II. Indications
- See Hyperlipidemia Management for formal criteria
- See Statin
- Hyperlipidemia
- Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
III. Contraindications
- See Statin
- Drug Interactions
- Pregnancy (Teratogen)
- Acute Liver Failure or decompensated Cirrhosis
IV. Mechanism
- See Statin
V. Efficacy
- See Statin
- Pitavastatin 1 mg lowers LDL 29%
- Pitavastatin 2 mg lowers LDL 36 to 39%
- Pitavastatin 4 mg lowers LDL 41 to 45%
VI. Adverse Effects
- See Statin
- See Statin-Induced Myopathy
VII. Safety
- Pregnancy Category X
- Contraindicated in Lactation
VIII. Pharmacokinetics
- See Statin
-
Cytochrome P450 Metabolism
- Similar to Pravastatin, in that Pitavastatin is not significantly metabolized by P450 system
- Safer to use in combination with other drugs
IX. Dosing: Adult
- 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)
- Pitavastatin 2 to 4 mg orally daily
-
Hemodialysis or End-Stage Renal Disease (ESRD)
- Pitavastatin 1 to 2 mg orally daily
X. Dosing: Child
- Approved for children over age 8 years old
- Start 2 mg orally daily
- Maximum: 4 mg/day
XI. Management: Statin choices if special concerns
- Preferred agents if risk of Drug Interactions
- Pravastatin (no CYP 450 METABOLISM)
- Fluvastatin
- Preferred agents if Renal Function impaired
- Atorvastatin
- Fluvastatin
- Avoid Pravastatin if Creatinine Clearance <60 ml/min
- If used, start dosing at 10 mg and titrate slowly
XII. Monitoring
XIII. Drug Interactions (See Contraindications above)
- See Statin
-
CYP3A4/organic anion transporting polypeptide inhibitors
- Cyclosporine (10-20 fold increase in Statin serum levels)
- Avoid with Pitavastatin
- Macrolides (Erythromycin, Clarithromycin - 6-10 fold increase in Statin serum levels)
- Avoid with Pitavastatin over 1 mg daily
- Azithromycin appears to be safe with Statins
- Protease inibitors (Atazanavir, Ritonavir, Lopinavir/Ritonavir)
- Avoid with Pitavastatin
- Cyclosporine (10-20 fold increase in Statin serum levels)
-
CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Caution or avoid with Pitavastatin
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Other interactions
- Mibefradil (Posicor)
- Niacin
- Alcohol
- Increases risk of liver enzyme elevations
XIV. Resources
- See Statin
- Pitavastatin (DailyMed)
XV. References
- (2017) Presc Lett 24(11): 62
- (2012) Presc Lett 19(5): 25
- (2012) Presc Lett, Characteristics of Various Statins, #280502
- Carpenter (2019) Am Fam Physician 99(9):558-64 [PubMed]
- Chong (2001) Am J Med 111:390-400 [PubMed]
- Crouch (2001) Am Fam Physician 63(2):309-20 [PubMed]
- Gillett (2011) Am Fam Physician 83(6): 711-6 [PubMed]
- Jones (1998) Am J Cardiol 81:582-7 [PubMed]
- Sasaki (1998) Clin Ther 20:539-48 [PubMed]
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