II. Indications
- 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
III. Contraindications
- See Statin
- Drug Interactions
- Pregnancy (Teratogen)
- Acute Liver Failure or decompensated Cirrhosis
IV. Mechanism
- See Statin
V. Efficacy
- 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%
VI. Adverse Effects
- See Statin
- See Statin-Induced Myopathy
VII. Safety
- Pregnancy Category X
- Contraindicated in Lactation
VIII. Pharmacokinetics
- 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
IX. Dosing: Adults
- 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
X. Dosing: Child
- Approved for children over age 10 to 16 years old with heterozygous Familial Hyperlipidemia
- Start 20 mg orally daily
- Maximum: 80 mg/day
XI. Monitoring
XII. 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
- Cyclosporine (10-20 fold increase in Statin serum levels)
-
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
- Amiodarone
-
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
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
-
CYP2C9 Inhibitor
-
Fluconazole (Diflucan)
- Caution with Fluvastatin
-
Fluconazole (Diflucan)
- Other interactions
- Mibefradil (Posicor)
- Niacin
- Alcohol
- Increases risk of liver enzyme elevations
XIII. Resources
- See Statin
- Fluvastatin (DailyMed)
XIV. 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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Related Studies
| fluvastatin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FLUVASTATIN ER 80 MG TABLET | Generic | $3.09 each |
| FLUVASTATIN SODIUM 20 MG CAP | Generic | $3.07 each |
| FLUVASTATIN SODIUM 40 MG CAP | Generic | $3.12 each |