Fluvastatin

LESCOL

What it isHMG-CoA reductase inhibitor; hyperlipidemia.

Why this oneMetabolized mainly by CYP2C9 rather than CYP3A4, so it avoids the common statin interactions.

What limits itLow potency can leave LDL above goal; muscle symptoms still end treatment despite its cleaner interaction profile.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Hypercholesterolemia / mixed dyslipidemia (LDL-C goal ≥25% reduction)	Adult	40 mg QHS or 40 mg BID	40-80 mg/day	80 mg/day
Hypercholesterolemia (LDL-C goal <25% reduction)	Adult	20 mg QD	20 mg QD	80 mg/day
Heterozygous familial hypercholesterolemia	Children 10-16 y	20 mg QD	per response	40 mg BID

Titration Adjust at 4-week intervals (adults, max effect seen within 4 weeks); 6-week intervals in pediatric patients

Renal Undefined

Hepatic Contraindicated in active liver disease or unexplained persistent transaminase elevations

Myopathy and rhabdomyolysis (risk increased with age ≥65, hypothyroidism, renal impairment, cyclosporine or gemfibrozil)
Immune-mediated necrotizing myopathy
Liver enzyme abnormalities

Pregnancy Contraindicated (Pregnancy Category X); may cause fetal harm, cholesterol needed for fetal development.

Lactation Contraindicated in nursing mothers.

NO BOXED WARNINGS

Principal riskLow potency; myopathy

Cost, est. cash$10–$300/month

Generic entry2012

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryX

Defining liabilityMyopathy/rhabdomyolysis and hepatotoxicity; interaction burden varies by agent.

CYP2C9 substrate