Statin (HMG-CoA reductase inhibitor)
ATC code: C10AA04 (Fluvastatin)
Brand names
Lescol XL, Digaril Prolib, Fluvastatina Cinfa, Fluvastatina Normon
Fluvastatin reversibly and competitively inhibits hepatic HMG-CoA reductase – hepatocytes synthesize less cholesterol and take up more via apo-B/E receptors. Efficacy below atorvastatin and rosuvastatin: 20-35% LDL-C reduction at 20-80 mg. Minimal CYP3A4 metabolism (mostly CYP2C9), so fewer drug interactions; suitable for patients intolerant of atorvastatin or simvastatin.
Second line
Primary hypercholesterolemia and mixed dyslipidemia in patients intolerant of more potent statins (myopathy on atorvastatin or simvastatin) or needing to minimize CYP3A4 drug interactions. Per 2019 and SEA 2023 – second-line. Dose: 20-80 mg once daily in the evening (XL form) or 40 mg twice daily. Full effect at 4 weeks. In transplant recipients (especially renal), fluvastatin is often chosen due to minimal interaction with tacrolimus and cyclosporine.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Statins, including fluvastatin, are sometimes marketed as a longevity drug for all adults over 40. Per 2019, 2018, and SEA 2023, statin therapy in adults without diagnosed dyslipidemia or familial hypercholesterolemia is not started at ASCVD risk <5%: benefits do not exceed harms (myopathy, transaminitis, raised blood glucose). In the potency race, fluvastatin loses to atorvastatin/rosuvastatin; prescribing it just in case has no rationale. If prescribed without SCORE2 risk calculation or a lipid panel, consider getting a second opinion and a formal risk estimate.
1 pair found. Sorted from critical to minor.
Mechanism
Cyclosporine inhibits OATP1B1. Fluvastatin rises 2-fold. recommends dose cap.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Cap fluvastatin at 20 mg/day.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
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Contraindicated. Effective contraception in women of reproductive age; stop 1-2 months before planned conception.
Contraindicated. Defer therapy until breastfeeding ends.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Fluvastatin is evaluated for the following indications with varying evidence strength: Dyslipidemia (evidence tier A), Anti-aging and longevity (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Fluvastatin (≥ 1 in 100): Myalgia, GI upset, Headache, Transaminase elevation, Insomnia. See the Safety section for uncommon and serious reactions.
FDA category X. Contraindicated. Effective contraception in women of reproductive age; stop 1-2 months before planned conception.
Contraindicated. Defer therapy until breastfeeding ends.
Fluvastatin is contraindicated in: Hypersensitivity; Active liver disease or unexplained persistent transaminase elevation; Pregnancy and breastfeeding; Concomitant high-dose fluconazole. Full list in the Safety section.