Livalo (pitavastatin) to Lower Cholesterol

• What is Livalo (pitavastatin)?
• How is Livalo (pitavastatin) prescribed?
• With which drugs does Livalo (pitavastatin) interact?
• What about taking Livalo (pitavastatin) during pregnancy?
• What are the side effects of Livalo (pitavastatin)?

Livalo (pitavastatin) is a cholesterol-lowering drug approved by the Food and Drug Administration in August 2009. Livalo is an HMG-CoA reductase inhibitor or "statin."

Other statins include:

• Zocor (simvastatin),
• Pravachol (pravastatin),
• Mevacor (lovastatin),
• Lipitor (atorvastatin), and
• Crestor (rosuvastatin).

Statins reduce cholesterol by reducing the activity of HMG-CoA reductase, an enzyme in the liver that is necessary for the production of cholesterol.

In one study Livalo (pitavastatin), 4 mg daily:

• reduced total cholesterol by 32%
• reduced LDL ("bad") cholesterol by 45%,
• reduced triglycerides by 19%,
• reduced apolipoprotein B by 35%, and
• raised HDL ("good") cholesterol by 5%.

The 4 mg dose of Livalo (pitavastatin) is comparable to 20 mg of atorvastatin in reducing cholesterol. However, Livalo increases HDL more than Lipitor (atorvastatin). The 2 mg and 4 mg doses of Livalo are comparable to 20 mg and 40 mg doses of Zocor (simvastatin), respectively.

• The usual dose range of Livalo is 1 to 4 mg daily administered at any time of the day without regard to meals.
• Therapy is usually initiated at 2 mg daily and increased after 4 weeks up to a maximum dose of 4 mg daily.
• Doses greater than 4 mg daily are associated with severe muscle toxicity.
• The recommended dose for individuals with moderate renal dysfunction or on dialysis is 1 to 2 mg daily.

• Sandimmune, Neoral, Restasis, Gengraf Capsules, Gengraf Oral Solution (cyclosporine), erythromycin, Reyataz (atazanavir), Rifadin, Rifamate, Rifater, Priftin (rifampin), and Lopid (gemfibrozil) significantly increase blood levels of Livalo.
• Because of the effect of cyclosporine and erythromycin on Livalo blood levels, cyclosporine should not be administered with Livalo and a dose of 1 mg daily should not be exceeded when Livalo is used in combination with erythromycin.
• When combined with Priftin (rifampin) the maximum recommended dose of Livalo is 2 mg daily.
• Grapefruit juice and Fenofibrate also increase blood levels of Livalo but to a lesser extent.
• Sporanox, Sporanox Injection, Sporanox Oral Solution (itraconazole) decreases blood levels of Livalo.
• Since other statins interact with the components of Kaletra Tablets, Kaletra Capsules (lopinavir and ritonavir), Livalo should not be used with this combination.
• Fibrates, Niaspan, Advicor, Niacor (niacin), and Lopid (gemfibrozil) are known to increase adverse effects of statins and should be used cautiously with Livalo.

Like other statins, Livalo should not be used during pregnancy because statins are harmful to the fetus.

Common side effects of Livalo include back pain, muscle pain, constipation and diarrhea. Livalo, may cause persistent abnormal liver function tests and rarely fatal or non-fatal liver failure. Liver function tests are performed before starting Livalo and if signs or symptoms of liver injury occur.

Like other statins Livalo may cause fatal muscle damage (rhabdomyolysis) at any dose, but most often at higher doses, or when used in combination with other drugs that increase its blood levels. All patients should promptly report unexplained muscle pain, tenderness, or weakness, especially if associated with malaise or fever. Livalo should be discontinued if rhabdomyolysis is diagnosed or suspected.

Livalo may increase HbA1c and fasting serum glucose levels.