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In adults, fluvastatin is indicated for hypercholesterolemia and mixed dyslipidemia to decrease the amount of total cholesterol in the blood. Specifically, this therapy reduces low-density lipoprotein cholesterol and triglycerides and increases high-density lipoproteins. When combined with a low-fat diet, a weight-loss program, and exercise, fluvastatin may reduce the risk of heart attack and stroke in people who have heart disease or are at risk of developing heart disease. This activity outlines the indications, dosing, contraindications, monitoring, and toxicity of fluvastatin and highlights the role of the interprofessional team in directing patient therapy to improve outcomes for patients with cardiovascular disease. Objectives: Identify the mechanism of action of fluvastatin. Review the indications for initiating therapy with fluvastatin. Outline the contraindications to fluvastatin. Explain the importance of collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients receiving treatment with fluvastatin. Access free multiple choice questions on this topic.

Although rare with statins, rhabdomyolysis is a serious and potentially fatal complication. Rhabdomyolysis is the most severe form of myotoxicity and can occur with the administration of any statin. Patient risk factors that may predispose an individual to develop statin-induced rhabdomyolysis include low body mass index, advanced age, female sex, hypothyroidism, hypertension, polypharmacy, and alcohol or drug use disorder. Although rhabdomyolysis can occur with monotherapy, it is more likely to occur when combined with other drugs. Data about this toxicity primarily comes from individual case studies and shows that statins, including fluvastatin, are the most common cause of statin-related rhabdomyolysis when combined with fibrates. Individual case studies also show that statins combined with antifungals, macrolides, fusidic acid, cyclosporin, protease inhibitors, and calcium channel blockers increase the risk for rhabdomyolysis. In addition, cases of myopathy have been reported during postmarketing experience with concomitant administration of fluvastatin and colchicine.[13] In patients presenting with rhabdomyolysis, clinicians should discontinue fluvastatin. Additionally, clinicians should rapidly assess the patient’s renal function (serum creatinine, urine myoglobin) and CPK levels. Rhabdomyolysis is managed with intravenous rehydration and, in severe cases, dialysis.[19] For statin-induced immune-mediated necrotizing myopathy (INMM), the mainstay of treatment is immunosuppressant drugs, including corticosteroids and azathioprine, and cessation of statins. In addition, intravenous immunoglobulin (IVIG) and plasmapheresis have been used in some cases.[12]

The healthcare team, i.e., clinicians, nurses, and pharmacists, must work together to ensure that patients with dyslipidemia correctly take their medications, e.g., fluvastatin, and, importantly, discuss any serious adverse drug reactions they encounter, e.g., muscle pain, jaundice, etc. Clinicians should review a complete medication list for the patient before prescribing fluvastatin to prevent clinically significant drug interactions. Nursing should verify dosing before administration, and pharmacists should perform medication reconciliation to answer any questions or address concerns other healthcare team members may have. Clinicians should use the ASCVD (atherosclerotic cardiovascular disease) risk algorithm, a standardized guideline to predict risk and guide management for patients at risk of ASCVD for shared clinical decisions.[20] Additionally, the USPSTF (US Preventive Services Task Force) recommends initiating low to moderate intensity statins in adults of  40 to 75 years without a history of Cardiovascular Disease (CVD) having one or more CVD risk factors (diabetes, hypertension, dyslipidemia, or smoking) and a calculated 10-year CVD  risk of 10% or greater.[21] An interprofessional team approach and collaboration between clinicians, specialists, nursing, and pharmacists is essential to optimize patient outcomes on fluvastatin therapy.[Level V]