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Livalo: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 26, 2020.

1. How it works

  • Livalo is a brand (trade) name for pitavastatin (also called pitavastatin calcium) which may be used for the treatment of high cholesterol.
  • Pitavastatin works by blocking an enzyme, called HMG-CoA reductase, in the liver that catalyzes the conversion of HMG-CoA to mevalonate, a rate-limiting step in the synthesis of cholesterol. This accelerates the expression of LDL-receptors followed by the uptake of LDL from the blood to the liver, which decreases total cholesterol. Cholesterol synthesis in the liver is suppressed which also decreases levels of very-low-density lipoproteins.
  • Livalo belongs to the class of medicines known as statins. Livalo is also known as an HMG-CoA reductase inhibitor.

2. Upsides

  • Livalo may be used in conjunction with dietary measures to lower elevated levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), triglycerides (TG), and to increase high-density lipoprotein cholesterol (HDL-C) in adults with primary hyperlipidemia or mixed dyslipidemia.
  • May also be used in children aged 8 years and older with heterozygous familial hypercholesterolemia (HeFH) to reduce elevated TC, LDL-C, and Apo B.
  • May be taken any time of the morning or night.
  • Not reported to interact significantly with grapefruit juice.
  • Livalo is available as a cost-saving generic under the name pitavastatin and Nikita.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Nasopharyngitis (swelling of the nasal passages and back of the throat), arthralgia (joint pain), belching or excessive gas, constipation or diarrhea, croaky voice or hoarseness, difficulty sleeping, dyspepsia, a headache, pain, and urinary tract infections.
  • Muscle pain, tenderness, or weakness. Initially, this needs further investigating to rule out more serious muscle effects (such as rhabdomyolysis - the destruction of muscle cells). People aged older than 65, taking certain medications (for example cyclosporine, itraconazole, HIV antivirals), who drink more than two alcoholic drinks per day, or with kidney disease appear more at risk of serious side effects.
  • Livalo, like other statins, may rarely affect liver function, manifesting as changes in liver function tests or jaundice (yellowing of the skin) requiring dosage reduction or discontinuation.
  • May also affect some diabetes markers (such as HbA1c or fasting glucose), and may not be suitable in those with liver or kidney disease, or those who have recently had a stroke or a TIA (transient ischemic attack).
  • Rarely, has been associated with memory loss, forgetfulness, amnesia, memory impairment, and confusion. These symptoms typically resolve with discontinuation.
  • The effect of Livalo on cardiovascular morbidity and mortality has not been determined.
  • The dosage of Livalo needs to be reduced in adults with moderate and severe renal impairment (eGFR 30 – 59 mL/minute/1.73 m2 and 15 – 29 mL/minute/1.73 m2, respectively) and end-stage renal disease receiving hemodialysis to 1 mg once daily. The maximum recommended dose for these patients is 2 mg once daily.
  • Do not use Livalo in patients with active liver disease including unexplained persistent elevations of hepatic transaminase levels.
  • The link between statins and memory loss is controversial. Some large studies have shown no effect, and have implied that statins pose no threat and may, in fact, prevent dementia, whereas others found an association between statin use and memory loss and confusion, prompting the FDA to order labeling changes on all statins.
  • Should not be taken during pregnancy or while breastfeeding.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Livalo is effective at lowering levels of total cholesterol, LDL-C, and triglycerides (TG) to a similar level as the most potent statins, simvastatin, and atorvastatin; however, it may be more effective than other statins at increasing HDL-C levels. Livalo has fewer drug interactions than atorvastatin and simvastatin, as Livalo is minimally metabolized by cytochrome P450 (CYP) enzymes.

