Efficacy and safety of fluvastatin in special patient groups

Fluvastatin, the first entirely synthetic 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitor, is structurally distinct from the others in its class: lovatatin, simvastatin, and pravastatin. This structural difference results in low systemic exposure, high protein binding, rapid absorption from the gastrointestinal tract, the shortest half‐life compared with the other agents noted, high selectivity for the iver, no circulating metabolites, and extensive first‐pass netabolism. However, as with other HMG‐CoA reductase inhibitors, fluvastatin is an effective agent for lowering low‐ensity lipoprotein cholesterol. To date, no cases of drug‐related myopathy have been reported in patients taking fluvatatin. The combination of efficacy and safety makes fluvatatin an appropriate choice for first‐line therapy in the treatment of special populations, such as patients with familial ypercholesterolemia or non‐insulin‐dependent diabetes, as well as transplant patients who are on cyclosporine. A study of enal transplant patients has shown that the bioavailability of luvastatin is increased twofold by concomitant cyclosporine, which is a smaller increase than those reported for lovastatin, imvastatin, and pravastatin. Thus, fluvastatin appears to be both safe and efficacious in the treatment of patients with transplant‐induced hypercholesterolemia.