Dosing

		Minimally metabolized through the CYP 450 family of enzymes
		One tablet, once daily
		Taken with or without food

(2 mg, 4 mg) - (90 and 500 tablets)

The recommended starting dose is 2 mg once daily. Do not exceed 4 mg once-daily dose.
After 4 weeks, analyze lipid levels and adjust dosing accordingly.
Patients with moderate and severe renal impairment not on hemodialysis (GFR 30-59 mL/min/1.73 m² and 15-29 mL/min/1.73 m², respectively) and patients with end-stage renal disease on hemodialysis should receive a starting dose of Zypitamag^® 1 mg once daily and a maximum dose of Zypitamag^® 2 mg once daily. Zypitamag^® is not available in a 1 mg dose; use an alternative formulation of pitavastatin.
In patients taking erythromycin, a dose of Zypitamag^® 1 mg once daily should not be exceeded. Zypitamag^® is not available in a 1 mg dose; use an alternative formulation of pitavastatin.
In patients taking rifampin, a dose of Zypitamag^® 2 mg once daily should not be exceeded.

Refer to Prescribing Information for complete dosing information and to the Important Safety Information for dose-dependent skeletal muscle effects.

Key considerations outlined in the 2013 ACC/AHA Guidelines and 2014 recommendations published by the National Lipid Association lend credence to an individualised approach to lipid-modifying treatment¹^,2

Assessing patients' individual risks: Evaluate age, comorbidities, and treatment regimens, including complexity, polypharmacy, and potential drug interactions.
Determining treatment: Consider statins as first-line drug treatment.
Selecting appropriate statin and dose: Discussion with patient to help minimize individual challenges to optimize goal achievement.

Pitavastatin (2 mg, 4 mg) is recommended as a moderate intensity statin. Patient candidates may exist for high-intensity statin but may meet the need for moderate-intensity statin based on the following intensity-modifying criteria.

References:

1. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt. B):2889-2934
2. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 - executive summary. J Clin Lipidol. 2014;8(5):473-488

Important Safety Information | Prescribing Information | Patient Site

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IMPORTANT SAFETY INFORMATION FOR ZYPITAMAG™ (pitavastatin) tablets

INDICATIONS & USAGE

ZYPITAMAG is indicated as an adjunct to diet to reduce low-density lipoprotein cholesterol (LDL-C) in adult patients with primary hyperlipidemia.

Pediatric use information is approved for Kowa Co Ltd LIVALO (pitavastatin) tablets. However, due to Kowa Co Ltd marketing exclusivity rights, this drug product is not labeled with that information.

CONTRAINDICATIONS

ZYPITAMAG is contraindicated in the following conditions:

Concomitant use of cyclosporine.
Acute liver failure or decompensated cirrhosis.
Hypersensitivity to pitavastatin or any excipients in ZYPITAMAG. Hypersensitivity reactions including angioedema, rash, pruritus, and urticaria have been reported with pitavastatin.

WARNINGS & PRECAUTIONS

Myopathy and Rhabdomyolysis: Risk factors include age 65 years or greater, uncontrolled hypothyroidism, renal impairment, concomitant use with certain other drugs (including other lipid-lowering therapies), and higher ZYPITAMAG dosage. ZYPITAMAG is contraindicated in patients taking cyclosporine and not recommended in patients taking gemfibrozil. The following drugs when used concomitantly with ZYPITAMAG may also increase the risk of myopathy and rhabdomyolysis: lipid-modifying dosages of niacin (>1 g/day), fibrates, and colchicine. Discontinue ZYPITAMAG if markedly elevated CK levels occur or if myopathy is either diagnosed or suspected. Temporarily discontinue ZYPITAMAG in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis; e.g., sepsis; shock; severe hypovolemia; major surgery; trauma; severe metabolic, endocrine, or electrolyte disorders; or uncontrolled epilepsy. Inform patients of the risk of myopathy and rhabdomyolysis when starting or increasing the ZYPITAMAG dosage. Instruct patients to promptly report any unexplained muscle pain, tenderness or weakness particularly if accompanied by malaise or fever.
Immune-Mediated Necrotizing Myopathy (IMNM): There have been rare reports of IMNM, an autoimmune myopathy, associated with statin use, including reports of recurrence when the same or a different statin was administered. IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. Additional neuromuscular and serologic testing may be necessary. Treatment with immunosuppressive agents may be required. Discontinue ZYPITAMAG if IMNM is suspected.
Hepatic Dysfunction: Increases in serum transaminases can occur. Rare postmarketing reports of fatal and non-fatal hepatic failure have occurred. Consider liver enzyme testing before initiating therapy and as clinically indicated thereafter. If serious hepatic injury with clinical symptoms and/or hyperbilirubinemia or jaundice occurs, promptly discontinue ZYPITAMAG.
Increases in HbA1c and Fasting Serum Glucose Levels: Increases of each have been reported with statins, including ZYPITAMAG. Optimize lifestyle measures, including regular exercise, maintaining a healthy body weight, and making healthy food choices.

ADVERSE REACTIONS: The most frequent adverse reactions (rate ≥ 2%) are myalgia, constipation, diarrhea, back pain, and pain in extremity. This is not a complete list of all reported adverse events.

For additional information, refer to full Prescribing Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.