General Information About Livalo (Pitavastatin)

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Livalo (pitavastatin) is a cholesterol-lowering medication that belongs to the statin class of drugs. It is used to elevated lipid levels in primary hyperlipidemia or mixed dyslipidemia in cases where diet, lifestyle changes, or other medications are not completely lowering lipid levels. Livalo is one of the more potent statins on the market.

According to studies, the manufacturers of Livalo, 2 mg of Livalo is as efficient at lowering lipids as 10 mg of Lipitor (atorvastatin).

Additionally, 2 mg of Livalo lowers cholesterol to an extent similar to 20 mg of Zocor (simvastatin). Like other statins, Livalo affects all aspects of your cholesterol profile: It lowers LDL and triglycerides, and raises HDL. Pivotal studies examining the effect of Livalo on lipid levels has shown that:

  • LDL cholesterol is lowered by up to 44%
  • Total cholesterol levels are lowered by about 32%.
  • Triglycerides are lowered by 19%.
  • HDL cholesterol levels are increased by an average of 5%.
  • Apolipoprotein B is lowered by about 35%.

Livalo was approved for use in the United States by the Food and Drug Administration (FDA) in August of 2009. Before being approved in the US, pitavastatin was available for use in other countries over five years earlier.

How Does Livalo Work?

Livalo blocks an enzyme called 3-hydroxy-3methylglutaryl coenzyme A (HMG CoA) reductase, which is an important protein needed in the production of cholesterol in the body.

This action reduces total cholesterol, LDL, and VLDL cholesterol in the body.

How Should Livalo be Taken?

Livalo is available in a tablet form and can be taken with or without food once a day, as directed by your healthcare provider. Doses of Livalo should not exceed 4 mg a day. Livalo should be taken in conjunction with a diet to lower your cholesterol and triglycerides.

Livalo is usually prescribed when lifestyle changes or other medications are not effectively lowering your lipids.

You should make sure that you attend your healthcare provider’s appointments regularly since she or he will need to monitor your lipid levels, as well as other parameters, while you are taking this medication.

Who Should Not Take Livalo?

If you have one of the medical conditions listed below, you should not take Livalo. IN these cases, your healthcare provider may place you on a different treatment to lower your lipids:

  • Allergy to Livalo. If you have had a previous allergy to Livalo or any of its ingredients, you should not take this medication.
  • Active liver disease. If you have active liver disease or abnormal liver enzyme levels, Livalo should not be taken.
  • Pregnancy. Livalo is categorized as a Pregnancy Category X. Livalo has been shown to cross the placental barrier in rats and there have been reports of miscarriages and fetal abnormalities in animal studies. Additionally, this has also been reported in pregnant women taking statin medications. If you are planning to become pregnant or are already pregnant and are taking Livalo, your healthcare provider will weigh the benefits of taking the medication on your health and the possible risks to your child.
  • Nursing. Livalo has been shown to cross into breastmilk. It is not known what type of effect this can have on your child.
  • Taking Cyclosporine. This medication can increase levels of Livalo in the body, potentially causing toxic effects in the body. The manufacturer recommends that if you are taking Livalo, you should not take cyclosporine.

What Conditions Need to Be Monitored While Taking Livalo?

If you are taking Livalo, your healthcare provider may need to monitor you more closely if you have certain medical conditions that could be aggravated by taking the medication. If you have any of the following conditions below, your healthcare provider may decide to start you on Livalo at a lower dose, and will need to monitor you to determine whether or not taking Livalo will be potentially harmful to you. These medical conditions include:

  • Elevated liver enzymes. In studies, Livalo increased the liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Although in most cases this increase is temporary, your healthcare provider will monitor these levels to make sure that your liver enzymes are not elevated to dangerous levels.
  • Kidney disease. If you have moderate or severe kidney disease, your healthcare provider may start you on the lowest dose of Livalo and monitor your health while on the medication.
  • Elevated blood glucose levels. Studies have shown that Livalo may increase hemoglobin A1C and fasting glucose levels. If you have diabetes, your healthcare provider may monitor these components in your blood and adjust your dose of Livalo.

What Types of Side Effects Will Livalo Cause?

The most common side effects include back pain, gastrointestinal problems (such as constipation or diarrhea), muscle pain, and pain in the extremities. Other less commonly experienced side effects include headache and joint pain. If you are experiencing any side effects from taking Livalo that become prolonged or bothersome, you should let your healthcare provider know.

As with other statins, a rare side effect – rhabdomyolysis - may also occur in individuals taking Livalo. Symptoms of rhabdomyolysis include muscle soreness and weakness, as well as soda-colored urine. Your risk of experiencing this side effects may occur if you are taking other medications, increased age, and other medical conditions. If you experience any symptoms of rhabdomyolysis, you should immediately notify your healthcare provider.

Are There Any Medications that Could Interact with Livalo?

The following drugs may interact with Livalo, increasing the likelihood of experiencing side effects (especially myopathy). With the exception of cholesterol-lowering drugs listed below, these drugs can increase levels of Livalo in your body.

  • Cholesterol-lowering drugs (nicotinic acid, fibrates)
  • Rifampin
  • Erythromycin
  • Colchicine

This is not a complete list. You should let your healthcare provider know of all medications – including herbal medications and over-the-counter drugs – that you are taking while taking Livalo. This will help you healthcare provider to monitor you for possible drug interactions while taking the medication. If you are required to take one of the drugs listed above, your healthcare provider may need to adjust your dose, monitor you more closely for side effects, or discontinue one of the drugs.

The Bottom Line

Livalo is the most recent lipid-lowering medication approved for us in the United States. In other studies, it appears to be just as effective in lowering lipids in equally potent doses of simvastatin and atorvastatin. Livalo appears to go through another pathway in the liver to get metabolized in comparison to other statins, which minimizes the number of drug interactions noted in individuals taking this medication. However, Livalo has not been extensively studied in the prevention of death or disability due to cardiovascular disease.

Sources

Duggan ST. Pitavastatin: a review of its use in the management of hypercholesterolemia or mixed dyslipidemia. Drugs 2012;72:565-584.

Ose L, Budinski D, Hounslow N, et al. Comparison of pitavastatin with simvastatin in primary hypercholesterolaemia or combined dyslipidaemia. Curr Med Res & Opin 2009; 25: 2755-64 15.

Budinski D, Arneson V, Hounslow N, et al. Pitavastatin compared with atorvastatin in primary hypercholesterolemia or combined dyslipidemia. Clin Lipidol 2009; 4: 291-302

LIVALO [package insert]. Cincinnati, OH: Kowa Pharmaceuticals America, 10/2013

Micromedex 2.0.  Truven Health Analytics, Inc. Greenwood Village, CO.  Available at: http://www.micromedexsolutions.com.  Accessed February 10, 2016

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