Lovastatin is a member of the drug class of statins, used for lowering cholesterol and preventing cardiovascular disease (hypolipidemic agents). The mode of action of statins is HMG-CoA reductase enzyme inhibition. This enzyme is needed by the body to make cholesterol.

Lovastatin is indicated for reducing the risk of Myocardial infarction, unstable angina, and for treating Hypercholesterolemia.

Lovastatin was isolated from a strain of Aspergillus terreus and it was the first statin approved by the FDA (August 1987).

Lovastatin is also naturally produced by certain higher fungi such as Pleurotus ostreatus (oyster mushroom) and closely related Pleurotus spp. (Bobek et al., 1998)

In 1998, the US Food and Drug Administration (FDA) placed a ban on the sale of dietary supplements derived from red yeast rice, which naturally contains lovastatin, arguing that products containing prescription agents require drug approval.

Like other statins, lovastatin has been associated with rhabdomyolysis is a very small proportion of patients; the risk is increased in concomitant use of fibrates.

Brand names

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• Mevacor®
• Advicor® (as a combination with niacin)
• Altocor®
• Altoprev®

Pharmacology and dose

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Lovastatin causes cholesterol to be lost from LDL, but also reduces the concentration of circulating LDL (low density lipoprotien) particles. Apolipoprotein B concentration falls substantially during treatment with lovastatin. Lovastatin's ability to lower LDL is thought to be due to a reduction in VLDL, which is a precursor to LDL. Also, Lovastatin may increase the number of LDL receptors on the surface of cell membranes, and thus increase the breakdown of LDL. Lovastatin can also produce slight to moderate increases in HDL, and slight to moderate decreases in triglycerides. Both of these effects are benefical typically beneficial to a patient with a poor lipid profile.

Both lovastatin and its b-hydroxyacid metabolite are highly bound (>95%) to human plasma proteins. Animal studies demonstrated that lovastatin crosses the blood-brain and placental barriers (2). Elderly patients, or those with renal insufficiency may have higher plasma concentrations of lovastatin after administration and may require a lower dose. The usual recommended starting dose is 20 mg once a day given with the evening meal, and the dose range is 10-80 mg a day in a single dose, or divided into two doses.

Side effects and warnings

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Lovastatin is usually well tolerated. Lovastatin, and all statin drugs, can rarely cause myopathy or rhabdomyolysis, which can be life threatening if not recognised and treated in time.

Drug interactions

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Some of the possible interactions and side effects: lovastatin, as with all the statin drugs, should not be used by patients who drink grapefruit juice, because the juice inhibits CYP3A4, and thus decreases the metabolism of lovastatin and increases in plasma concentrations. Drinking grapefruit juice during lovastatin therapy increases the risk of serious side effects.

Lovastatin at doses higher than 20 mg per day should not be used in conjunction with gemfibrozil, niacin, cyclosporin, or other fibrates. This is because of the significantly increased risk of rhabdomyolysis.

Patients should promptly explain to a physician any unexplained muscle pain or weakness while on lovastain.

References

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• Bobek P, Ozdin L, Galbavy S. Dose- and time-dependent hypocholesterolemic effect of oyster mushroom (Pleurotus ostreatus) in rats. Nutrition 1998;14:282-6. PMID 9583372.
• Rxlist.com - The Internet Drug Index. Lovastatin http://www.rxlist.com/cgi/generic/lovastat.htm. (2)

Statins

Lovastatina | Lovastatine | โลวาสแตติน