- See Hyperlipidemia Management for formal criteria
- See Statin
-
Hyperlipidemia
- Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
- Fluvastatin is a preferred Statin if risk of significant Drug Interactions (fewer Drug Interactions)
- Fluvastatin is a preferred Statin in Renal Insufficiency
- See Statin
- Fluvastatin 20 mg lowers LDL 17 to 22% (recommended starting dose)
- Fluvastatin 40 mg lowers LDL 23 to 25%
- Fluvastatin 80 mg lowers LDL 33 to 35%
- Pregnancy Category X
- Contraindicated in Lactation
- See Statin
- First-pass metabolism in all Statins except Pravastatin
-
Protein binding
- As with most Statins (except Pravastatin), Fluvastatin is 90% Protein bound
-
Cytochrome P450 Metabolism
- CYP3A4 isoenzyme metabolizes most Statins
- CYP2C9 isoenzyme metabolizes Fluvastatin
- Specific LDL and HDL targets have been replaced with high-intensity Statin if 10 year Cardiovascular Risk >20%
- Low intensity Statin (age >75 years, or Statin intolerant)
- Fluvastatin 20-80 mg orally daily
- Approved for children over age 10 to 16 years old with heterozygous Familial Hyperlipidemia
- Start 20 mg orally daily
- Maximum: 80 mg/day
- See Statin
-
Liver transaminase testing (AST,ALT) is no longer routinely indicated as of March 2012
-
Drug Interactions (See Contraindications above)
- See Statin
-
CYP3A4/organic anion transporting polypeptide inhibitors
- Cyclosporine (10-20 fold increase in Statin serum levels)
- Avoid with Fluvastatin
-
CYP3A4/CYP2C9 Inhibitor
- Amiodarone
- Increased risk of Statin Myopathy (esp. with age >65, Obesity, renal or liver Impairment)
- Caution with Fluvastatin (consider dose adjustment)
- Warfarin (Increased INR and bleeding risk)
- Among the highest risk with Fluvastatin
-
CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Caution with Fluvastatin
-
CYP2C9 Inhibitor
-
Fluconazole (Diflucan)
- Caution with Fluvastatin
- Other interactions
- Mibefradil (Posicor)
- Niacin
- Alcohol
- Increases risk of liver enzyme elevations
loading