Fluvastatin

What is Fluvastatin for?

Fluvastatin belongs to a group of lipid-regulating medicines called statins. It is used in combination with a healthy diet and lifestyle to reduce the level of  ‘bad’ cholesterol in the blood, and raise the level of ‘good cholesterol’. It is prescribed to patients at high risk of developing heart disease, such as a heart attack or stroke.

How does Fluvastatin work?

Cholesterol is produced by the liver and plays a vital role in the functioning of all cells in the body. A high level of high-density lipoprotein (HDL), known as ‘good cholesterol’, is good for you, but a high level of low-density lipoprotein (LDL), or ‘bad’ cholesterol, can cause a blockage in the arteries, leading to a heart attack or stroke. The best way to prevent heart disease is to eat a healthy diet that is low in saturated fats, and to exercise regularly. Alongside these measures, Fluvastatin is prescribed to people at high risk of heart disease and works by reducing the amount of LDL produced in the liver.

How long does it take for Fluvastatin to work?

If Fluvastatin is taken correctly cholesterol levels should begin to drop noticeably within 4 weeks. Statins are most effective when taken over a long period of time and when accompanied by the appropriate lifestyle changes.

How do I know if Fluvastatin is working?

You will not be able to feel Fluvastatin working, but your doctor may wish to conduct regular blood tests to monitor your cholesterol level during treatment. The effectiveness of Fluvastatin is entirely dependent on the lifestyle of the patient, and it is therefore imperative to maintain a low-fat diet when taking this medication.

How effective is Fluvastatin?

When accompanied by a healthy, low-fat diet, regular exercise and weight-loss where necessary, Fluvastatin is considered to be a safe and effective means of treating high cholesterol.

Active ingredients

The active ingredient in Fluvastatin is fluvastatin sodium.

Inactive ingredients

The inactive ingredients in Fluvastatin are mannitol, talc, magnesium stearate, gelatin, titanium dioxide (E171), yellow iron oxide (E172), red iron oxide (E172), titanium dioxide (E171), shellac, soya lecithin, Antifoam DC 1510, iron oxide black (E172) propylene glycol.

How to take Fluvastatin

Always take Fluvastatin as instructed by a doctor. Before starting this medication, your doctor will place you on a low-cholesterol diet which you must follow for the duration of treatment. Fluvastatin can be taken with or without food at the same time or times each day. To help you remember, try and make this a part of your daily routine.

If you forget to take a dose, try and remember to take it within the next 4 hours. If 4 hours has already passed, just skip the dose and take your next tablet at the scheduled time. Never take a double dose to make up for a missed one.   

Fluvastatin dosage

Fluvastatin is available as either 20 mg tablets of 40 mg tablets. A doctor will prescribe a dose ranging from 20 to 80 mg per day dependent on the cholesterol level of the patient. Dosage may be increased at intervals of 4 or more weeks if necessary.

Contraindications

Do NOT take Fluvastatin if:

• You are allergic to any of the ingredients in this mediation 
• You are allergic to peanut or soya
• You currently have liver problems, or if you have unexplained high levels of certain liver enzymes (transaminases)
• You are pregnant or breastfeeding

Before taking Fluvastatin, tell your doctor if:

• You have previously had liver disease. They will wish to do liver tests throughout treatment.
• You are taking or have in the last 7 days taken fusidic acid, orally or by injection.
• You have a kidney disease
• You have a thyroid disease (hypothyroidism)
• You have a medical history of muscle diseases yourself or in your family
• You had muscle problems with other lipid-lowering medicine
• You regularly drink large amounts of alcohol
• You have severe respiratory failure
• You have diabetes

Drug interactions

Before taking Fluvastatin, tell your doctor if you are taking any other medicines, including those purchased over the counter without a prescription. In particular, tell your doctor if you are taking:

• Ciclosporin (immunosuppressant)
• Fibrates, nicotinic acid of bile acid sequestrants
• Fluconazole (used to treat fungal infections)
• Rifampicin (antibiotic)
• Phenytoin (for epilepsy)
• Oral anticoagulants such as Warfarin
• Glibenclamide (for diabetes)
• Colchicines (for gout)
• Fusidic acid. If you need to take oral fusidic acid to treat a bacterial infection you will need to temporarily stop using this treatment.
• Red yeast rice products, used in chinese medicine to lower cholesterol and may contain a statin called lovastatin   

Fluvastatin and Alcohol

You should limit the amount of alcohol you drink while taking this medication, as the combination of alcohol and Fluvastatin can increase your risk of liver problems.

Fluvastatin and foods to avoid

While taking Fluvastatin, do not drink more than 2 small glasses of grapefruit juice per day. Grapefruit juice can increase the concentration of stains in your system and interfere with they way they work.

