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Fluvastatin: Effects, Dosage & Side Effects

Fluvastatin is a prescription medication used to lower elevated cholesterol levels in the blood and belongs to the group of statins.

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Things worth knowing about "Fluvastatin"

Fluvastatin is a prescription medication used to lower elevated cholesterol levels in the blood and belongs to the group of statins.

What is Fluvastatin?

Fluvastatin is a lipid-lowering drug belonging to the class of statins (HMG-CoA reductase inhibitors). It is used to reduce elevated cholesterol and triglyceride levels in the blood, thereby lowering the risk of cardiovascular disease. Fluvastatin was the first fully synthetic statin and is available as capsules and extended-release tablets.

Indications

Fluvastatin is prescribed for:

Primary hypercholesterolaemia: elevated LDL cholesterol levels without an identifiable underlying disease
Mixed dyslipidaemia: simultaneous abnormalities in cholesterol and triglyceride levels
Secondary prevention: reducing the risk of heart attacks and other cardiovascular events in patients with coronary heart disease
Patients after coronary intervention (e.g. balloon angioplasty or stent placement)

Mechanism of Action

Fluvastatin competitively inhibits the enzyme HMG-CoA reductase (3-hydroxy-3-methylglutaryl coenzyme A reductase), which catalyses the rate-limiting step in cholesterol biosynthesis in the liver. By inhibiting this enzyme, the body's own cholesterol production is reduced. In response, the liver increases the number of LDL receptors on its surface, leading to greater uptake of LDL cholesterol from the blood. The result is a significant reduction in LDL cholesterol (so-called bad cholesterol), a moderate reduction in triglycerides, and a slight increase in HDL cholesterol (so-called good cholesterol).

Dosage

The dosage of fluvastatin depends on the individual therapeutic goal and tolerability:

Standard dose: 20–40 mg daily as a capsule, generally taken in the evening
Higher dose: 80 mg daily as an extended-release tablet, which must be swallowed whole
Fluvastatin can be taken regardless of meals.
Regular laboratory monitoring of blood lipid levels and liver enzymes is recommended.

Side Effects

Like all statins, fluvastatin can cause side effects. Common and clinically relevant adverse effects include:

Muscle complaints: myalgia (muscle pain), less commonly myopathy or rhabdomyolysis (severe muscle breakdown)
Liver problems: elevated liver enzymes (transaminases), rarely hepatitis
Gastrointestinal symptoms: nausea, abdominal pain, indigestion, diarrhoea
Headaches and sleep disturbances
Increased risk of diabetes with long-term use (a class effect of statins)

If severe muscle pain or brown discolouration of urine occurs, medical advice should be sought immediately as this may indicate rhabdomyolysis.

Interactions

Fluvastatin may interact with various medications:

Ciclosporin: significantly increases fluvastatin blood levels
Fluconazole and other azole antifungals: inhibit the breakdown of fluvastatin and increase the risk of side effects
Rifampicin: accelerates the breakdown of fluvastatin and reduces its effectiveness
Anticoagulants (e.g. phenprocoumon, warfarin): fluvastatin may enhance their effect; regular INR monitoring is necessary
Fibrates and nicotinic acid: combined use increases the risk of muscle-related problems

Contraindications

Fluvastatin must not be taken in cases of:

Active liver disease or persistently elevated liver enzymes
Pregnancy and breastfeeding
Known hypersensitivity to fluvastatin or any of the excipients

References

European Medicines Agency (EMA): Product information for Fluvastatin (Lescol / Canef), updated Summary of Product Characteristics.
Mach F. et al. - 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal, 2020; 41(1): 111–188.
Kasper D. L. et al. (eds.) - Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.

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