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Pitavastatin

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Pitavastatin, Livalo

  • See Also
  1. Hyperlipidemia
  2. Statin
  3. Statin-Induced Myopathy
  4. Atorvastatin
  5. Rosuvastatin
  6. Simvastatin
  7. Fluvastatin
  8. Lovastatin
  9. Pravastatin
  • Indications
  1. See Hyperlipidemia Management for formal criteria
  2. See Statin
  3. Hyperlipidemia
  4. Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
  • Contraindications
  1. See Statin
  2. Drug Interactions
    1. See Statin regarding Myopathy and hepatitis risk
  3. Pregnancy (Teratogen)
  4. Acute Liver Failure or decompensated Cirrhosis
  • Mechanism
  1. See Statin
  • Efficacy
  1. See Statin
  2. Pitavastatin 1 mg lowers LDL 29%
  3. Pitavastatin 2 mg lowers LDL 36 to 39%
  4. Pitavastatin 4 mg lowers LDL 41 to 45%
  • Adverse Effects
  1. See Statin
  2. See Statin-Induced Myopathy
  • Safety
  1. Pregnancy Category X
  2. Contraindicated in Lactation
  • Pharmacokinetics
  1. See Statin
  2. Cytochrome P450 Metabolism
    1. Similar to Pravastatin, in that Pitavastatin is not significantly metabolized by P450 system
    2. Safer to use in combination with other drugs
  • Dosing
  • Adult
  1. Specific LDL and HDL targets have been replaced with high-intensity Statin if 10 year Cardiovascular Risk >20%
  2. Low intensity Statin (age >75 years, or Statin intolerant)
    1. Pitavastatin 2 to 4 mg orally daily
  3. Hemodialysis or End-Stage Renal Disease (ESRD)
    1. Pitavastatin 1 to 2 mg orally daily
  • Dosing
  • Child
  1. Approved for children over age 8 years old
  2. Start 2 mg orally daily
  3. Maximum: 4 mg/day
  • Management
  • Statin choices if special concerns
  1. Preferred agents if risk of Drug Interactions
    1. Pravastatin (no CYP 450 METABOLISM)
    2. Fluvastatin
  2. Preferred agents if Renal Function impaired
    1. Atorvastatin
    2. Fluvastatin
    3. Avoid Pravastatin if Creatinine Clearance <60 ml/min
      1. If used, start dosing at 10 mg and titrate slowly
  • Monitoring
  1. See Statin
  2. Liver transaminase testing (AST,ALT) is no longer routinely indicated as of March 2012
  • Drug Interactions (See Contraindications above)
  1. See Statin
  2. CYP3A4/organic anion transporting polypeptide inhibitors
    1. Cyclosporine (10-20 fold increase in Statin serum levels)
      1. Avoid with Pitavastatin
    2. Macrolides (Erythromycin, Clarithromycin - 6-10 fold increase in Statin serum levels)
      1. Avoid with Pitavastatin over 1 mg daily
      2. Azithromycin appears to be safe with Statins
    3. Protease inibitors (Atazanavir, Ritonavir, Lopinavir/Ritonavir)
      1. Avoid with Pitavastatin
  3. CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
    1. Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
      1. Caution or avoid with Pitavastatin
  4. Other interactions
    1. Mibefradil (Posicor)
    2. Niacin
    3. Alcohol
      1. Increases risk of liver enzyme elevations
  • Resources
  1. See Statin
  2. Pitavastatin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=44dcbf97-99ec-427c-ba50-207e0069d6d2
  • References
  1. (2017) Presc Lett 24(11): 62
  2. (2012) Presc Lett 19(5): 25
  3. (2012) Presc Lett, Characteristics of Various Statins, #280502
  4. Carpenter (2019) Am Fam Physician 99(9):558-64 [PubMed]
  5. Chong (2001) Am J Med 111:390-400 [PubMed]
  6. Crouch (2001) Am Fam Physician 63(2):309-20 [PubMed]
  7. Gillett (2011) Am Fam Physician 83(6): 711-6 [PubMed]
  8. Jones (1998) Am J Cardiol 81:582-7 [PubMed]
  9. Sasaki (1998) Clin Ther 20:539-48 [PubMed]