Fluvastatin side effects

Like all medications, Fluvastatin can cause side effects in some patients. Serious side effects are rare, but if you experience any of the following stop taking this medication and seek medical help immediately:

• Signs of a serious allergic reaction (skin swelling, difficulty breathing, dizziness)
• Unexplained muscle pain, tenderness or weakness
• Signs of hepatitis (unusual tiredness or fever, yellowing of the skin or whites of the eyes, dark coloured urine)
• Signs of skin reactions such as rash, hives, redness, itching, swelling of the face, eyelids and lips.
• Signs of decreased blood platelets (bleeding or bruising more than usual)
• Signs of blood vessel inflammation (purple or red skin lesions)
• Signs of lupus erythematosus-like reaction (red blotchy rash, mainly on the face, accompanied by fatigue, fever, nause, loss of appetite.
• Signs of inflamed pancreas (severe upper stomach pain).

Common side effects, affecting up to 1 in 10 people, include:

• Difficulty in sleeping
• Headache
• Stomach discomfort
• Abdominal pain
• Nausea

Very rarely (1 in 10,00), patients might experience tingling or numbness of the hands and feet, disturbed or decreased sensibility, or muscle weakness that is constant.  

Does Fluvastatin have less side effects than other statins?

Fluvastatin is thought to have less side effects than some other statins, although different people react differently to different statins. You doctor will assess your medical history and decide which type of statin is best suited to you. If you experience troublesome side effects, spek to your doctor about the possibility of switching to a different type of statin.

Switching statins

Different types of statins are prescribed according to the patient’s cholesterol level. To begin with, a doctor will usually prescribe a low-intensity statin at a low dose which can be increased over time. If your doctor feels that you need a stronger dose, or if you are experiencing side effects with the treatment, they may suggest switching to another statin of a different intensity level. You should never stop taking statins or switch to a different variant without the instruction of a doctor.

Lifestyle changes to make when taking Fluvastatin

Making a few lifestyle changes is the best way of reducing LDL in the blood and will also greatly increase the effectiveness of cholesterol-lowering medication. Your doctor will place you on a low-cholesterol diet before starting this medication. Try to cut down on foods which are high in saturated fats, including fatty cuts of meat and processed meats, butter and lard, cream and ice cream, cheese (particularly hard cheese), cakes, biscuits, chocolate, and products containing coconut or palm oil. If you are overweight, the best way to lower your cholesterol is to lose weight healthily and according to an approved diet plan. Exercising regularly is also extremely beneficial and will improve your general wellbeing. You should also try to cut down on alcohol and caffeine and, if you haven’t done so already, quit smoking.

Fluvastatin vs other statins

The 5 types of statin available on prescription in the UK are Fluvastatin (Lescol), Atorvastatin (Lipitor), Pravastatin (Lipostat), Rosuvastatin (Crestor) and Simvastatin (Zocor). Different statins work differently for different people; if you are experiencing troublesome side effects, your doctor may recommend switching to a different type of statin. The main difference between statins is their lowering effect on cholesterol levels. Fluvastatin, Pravastatin and Simvastatin are low-intensity statins and are sufficient for lowering cholesterol in most patients. If your doctor feels that a higher dose is needed, they may suggest a high-intensity statin, such as Atorvastatin or Rosuvastatin.

Alternatives to Fluvastatin

Statins are an effective means of lowering cholesterol and different people are different variations. A consultation with a doctor will help determine which option is best for you. However, if your doctor does not think that statins are right for you they may decided to ut you on a different type of treatment.

Aspirin is sometimes prescribed at a low daily dose to help prevent blood clots forming in patients at a high risk of cardiovascular disease (CVD). It is usually only prescribed to patient over the age of 40 and will require periodic blood tests to monitor the function of the liver.

Alternatively, Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices into your blood. It can be taken alone or in combination with a statin, and although it is not as effective as statins, it is less likely to cause side effects.

You may be prescribed a bile acid sequestrant or a fibrate, which bind to bile acids in the intestine and stop them being reabsorbed. Your body then uses cholesterol to make more bile acid, reducing the cholesterol level in the blood. They are prescribed to people who’s high cholesterol levels are due to a raised level of triglycerides in the blood.

Newer treatments have been developed for patients who have tried other alternatives without success. Alirocumab and Evolocumab help the liver remove cholesterol from the blood and are injected once every 2 weeks.  

Will I have to take Fluvastatin for ever?

Fluvastatin is intended for long-term use, and indeed works better when taken over a period of several years. Many people do continue taking statins for the rest of their life, as cholesterol levels tend to rise again once they are stopped. For patients at high risk of developing heart disease, such as those with a history of heart attack or stroke, coming off of statins can be extremely dangerous. For this reason, statins are usually prescribed to patients at a continuously high risk of heart disease.  

Sources

• Patient Information Leaflet
• NHS > High Cholesterol
• WedMD > Fluvastatin
• UHMS Lipid Therapy Guidelines > Statin Dose Intensity and Equivalency Chart