Pitavastatin

LIVALO

What it isHMG-CoA reductase inhibitor; hyperlipidemia.

Why this oneMinimal CYP metabolism, so it is an option with protease inhibitors and other strong inhibitors where most statins are restricted.

What limits itModerate potency only. Cyclosporine is contraindicated; cost is higher than the generics.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Primary hyperlipidemia / mixed dyslipidemia (LDL-C lowering)	Adults & peds ≥8 yr	2 mg QD	2–4 mg QD	4 mg QD

Titration Reassess LDL-C after ≥4 weeks before adjusting

Renal Moderate/severe impairment & ESRD on HD: start 1 mg QD, max 2 mg QD

Hepatic Contraindicated in acute liver failure or decompensated cirrhosis

Take once daily with or without food, at the same time each day
If LDL-C goal not met on 4 mg, switch to an alternative LDL-C-lowering treatment

Myopathy and rhabdomyolysis (risk ↑ with age ≥65, hypothyroidism, renal impairment, interacting drugs, higher dose)
Immune-mediated necrotizing myopathy
Hepatic dysfunction / transaminase elevations
Increases in HbA1c and fasting glucose

Pregnancy Discontinue when pregnancy recognized; may cause fetal harm (mechanism-based)

Lactation Breastfeeding not recommended during treatment

NO BOXED WARNINGS

Principal riskMyopathy; contraindicated with cyclosporine

Cost, est. cash$300–$2,500/month

Generic entry2031 est.

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.

OATP substrate