In Sodium

fluvastatin sodium (flue va sta' tin) Lescol, Lescol XL Pregnancy Category X Drug classes

Antihyperlipidemic Statin Therapeutic actions

A fungal metabolite that inhibits the enzyme HMG-CoA that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDL (associated with increased risk of CAD), and either an increase or no change in serum HDL (associated with decreased risk of CAD). Indications

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Adjunct to diet in the treatment of elevated total cholesterol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) where response to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures has not been adequate To slow progression of coronary atheroscleroses in patients with CAD, along with diet and exercise Reduction of the risk of undergoing coronary revascularization procedures in patients with CAD

Contraindications and cautions

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Contraindicated with allergy to fluvastatin, allergy to fungal byproducts, pregnancy, lactation. Use cautiously with impaired hepatic function, cataracts.

Available forms

Capsules—20, 40 mg; extended-release capsules—80 mg Dosages ADULTS

Initial dosage, 20 mg/day PO administered in the evening. Maintenance doses, 20– 80 mg/day PO; give 80 mg/day as two 40-mg doses, or use 80-mg extended release form. PEDIATRIC PATIENTS

Safety and efficacy not established. Pharmacokinetics Route Oral

Onset Slow

Peak 4–6 wk

Metabolism: Hepatic; T1/2: 3–7 hr Distribution: Crosses placenta; enters breast milk

Excretion: Bile and feces Adverse effects

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CNS: Headache, blurred vision, dizziness, insomnia, fatigue, muscle cramps, cataracts GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn Hematologic: Elevations of CPK, alkaline phosphatase and transaminases Other: Rhabdomyolysis

Interactions

Drug-drug • Possible severe myopathy or rhabdomyolysis if taken with cyclosporine, erythromycin, gemfibrozil, niacin, other statins • Increased levels of phenytoin Drug-food • Decreased metabolism and increased risk of toxic effects if taken with grapefruit juice; avoid this combination Nursing considerations Assessment

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History: Allergy to fluvastatin, fungal byproducts; impaired hepatic function; cataracts (use caution); pregnancy; lactation Physical: Orientation, affect, ophthalmologic exam; liver evaluation; lipid studies, liver function tests, muscle pain, CK

Interventions

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Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. Doses of 80 mg/day should be taken as two 40-mg doses. Before administering, ensure that patient is not pregnant and understands need to avoid pregnancy. Arrange for regular follow-up during long-term therapy. Arrange for periodic ophthalmologic exam to check for cataract development.

Teaching points

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Take drug in the evening. Do not drink grapefruit juice while using this drug. Institute dietary changes, and maintain a low-cholesterol diet while taking this drug. This drug cannot be taken during pregnancy; using barrier contraceptives is advised. Arrange to have periodic ophthalmic exams while you are taking this drug. These side effects may occur: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen). Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine or light-colored stools, muscle pain, fever.

Adverse effects in Italic are most common; those in Bold are life-threatening.