Lovastatin Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Hyperlipidemia

Immediate-release formulation:
Initial dose: 20 mg orally once a day with the evening meal.
Maintenance dose: 10 to 80 mg orally once a day or in 1 or 2 divided doses.
Comment: Lower doses are suggested for a smaller reduction in cholesterol level.

Extended-release formulation:
Initial dose: 20, 40, or 60 mg orally once a day at bedtime. Patients requiring smaller reductions in cholesterol may start with 10 mg orally at bedtime.
Maintenance dose: 10 to 60 mg orally given once a day at bedtime.

Usual Pediatric Dose for Heterozygous Familial Hypercholesterolemia

Immediate-release:
Initial:
10 to 17 years: 10 mg orally once a day
Maintenance:
10 to 17 years: 10 to 40 mg orally once a day
Comments: Dosage adjustments should be made no earlier than every 4 weeks, adding no more than 10 mg to the current dose each time.

Extended-release:
This formulation of lovastatin is not recommended for pediatric patients.

Renal Dose Adjustments

CrCl less than 30 mL/min: Dosage increases above 20 mg orally once a day should be done with careful monitoring for adverse reactions.

Liver Dose Adjustments

Data not available

Dose Adjustments

-Adjustments should be made at intervals of 4 weeks or more.
-The concomitant use of lovastatin with CYP450 3A4 inhibitors should be avoided. Lovastatin doses should not exceed 20 mg orally per day in patients receiving concomitant gemfibrozil, cyclosporine, danazol, niacin (doses greater than or equal 1 gram/day), or other fibrates. Lovastatin doses should not exceed 40 mg orally per day in patients receiving concomitant amiodarone or verapamil therapy.
-In patients receiving a course of treatment with a systemic antifungal azole, macrolide antibiotic, or ketolide antibiotic, interruption of lovastatin therapy should be considered.

Precautions

It is recommended that liver function tests be performed prior to initiation of therapy in patients with a history of liver disease, or when otherwise clinically indicated. It is also recommended that liver function tests be performed in all patients prior to use of 40 mg or more daily and thereafter when clinically indicated. Discontinuation of lovastatin therapy is recommended if liver function tests (AST or ALT) persist at three times the upper limit of normal or greater.

Consult WARNINGS section for additional precautions.

Dialysis

There are no data on the pharmacokinetics of lovastatin in patients on hemodialysis. Based on the pharmacokinetics of this drug, supplemental doses after dialysis do not appear to be necessary.

Other Comments

Administration advice:
-Extended-release tablets of lovastatin should be swallowed whole and not chewed or crushed.

Laboratory considerations:
-Cholesterol levels should be monitored periodically with consideration given to reducing the dosage if cholesterol levels fall significantly below the targeted range.
-All patients should have a baseline serum creatine kinase (CK) enzyme level measured and if at any time after initiating therapy a patient complains of muscle soreness, tenderness, or pain another CK level should be drawn for comparison. If elevated, the drug should be discontinued.

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