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Patients Who May BenefitThose who are taking multiple medicationsDrug-drug interactions can potentially cause adverse drug reactions in patients taking multiple medications. |
ZYPITAMAG has Reduced Potential for Drug Interactions Compared to Most Statins
Cytochrome P450 (CYP) enzymes affect the metabolism of 70-80% of all drugs in clinical use, including commonly prescribed statins.1
ZYPITAMAG is only minimally metabolized via CYP and primarily metabolized by glucuronidation†. In combination with most drugs, ZYPITAMAG has a reduced potential for certain drug interactions.
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The principal route of pitavastatin metabolism is glucuronidation via liver uridine 5'-diphosphate glucuronosyltransferase (UGT) with subsequent formation of pitavastatin lactone. There is only minimal metabolism by the cytochrome P450 system. Pitavastatin is marginally metabolized by CYP2C9 and to a lesser extent by CYP2C8.
*CYP2C9 isoenzyme is primarily involved in the metabolism of fluvastatin (approximately 75%), while CYP2C8 and CYP3A4 isoenzymes are involved to a much less extent, i.e., approximately 5% and approximately 20%, respectively.
Dosage and Administration of ZYPITAMAG2
- The recommended starting ZYPITAMAG dosage is 2 mg once daily. The maximum recommended dosage is ZYPITAMAG 4 mg once daily.
- Lipid levels should be analyzed after 4 weeks and the dosage adjusted accordingly.
- ZYPITAMAG can be taken orally once daily with or without food.
- ZYPITAMAG should be taken at the same time each day.
Please refer to the Important Safety Information below.
Drug interactions that increase risk of myopathy and rhabdomyolysis with ZYPITAMAG2:
- Cyclosporine: Concomitant use with ZYPITAMAG is contraindicated
- Gemfibrozil: Avoid concomitant use with ZYPITAMAG
- Fibrates: Consider if the benefit of using fibrates concomitantly with ZYPITAMAG outweighs the increased risk of myopathy and rhabdomyolysis
- Niacin: Consider if the benefit of using lipid-modifying doses (>1 g/day) of niacin concomitantly with ZYPITAMAG outweighs the increased risk of myopathy and rhabdomyolysis
- Colchicine: Consider the risk/benefit of concomitant use with ZYPITAMAG
ZYPITAMAG has no contraindications, dose restrictions, or limitations with certain medications, including2:
- Diltiazem LA: Calcium channel blocker
- Itraconazole: Azole antifungal
- Warfarin: Anticoagulant┼
- Enalapril: Angiotensin-converting enzyme inhibitor
- Digoxin: Cardiac glycoside
- Grapefruit Juice
- Atazanavir: HIV protease inhibitor
- Darunavir/Ritonavir: HIV protease inhibitors
- Lopinavir/Ritonavir: HIV protease inhibitors
- Ezetimibe: Cholesterol absorption inhibitor
┼ Patients receiving warfarin should still have their PT and INR monitored when pitavastatin is added to their therapy.
Help your patient find the Right Statin, Right Away
Zypitamag is accessible like a generic statin.
Click another example of a patient group who may benefit from Zypitamag:
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Are taking multiple medications |
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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.
