pitavastatin

Pitavastatin is a prescription statin medication used to lower low-density lipoprotein (LDL) cholesterol and triglycerides, while modestly raising high-density lipoprotein (HDL) cholesterol. It is used to reduce the risk of cardiovascular events in adults with hyperlipidemia or mixed dyslipidemia and is sometimes used for primary prevention based on individual risk factors. In the United States, pitavastatin is marketed as Livalo and is also available in generic form.

Mechanism and pharmacokinetics: Pitavastatin inhibits HMG-CoA reductase, the enzyme involved in hepatic cholesterol synthesis. This leads to upregulation of LDL receptors and a decrease in circulating LDL cholesterol, with additional modest improvements in triglycerides and HDL cholesterol. It is primarily metabolized by glucuronidation rather than widespread cytochrome P450 pathways, and excreted mainly via bile. The comparatively low reliance on CYP enzymes is associated with a lower potential for certain drug interactions.

Dosing and administration: Pitavastatin is taken orally once daily, with or without food. Typical starting doses are 1 mg daily, with a maximum of 4 mg daily depending on response and tolerance. Dose adjustments are guided by baseline lipid levels, patient factors, and concurrent medications. No routine dose adjustment is required solely for mild to moderate renal impairment.

Safety and considerations: Pitavastatin is contraindicated in pregnancy and breastfeeding and in active liver disease. Liver enzymes should be checked before starting therapy and monitored during treatment. Common side effects include headache, muscle or back pain, and digestive upset; rare but serious risks include myopathy and rhabdomyolysis, particularly with higher doses or interacting drugs. Caution is advised when used with other lipid-lowering agents that can increase the risk of muscle damage.