Monograph Details
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Cardiovascular System
> Hyperlipoproteinemias
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MEVACOR |
| Manufacturer |
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Merck & Co., Inc. |
| Legal Classification |
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Rx
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| Pharmacological Class |
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HMG-CoA reductase inhibitor. |
| Generic Name |
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Lovastatin 10mg, 20mg, 40mg; tabs. |
| Indications |
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To reduce risk of MI, unstable angina, and coronary revascularization procedures in patients without symptomatic cardiovascular disease (CVD), average to moderately elevated total-C and LDL-C, and below average HDL-C. Primary hypercholesterolemia (Types IIa and IIb) to reduce elevated total-C and LDL-C when response to nondrug therapy is inadequate. To slow progression of coronary atherosclerosis in patients with coronary heart disease to lower total-C and LDL-C. Adjunct to nondrug therapy to reduce total-C, LDL-C and apo B in patients 10–17yrs of age (≥1yr post-menarche) with heterozygous familial hypercholesterolemia if LDL-C remains >189mg/dL, or if LDL-C remains >160mg/dL with either family history of premature cardiovascular disease (CVD) or if patient has at least 2 other CVD risk factors. |
| Children |
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<10yrs: not recommended. 10–17yrs: initially 10–20mg once daily, may increase at 4 week intervals. Usual range: 10–40mg/day; max 40mg/day. |
| Adults |
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Give with evening meal. ≥17yrs: initially 10–20mg/day, may increase at 4 week intervals; max 80mg/day in single or divided doses. Concomitant cyclosporine: initially 10mg daily; max 20mg/day. Concomitant fibrates, niacin, or if CrCl <30mL/minute: usual max 20mg/day. Reevaluate periodically. |
| Contraindications |
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Active liver disease. Unexplained, persistent elevated serum transaminases. Pregnancy (Cat.X). Nursing mothers. |
| Precautions |
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See literature. Monitor liver function (before therapy, at 6 and 12 weeks after start or dose increases, then periodically); discontinue if serum transaminase levels ≥3xULN persist. History of liver disease. Alcoholism. Discontinue if myopathy, elevated CPK or ALT (SGOT) levels occur; suspend if a predisposition to development of renal failure secondary to rhabdomyolysis develops. Homozygous familial hypercholesterolemia. |
| Interactions |
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Not recommended with ketoconazole, itraconazole, voriconazole, HIV protease inhibitors, erythromycin, clarithromycin, nefazodone, grapefruit juice >1 quart daily; increased risk of myopathy with these and other CYP3A4 inhibitors (eg, cyclosporine); suspend lovastatin and monitor if a short course of these antifungals or antibiotics is needed. Avoid gemfibrozil, clofibrate, macrolides, niacin. Monitor oral anticoagulants. Separate dosing of cholestyramine, colestipol (give 1 hour before or 4 hours after). Caution with spironolactone, cimetidine, other steroid hormone suppressive drugs, verapamil. |
| Adverse Reactions |
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GI upset, headache, rash, pruritus, myalgia, dizziness, blurred vision, elevated serum transaminases, myopathy, rhabdomyolysis with renal dysfunction. |
| How Supplied |
Tabs 10mg—60
20mg, 40mg—60, 90, 1000 |
| Additional Resources |
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• Related Prescribing Note |
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