhabdomyolysis.Food enhances blood levels of lovastatin.
Renal ImpairmentOral (Adults) CCr <30 mL/min—dosage should not exceed 20 mg/day unless carefully titrated.
Availability (generic available)
- Obtain a diet history, especially with regard to fat consumption.
- Lab Test Considerations: Evaluate serum cholesterol and triglyceride levels before initiating, after 4–6 wk of therapy, and periodically thereafter.
- Monitor liver function tests prior to initiation of therapy and as clinically indicated. If symptoms of serious liver injury, hyperbilirubinemia, or jaundice occur, discontinue simvastatin and do not restart. May also cause ↑ alkaline phosphatase and bilirubin levels.
- If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued.
Potential Nursing DiagnosesDeficient knowledge, related to medication regimen (Patient/Family Teaching)
Noncompliance (Patient/Family Teaching)
- Do not confuse Mevacor with Benicar (olmesartan).
- Oral: Administer with food. Administration on an empty stomach decreases absorption by approximately 30%. Initial once-daily dose is administered with the evening meal. Swallow extended-release tablets whole; do not crush, break or chew.
- Avoid grapefruit and grapefruit juice during therapy; may increase risk of toxicity.
- Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Advise patient to avoid drinking more that 200 mL/day of grapefruit juice during therapy. Medication helps control but does not cure elevated serum cholesterol levels.
- Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
- Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare).
- Advise patient to notify health care professional of medication regimen before treatment or surgery.,.
- Instruct female patients to notify health care professional promptly if pregnancy is planned or suspected or if breastfeeding.
- Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.
- Decrease in LDL and total cholesterol levels.
- Increase in HDL cholesterol levels.
- Decrease in triglyceride levels.
- Slowing of the progression of coronary artery disease.