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Livalo® (Pitavastatin)—Cholesterol Lowering Drug

What is Livalo®?

Livalo (pitavastatin) is a brand-name statin. Statins—HMG-CoA reductase inhibitors— are used to lower the cholesterol production in your liver by blocking the enzyme (HMG-CoA reductase) that is needed to make cholesterol.

Statins are also used to prevent plaque (fatty deposits) from accumulating in your blood vessels. When these plaques rupture, it can lead to heart attacks or strokes. Therefore, it’s important to keep your cholesterol at healthy levels to prevent heart disease.

Livalo is used:

  • to lower your blood levels of LDL, total cholesterol, and triglycerides while increasing HDL (good cholesterol) levels
  • to halt the development of plaque (accumulation of lipids, cholesterol, and other components inside and on the surface of your arterial walls),
  • to lessen the likelihood that individuals with coronary heart disease (CHD) may need to undergo revascularization treatments

Essentially, Livalo can help delay the onset of cardiovascular disease by lowering your cholesterol levels. This medication may potentially lessen the likelihood of a heart attack and/or stroke.

Livalo is approved for use in adults and children as young as 8 years old. It is unknown if Livalo is safe and effective in children younger than 8 years of age.

Compare Statins

Factors to Consider when Choosing a Statin​

There are many important factors to consider when choosing a statin. Some things to discuss with your healthcare provider include:​

  • What statin intensity do I require?​
  • How will my body process the statin?​
  • What statin is the safest?​
  • Which statin has the fewest side effects?

Is Livalo better than other statins?

Livalo may work well for those who have not responded well to previous statins and need a statin with less muscular discomfort. Livalo (pitavastatin) also has fewer drug interactions than other statins, making it a better alternative for those who take multiple drugs.

People who may benefit from pitavastatin are:
  • with type 2 diabetes
  • over 65 or older
  • on calcium channel blockers for high blood pressure
  • on warfarin
  • of Asian descent
  • with 2 or more risk factors for coronary heart disease (CHD)

Keep in mind that everyone is different, and you may respond differently to the same statin.

Learn more about pitavastatin use for various patient types

Livalo and foods

Grapefruit contains a chemical that can interfere with your body's ability to break down certain statin medications. Unlike most statins, Livalo does not interact with grapefruit or grapefruit juice.

Meals rich in fat or cholesterol, such as fried food and baked goods, will affect how well Livalo works.

Alcohol use may also increase your risk of liver damage and boost triglyceride levels.

How is Livalo processed in your body?

Most drugs pass through the liver where they are broken down by enzymes. The enzyme group called CYP-450 (cytochrome P-450) is the liver’s primary mechanism for processing drugs. The capacity of CYP-450 is limited and can be overloaded when you are on multiple drugs.

Livalo (pitavastatin) is primarily processed by a different liver enzyme called UGT (uridine 5'-diphosphate glucuronosyltransferase) and only slightly metabolized by CYP-450. Due to this difference, pitavastatin, like Livalo and Zypitamag are known to have a decreased risk of certain drug interactions.

Livalo vs Zypitamag

There is currently no generic alternative for Livalo. However, there is another FDA-approved brand pitavastatin, Zypitamag. Both Zypitamag and Livalo are considered to be bioequivalent by the FDA, meaning they have the same active component and function in the same way.

How To Take It

Livalo Dosage

Livalo is available in tablet form and can be taken by mouth once a day, with or without food. Keep the medication at room temperature between 15°C and 30°C, or 59° to 86° F.

Available doses:
  • Moderate-intensity: 2–4 mg daily
    Can reduce LDL by approximately 30%–49%
  • Low-intensity: 1 mg daily
    Can reduce LDL by no more than 30%

A 2 mg dose is generally the initial dose you may be prescribed, a maintenance dose may range from 1-4 mg, but the maximum dose for Livalo is 4 mg. In clinical studies doses of more than 4 mg (daily) were linked to an increased risk for severe myopathy (a skeletal muscle disorder that causes muscle weakness, stiffness, and spasms). Therefore, Livalo should only be used once a day at a maximum dose of 4 mg.

Your dosage is determined by your age, medical history, treatment response, and any additional drugs you may be taking. Your doctor will examine your cholesterol levels, 4 weeks after you start taking the medication. Depending on how high your level is, they could possibly increase your dose.

Follow your doctor's instructions and all guidelines provided on the medication label. For the greatest outcomes, your provider might periodically adjust your dosage. Never use more or less of this medication than is advised, or for an extended period of time, unless approved by your doctor.

What should I know about Livalo before taking it?

If you’re allergic to pitavastatin, or have any of the following conditions, you shouldn't take Livalo.

  • Hepatitis (inflammation in your liver), including abnormal liver enzyme testing
  • Kidney disease
  • If you are nursing or pregnant
  • When taking cyclosporine
  • Regularly consume a large amount of alcohol.

What are the side effects of Livalo?