5. Tips

  • Take once daily. May be taken at any time of the day (morning or night); however, it is best to be consistent with the time you take your tablets. Livalo may be taken with or without food.
  • The recommended starting dose of Livalo is 2 mg once daily which may be increased up to the maximum of 4 mg once daily dosage guided by the results of cholesterol tests taken 4 weeks after starting Livalo. Take Livalo exactly as directed by your doctor. Do not increase or decrease the dosage without his or her advice.
  • Limit your alcohol intake and avoid drinking more than two glasses of alcohol per day while you are taking Livalo. Livalo has a risk of causing liver problems and if you drink large amounts of alcohol this will increase your risk.
  • Seek urgent medical advice and consider temporarily withholding Livalo if you develop any acute muscle pain or have another condition that may increase your risk of serious muscle injury or kidney failure such as a severe infection, major surgery, trauma, uncontrolled seizures, severe electrolyte or metabolic disorders.
  • Adhere to the TLC diet, designed by the National Cholesterol Education Program (NCEP), or a similar diet, while taking Livalo.
  • Plan to do exercise regularly and stop smoking if you smoke. Try to avoid second-hand smoke.
  • See your doctor straight away if you notice any yellowing of your skin or shortness of breath, unexplained cough, or general tiredness. 
  • Livalo should not be taken during pregnancy or while breastfeeding. Ensure you use effective contraception while taking Livalo if you are a woman of childbearing age and talk to your doctor if you intend to become pregnant before you become pregnant.
  • Not everybody who takes a statin has side effects, but they tend to be more common in women, seniors, and people with liver or kidney disease. People who drink large amounts of alcohol or who take other medicines that may interact are also at a higher risk. Serious side effects from statins are rare, but see your doctor if your develop excessive thirst or have to urinate frequently; severe confusion or memory impairment; unexplained significant joint or muscle pain, tenderness, or weakness; unusual fatigue or weakness; loss of appetite; pain in your upper abdomen; dark-colored urine; or yellowing of your skin or eyes.
  • Always consult with your physician or pharmacist before taking any other medication, including over-the-counter or prescription drugs, herbal supplements, or vitamins.

6. Response and Effectiveness

  • Livalo reduces levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and triglycerides (TG) to a similar level as the most potent statins, simvastatin, and atorvastatin.
  • Livalo produces a larger increase in high-density lipoprotein-cholesterol (HDL-C) levels when compared to some of the other statins. This increase in HDL-C levels is sustained over the long-term. HDL-Cholesterol is often referred to as the “good” cholesterol as it collects any excess cholesterol and takes it back to the liver, where it is broken down and then removed from the body. Increasing your HDL cholesterol can lower your risk of heart disease and stroke.
  • Livalo has less drug-drug interactions than atorvastatin and simvastatin, as Livalo is minimally metabolized by cytochrome P450 (CYP) enzymes. Pravastatin and fluvastatin have the lowest risk of drug interactions as they are not metabolized by cytochrome p450 3A4 at all.

7. Interactions

Medicines that interact with Livalo may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Livalo. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Livalo include:

  • amiodarone
  • antibiotics, such as nitrofurantoin
  • bezafibrate and other fibrates (weigh up risks of myopathy and rhabdomyolysis Vs benefits of Livalo)
  • colchicine (weigh up risks of myopathy and rhabdomyolysis Vs benefits of Livalo)
  • cyclosporine (do not use Livalo with cyclosporine)
  • erythromycin (do not exceed Livalo 1mg daily)
  • gemfibrozil (do not use Livalo with gemfibrozil)
  • letermovir
  • niacin (weigh up risks of myopathy and rhabdomyolysis Vs benefits of Livalo)
  • strong CYP3A4 inducers such as efavirenz or rifampin (do not exceed Livalo 2mg daily)
  • warfarin.

Note that this list is not all-inclusive and includes only common medications that may interact with Livalo. You should refer to the prescribing information for Livalo for a complete list of interactions.

References

Livalo (pitavastatin calcium) [Package insert] Updated 05/2019. Kowa Pharmaceuticals America, Inc. https://www.drugs.com/pro/livalo.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Livalo only for the indication prescribed.

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