Altoprev

Generic name: lovastatin

Drug class: Statins

Dosage form: Extended-release tablets

Route of administration: Oral

Dose: 20 to 60 mg once daily in the evening

Mechanism of action: Lovastatin is a competitive inhibitor of HMG-CoA reductase, the enzyme responsible for converting HMG-CoA to mevalonate, a precursor of cholesterol. By inhibiting this enzyme, lovastatin reduces cholesterol synthesis in the liver, leading to decreased levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol in the bloodstream.

Drug usage cases:

• Adjunct to diet to reduce elevated total cholesterol, LDL-C, and triglycerides, and to increase high-density lipoprotein cholesterol (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and non-familial) and mixed dyslipidemia (Fredrickson types IIa and IIb).
• To reduce the risk of myocardial infarction, unstable angina, and coronary revascularization procedures in adults at high risk for coronary heart disease (CHD).
• As an adjunct to diet to reduce LDL-C and slow the progression of coronary atherosclerosis in adults with CHD.

Drug contraindications:

• Active liver disease or unexplained persistent elevations in hepatic transaminases.
• Hypersensitivity to lovastatin or any component of the formulation.
• Concomitant use with strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, clarithromycin, certain antiviral medications including dasabuvir/ombitasvir/paritprevir/ritonavir, and cobicistat-containing products) and erythromycin.

Side effects:

• Muscle-related: Myopathy, rhabdomyolysis (with symptoms such as muscle pain, tenderness, or weakness, especially if accompanied by fever, unusual tiredness, or dark-colored urine).
• Liver-related: Elevated serum transaminases, hepatitis, jaundice.
• Metabolic: Increased HbA1c and fasting serum glucose levels.
• Gastrointestinal: Nausea, abdominal pain, constipation, diarrhea.
• Neurological: Headache, dizziness, insomnia.
• Other: Fatigue, arthralgia, myalgia, sinusitis, urinary tract infection.

Warnings:

• Discontinue if myopathy is suspected or if markedly elevated creatine phosphokinase levels occur; suspend if a predisposition to the development of renal failure secondary to rhabdomyolysis develops.
• Monitor liver function before starting therapy and repeat as clinically indicated; discontinue if serious hepatic injury with clinical symptoms and/or hyperbilirubinemia or jaundice occurs.
• Use with caution in patients with a history of liver disease, heavy alcohol consumption, or renal impairment; dose adjustments may be necessary.
• Use with caution in elderly patients (≥65 years); monitor for muscle-related side effects.
• Advise females of reproductive potential to use effective contraception during treatment; discontinue if pregnancy is recognized.
• Not recommended for use during breastfeeding.

Use during pregnancy or breastfeeding: Lovastatin is contraindicated during pregnancy and breastfeeding. It may cause harm to the fetus and is excreted in human milk. Women who are pregnant or planning to become pregnant should discontinue lovastatin therapy. Women who are breastfeeding should also avoid using this medication due to potential risks to the nursing infant.