Fluvastatin

How it works

It competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis, which upregulates LDL receptors and increases clearance of LDL-cholesterol from the circulation.

Prescribing in practice

• It is contraindicated in active liver disease or unexplained persistent elevations in serum transaminases, and in pregnancy and breast-feeding.
• Patients should be advised to report promptly any unexplained muscle pain, tenderness or weakness because of the risk of myopathy and rhabdomyolysis.
• Review concurrent medicines for interactions, as the risk of muscle toxicity is increased by certain interacting drugs and the statin should not be combined with gemfibrozil.

Monitoring

Check liver function before starting and as clinically indicated thereafter, and measure creatine kinase if a patient reports significant muscle symptoms.

Counselling the patient

• Take the dose as directed, typically in the evening, and continue a cholesterol-lowering diet.
• Report any unexplained muscle pain, tenderness or weakness without delay.
• Avoid this medicine if you become pregnant and discuss contraception if relevant.

Evidence & guidelines

Statins as a class have robust randomised trial evidence for reducing cardiovascular events, and NICE recommends statin therapy for primary and secondary cardiovascular prevention.