Mosby's 2014 Nursing Drug Reference (184 page)

• Adult:
PO
20-40 mg/day in
PM
initially, usual range 20-80 mg, max 80 mg; may be given in 2 doses (40 mg
AM
, 40 mg
PM
); dosage adjustments may be made at ≥4-wk intervals

• Adolescent ≥1 yr postmenarche (10-16 yr):
PO
20 mg daily at bedtime, may increase q6wk, max 40 mg bid (cap) or 80 mg (ext rel)

• 
Do not break, crush, or chew ext rel tabs, use at any time of day (tab), in the evening (cap)

• 
Bile acid sequestrant should be given at least 4 hr before fluvastatin

• 
Give without regard to food

• 
Store at room temperature, protected from light

Increase:
effects of warfarin, digoxin, phenytoin

Increase:
myopathy—cycloSPORINE, niacin, colchicine, protease inhibitors, fibric acid derivatives

Increase:
effects of fluvastatin—alcohol, cimetidine, ranitidine, omeprazole, phenytoin

Decrease:
fluvastatin effect—cholestyramine, colestipol, separate by ≥4 hr

Increase:
adverse reactions—red yeast rice

• 
Grapefruit juice: possible increased toxicity

Increase:
LFTs, CK

Decrease:
platelets, WBC

• 
Hypercholesterolemia:
diet history: fats, fasting lipid profile (cholesterol, LDL, HDL, TG) before and q4-6wk, then q3-6mo when stable

• 
Hepatotoxicity/pancreatitis:
monitor hepatic studies before, q12wk after dosage change, then q6mo; AST, ALT, LFTs may be increased

• 
Renal studies in patients with compromised renal system: BUN, I&O ratio, creatinine

 
Myopathy, rhabdomyolysis:
muscle pain, tenderness; obtain baseline CPK if elevated; if these occur, product should be discontinued

• 
Therapeutic response: decrease in sLDL, VLDL, total cholesterol; increased HDL, decreased triglycerides, slowing of CAD

• 
That blood work will be necessary during treatment; to take product as prescribed, that effect may take ≥4 wk

• 
To report severe GI symptoms, headache, muscle pain, weakness, tenderness

• 
That previously prescribed regimen will continue: low-cholesterol diet, exercise program, smoking cessation

• 
To report suspected pregnancy; not to use during pregnancy (X), breastfeeding

• 
To take without regard to meals; take immediate release product in the evening, separate by ≥4 hr from bile-acid product

Black Box Warning:

Children <8 yr, suicidal ideation

• Adult:
PO
50 mg at bedtime, increase by 50 mg at 4-7 day intervals, max 300 mg; doses over 100 mg should be divided;
EXT REL
100 mg at bedtime, may
titrate upward by 50 mg/wk, max 300 mg/day

• Child 12-17 yr:
PO
25 mg at bedtime, increase by 25 mg/day q4-7days, max 300 mg/day; doses over 50 mg should be divided

• Child 8-11 yr:
PO
25 mg/day at bedtime, may increase q4-7days, max 200 mg/day

• Adult:
PO EXT REL CAP
(Luvox CR) 100 mg at bedtime initially, titrate as needed by 50 mg/wk to 100-300 mg/day;
PO
50 mg at bedtime, titrate as needed by 50 mg q4-7days to 50-300 mg/day

• Child/adolescent 12-17 yr:
PO
25 mg at bedtime, titrate by 25-50 mg q4-7days, max 300 mg/day; if total daily dose >50 mg, divide equally

• Adult:
PO
25 mg at bedtime, may titrate upward slowly

• Adult:
PO
up to 150 mg/day

• Adult:
PO
50 mg at bedtime × 4-7 days, titrate by 25-50 mg/dose q4-7days as needed

• Adult:
PO
50 mg/day, may titrate to 100 mg/day

• Adult:
PO
100 mg daily in combination with other agents

• Adult:
PO
25-50 mg at bedtime × 4-7 days then titrate by 25-50 mg/dose q4-7days, range 25-300 mg/day single or divided dose × 3-12 wk

• 
With food, milk for GI symptoms

• 
Immediate release:
give at bedtime; doses >100 mg/day (or >50 mg/day in those aged 8-17 yr) in 2 divided doses; if doses are not equal, give larger dose at bedtime

• 
Ext rel:
give at bedtime; do not break, crush, chew ext rel product

Increase:
CNS depression—alcohol, barbiturates, benzodiazepines

Increase:
effect of—ramelteon, thioridazine; do not use together

Increase:
fluvoxaMINE, toxicity levels—tricyclics, cloZAPine, alosetron, tiZANidine; do not use together

Increase:
metabolism, decrease effects—smoking

Increase:
serotonin syndrome, neuroleptic malignant syndrome: SSRIs, SNRIs, serotonin-receptor agonists, atypical antipsychotics

Increase:
bleeding risk—anticoagulants, NSAIDs, salicylates, thrombolytics

Decrease:
metabolism, increase action of propranolol, diazepam, lithium, theophylline, carBAMazepine, warfarin

Increase:
CNS effect—kava, valerian

Increase:
serotonin syndrome—tryptophan, St. John’s wort; do not use together

• 
Hepatic studies: AST, ALT, bilirubin

• 
Mental status: mood, sensorium, affect,
suicidal tendencies;
increase in psychiatric symptoms: depression, panic, obsessive-compulsive symptoms

• 
Constipation; most likely in geriatric patients

 
For toxicity: nausea, vomiting, diarrhea, syncope, increased pulse, seizures

• 
Storage at room temp; do not freeze

• 
Therapeutic response: decrease in depression

• 
That therapeutic effects may take 2-3 wk

• 
To use caution when driving, performing other activities requiring alertness because drowsiness, dizziness may occur

• 
Not to use other CNS depressants, alcohol, barbiturates, benzodiazepines, St. John’s wort, kava

• 
To notify prescriber if pregnancy is suspected, planned

• 
To notify prescriber of allergic reaction

• 
To increase bulk in diet if constipation occurs, especially in geriatric patients

Black Box Warning:

That suicidal thoughts/behaviors may occur

• 
To stop taking MAOIs at least 14 days before starting product