Pitavastatin

Usual Dosing (Adults)

CLINICAL PHARMACOLOGY
Mechanism of Action:
Pitavastatin competitively inhibits HMG-CoA reductase, which is a rate-determining enzyme involved with biosynthesis of cholesterol, in a manner of competition with the substrate so that it inhibits cholesterol synthesis in the liver. As a result, the expression of LDL-receptors followed by the uptake of LDL from blood to liver is accelerated and then the plasma TC decreases. Further, the sustained inhibition of cholesterol synthesis in the liver decreases levels of very low density lipoproteins.

INDICATIONS AND USAGE
Drug therapy should be one component of multiple-risk-factor intervention in individuals who require modifications of their lipid profile. Lipid-altering agents should be used in addition to a diet restricted in saturated fat and cholesterol only when the response to diet and other nonpharmacological measures has been inadequate.

Primary Hyperlipidemia and Mixed Dyslipidemia:
LIVALO® is indicated as an adjunctive therapy to diet to reduce elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), triglycerides (TG), and to increase HDL-C in adult patients with primary hyperlipidemia or mixed dyslipidemia.

Limitations of Use:
Doses of LIVALO greater than 4 mg once daily were associated with an increased risk for severe myopathy in premarketing clinical studies. Do not exceed 4 mg once daily dosing of LIVALO.
The effect of LIVALO on cardiovascular morbidity and mortality has not been determined.
LIVALO has not been studied in Fredrickson Type I, III, and V dyslipidemias.

DOSAGE AND ADMINISTRATION
General Dosing Information:
The dose range for LIVALO is 1 to 4 mg orally once daily at any time of the day with or without food. The recommended starting dose is 2 mg and the maximum dose is 4 mg. The starting dose and maintenance doses of LIVALO should be individualized according to patient characteristics, such as goal of therapy and response.
After initiation or upon titration of LIVALO, lipid levels should be analyzed after 4 weeks and the dosage adjusted accordingly.

Renal Dosing

Dosage in Patients with Renal Impairment:
Patients with moderate and severe renal impairment (glomerular filtration rate 30 - 59 mL/min/1.73 m2 and 15 - 29 mL/min/1.73 m2 not receiving hemodialysis, respectively) as well as end-stage renal disease receiving hemodialysis should receive a starting dose of LIVALO 1 mg once daily and a maximum dose of LIVALO 2 mg once daily.

Use with Erythromycin:
In patients taking erythromycin, a dose of LIVALO 1 mg once daily should not be exceeded.

Use with Rifampin:
In patients taking rifampin, a dose of LIVALO 2 mg once daily should not be exceeded.

Hemodialysis

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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