Fluvastatin

Fluvastatin is a statin medication used to lower cholesterol and reduce cardiovascular risk. It is a competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis. By inhibiting this enzyme, fluvastatin decreases hepatic cholesterol production, which upregulates LDL receptors on hepatocytes and lowers circulating low-density lipoprotein cholesterol. It may also produce modest increases in high-density lipoprotein cholesterol and reductions in triglycerides.

Fluvastatin is indicated for primary hyperlipidemia, mixed dyslipidemia, and to reduce the risk of cardiovascular events in certain patients with hyperlipidemia when used with diet and lifestyle changes. It is available in immediate-release capsules (20, 40, or 80 mg) and an extended-release formulation (Lescol XL) that is typically given as 80 mg once daily.

Contraindications include active liver disease, pregnancy, and lactation, as well as hypersensitivity to statins. Caution is advised in patients with hepatic impairment, kidney disease, or a history of alcohol misuse, and in older adults.

Common adverse effects include headache, abdominal pain, and elevations in liver enzymes. Serious but rare effects include myopathy and rhabdomyolysis, especially when used with other lipid-lowering agents or drugs that interact with fluvastatin. Patients should be monitored for muscle symptoms and undergo periodic liver function tests.

Drug interactions include cyclosporine, danazol, and certain fibrates, which can increase the risk of myopathy and rhabdomyolysis. Because fluvastatin is mainly metabolized by the CYP2C9 pathway, strong inhibitors or inducers of this enzyme can alter its levels. As with other statins, use in pregnancy or lactation is contraindicated.