Although Livalo is safe and effective for many individuals, it does cause an extensive amount of adverse effects that may not always be well tolerated by everyone taking them, including the following:

  1. Myopathy (skeletal muscle disorder)
    • Risk factors for myopathy include individuals older than 65 years, uncontrolled hypothyroidism, and/or renal impairment.
    • Common signs and symptoms of myopathy include dark brown urine, severe muscle weakness or pain, fever, tiredness, little urination, swelling in your hands or feet, and feeling tired or confused.
  2. Myalgias (muscle pain and/or soreness)
  3. Arthralgia (joint pain)
  4. Cognitive impairment
  5. Headache
  6. Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
  7. Insomnia
  8. Nausea
  9. Heartburn
  10. Abdominal pain
  11. Indigestion
  12. Constipation

Do not abruptly discontinue taking this medication if you believe you are encountering any negative side effects. Consult your doctor to determine whether a dose adjustment or switching to a different drug could be beneficial in your case.

Serious side effects
  1. Difficulty raising your arms and/or difficulty rising or standing
  2. Muscle aches in your hips, shoulders, neck, and back
  3. Hepatic (liver) issues, such as upper abdominal pain, weakness, fatigue, decreased appetite, dark urine, and jaundice (yellowing of the skin or eyes)
  4. Kidney issues, such as little to no urination, ankle or foot swelling, fatigue, or shortness of breath.

If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.

Who’s at a greater risk of developing statin side effects?

Your risk of adverse effects with statins may rise due to certain risk factors. You could be more susceptible to negative side effects if you:

  • are female
  • are older than 80
  • have kidney and/or liver issues
  • have particular ailments such as hypothyroidism or neuromuscular diseases, including amyotrophic lateral sclerosis (ALS)
  • consume an excessive amount of alcohol. Daily use of alcohol may increase your risk for liver problems, particularly when combined with Livalo.
Related Article

What is Statin Intolerance?

Statin intolerance is defined as one or more adverse effects associated with statin therapy, which resolves or improves with dose reduction or discontinuation, and can be classified as complete inability to tolerate any dose of a statin or partial intolerance, with inability to tolerate the dose necessary to achieve the patient-specific therapeutic objective. To classify a patient as having statin intolerance, a minimum of two statins should have been attempted, including at least one at the lowest approved daily dosage.

Can Livalo cause dementia?

The main result of a meta-analysis conducted by researchers was a comparison between the dementia risk among those using statins and that among people not taking statins. It was reported that there was a 17% lower incidence of dementia from all causes related to statin use.

Correspondingly, it was discovered that statin use was considered neutral in terms of vascular dementia (VaD) risk and was significantly associated with a reduced risk of Alzheimer's disease. As a result, it was concluded the use of statins was significantly linked to a lower prevalence of dementia.

Additionally, The Journal of the American College of Cardiology (JACC) recently published a study with the goal of bringing further attention to this subject. The researchers who carried out this study found no difference in dementia risk between individuals who used statins and those who did not after a 5-year follow-up period.

This result remained consistent for various modifications in cognitive, recollection, speech, executive function, or an assessment known as psychomotor speed, which evaluates how rapidly an individual can acquire information. Furthermore, statins have not been shown to cause or increase your risk of developing dementia.

Related Article
Do Statins Cause Dementia?

Concerns arose in 2012 after the FDA warned that statin users had complained of acute cognitive impairment while using these medications. To measure the strength of the relationship between statin therapy and the risk of dementia, a meta-analysis study was conducted.

Can I take Livalo if I’m pregnant?

Inform your doctor if you get pregnant or think you could be pregnant. Your doctor will advise you on whether you should discontinue this medication during pregnancy and if you should temporarily stop using Livalo while nursing or breastfeeding. Women who need statins and are at high risk of heart attack or stroke should not breastfeed. Studies on nursing mothers have shown negative effects on infants. Breastfeeding while taking Livalo is not recommended.

Kidney failure may result from muscle tissue degradation brought on by Livalo. If you experience serious muscle pain, soreness, or stiffness while taking this medication, consult your physician immediately, particularly if you're also experiencing fever, unusual fatigue, or dark urine.

Can Livalo interact with other medications?

Your physician must be aware of any additional medications you are taking because some of them might significantly raise your chance of developing serious muscle issues.

Inform your physician of all prescription and over-the-counter (OTC) medications, including:

  • Atazanavir
  • Cyclosporine
  • Gemfibrozil
  • Retrovir
  • Colchicine
  • Erythromycin
  • Niacin
  • Red yeast rice

Livalo should be used at least 1 hour before or at least 4 hours after taking some other cholesterol-lowering medicines, including bile acid-binding resins such as colestipol or cholestyramine. Livalo and these drugs may interact, inhibiting complete absorption.

What happens if I miss a dose?

Take Livalo as soon as you remember if you forget to take a dosage. However, just skip it if your missed dosage was more than 12 hours ago.

You can take your next dose again on your regular schedule. Consult your physician or pharmacist if you're unsure about taking a missed dosage or skipping it.

To make up for a missed dosage, do not take more medication. This might increase your likelihood of experiencing Livalo's adverse effects.

Consider utilizing a medicine reminder to ensure that you don't forget to take a dosage. This may entail using a timer or setting an alarm. On your phone, you might also download a reminder app.

Commonly Asked Questions about Livalo