Meta Information
ID:lovastatin
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/cyp3a4-strong-inhibitors
Target name:
Strong CYP3A4 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
These drugs block the primary enzyme (CYP3A4) that breaks down lovastatin, causing its blood levels to increase dramatically and raising the risk of severe muscle damage (rhabdomyolysis).
Actionable advice:
These medications should be strictly avoided with lovastatin; this combination is contraindicated.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Concomitant administration with strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/dietary/grapefruit-pomelo
Target name:
Grapefruit and Grapefruit Juice
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Grapefruit contains compounds that strongly inhibit the CYP3A4 enzyme in the gut wall, significantly increasing lovastatin absorption and risk of toxicity.
Actionable advice:
Grapefruit or its juice should not be consumed at all while taking lovastatin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
15-fold
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/intervention/gemfibrozil
Target name:
Gemfibrozil
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Gemfibrozil interferes with lovastatin's processing and removal from the body, leading to a high risk of severe muscle injury when used together.
Actionable advice:
Gemfibrozil should not be taken with lovastatin; this combination is contraindicated.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
combined use of lovastatin with gemfibrozil should be avoided
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Lovastatin may cause fetal harm as cholesterol is crucial for normal fetal development. It is classified as Pregnancy Category X.
Actionable advice:
Lovastatin should not be used during pregnancy or when planning to become pregnant.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
lovastatin is contraindicated during pregnancy and in nursing mothers
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to the potential for disrupting infant lipid metabolism, lovastatin is contraindicated in nursing mothers.
Actionable advice:
Lovastatin should not be used while breastfeeding.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
women taking lovastatin should not nurse their infants
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/condition/hepatic-impairment
Target name:
Active Liver Disease
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Lovastatin is metabolized by the liver and can worsen liver function; it is contraindicated in patients with active liver disease or unexplained high liver enzymes.
Actionable advice:
Lovastatin should not be used by those with active liver disease.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Active liver disease or unexplained persistent elevations of serum transaminases
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/dietary/meal
Target name:
Evening Meal
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking immediate-release lovastatin with food, particularly the evening meal, significantly enhances its absorption and effectiveness.
Actionable advice:
Immediate-release lovastatin should be taken at the same time as the evening meal.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
given with meals
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/circadian/evening
Target name:
Evening Time
Severity:
major
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The body's cholesterol production peaks overnight, so taking lovastatin in the evening ensures the drug is most active when it is most needed.
Actionable advice:
Lovastatin should be taken in the evening for maximum efficacy.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
with the evening meal
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/class/cyp3a4-moderate-inhibitors
Target name:
Moderate CYP3A4 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
These drugs moderately block the breakdown of lovastatin, increasing its concentration and the risk of muscle-related side effects. Dose adjustments are required.
Actionable advice:
A doctor should be informed about all medications, as the lovastatin dose may need to be limited (e.g., to 20-40mg).
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
dose of lovastatin should not exceed 20 mg daily in patients receiving concomitant medication with danazol, diltiazem, dronedarone, or verapamil
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
adjust_with_prescriber
Target id:
/class/immunosuppressants
Target name:
Cyclosporine
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Cyclosporine is a potent inhibitor of lovastatin's metabolism and transport, drastically increasing drug levels and the risk of severe myopathy.
Actionable advice:
This combination should be avoided; if necessary, the lovastatin dose must be strictly limited to 20 mg/day.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
use of lovastatin with cyclosporine should be avoided
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/intervention/danazol
Target name:
Danazol
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Danazol increases lovastatin levels, elevating the risk of muscle pain and damage. Dose limitation is necessary.
Actionable advice:
If taking danazol, your lovastatin dose should not exceed 20 mg/day.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
dose of lovastatin should not exceed 20 mg daily in patients receiving concomitant medication with danazol, diltiazem, dronedarone, or verapamil
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/intervention/diltiazem-verapamil
Target name:
Diltiazem or Verapamil
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
These calcium channel blockers are moderate CYP3A4 inhibitors that increase lovastatin levels and the risk of myopathy.
Actionable advice:
If taking diltiazem or verapamil, your lovastatin dose should not exceed 20 mg/day.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
dose of lovastatin should not exceed 20 mg daily in patients receiving concomitant medication with danazol, diltiazem, dronedarone, or verapamil
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/intervention/amiodarone
Target name:
Amiodarone
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Amiodarone inhibits CYP3A4, increasing lovastatin exposure and the risk of muscle-related side effects.
Actionable advice:
If taking amiodarone, your lovastatin dose should not exceed 40 mg/day.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
dose of lovastatin should not exceed 40 mg daily in patients receiving concomitant medication with amiodarone
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/intervention/red-yeast-rice
Target name:
Red Yeast Rice
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Red yeast rice contains monacolin K, which is chemically identical to lovastatin. Taking both is duplicative therapy and significantly increases the risk of side effects like myopathy.
Actionable advice:
Red yeast rice supplements should not be taken while using lovastatin.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Exact phrase from label:
Label source:
FDA label: Lovastatin (effective 2025-08-04) (mechanism class inference; RYR contains monacolin K = lovastatin)
Action type:
avoid
Target id:
/class/fibrates
Target name:
Fibrates (e.g., Fenofibrate)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining fibrates with lovastatin increases the risk of muscle problems (myopathy), although the risk is lower than with gemfibrozil.
Actionable advice:
This combination is best used with caution, and it is important to promptly report any unexplained muscle pain or weakness.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Other lipid-lowering drugs (other fibrates or ≥ 1 g/day of niacin)
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/intervention/niacin
Target name:
Niacin (≥1 g/day)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
High doses of niacin combined with lovastatin can increase the risk of developing severe muscle damage (myopathy and rhabdomyolysis).
Actionable advice:
This combination is best used with caution under medical supervision, especially at higher doses.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
≥ 1 g/day of niacin
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
informational_none
Target id:
/intervention/colchicine
Target name:
Colchicine
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking colchicine with lovastatin may increase the risk of myopathy, particularly in patients with kidney problems.
Actionable advice:
Any muscle pain or weakness is worth reporting to a doctor if this combination is used.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
myopathy, including rhabdomyolysis, have been reported with lovastatin coadministered with colchicine
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/intervention/warfarin
Target name:
Warfarin
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Lovastatin can slightly increase the blood-thinning effect of warfarin, raising the risk of bleeding.
Actionable advice:
Your INR (clotting time) should be monitored closely when starting, stopping, or changing your lovastatin dose.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
prothrombin time be determined before starting lovastatin
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/class/bile-acid-sequestrants
Target name:
Bile Acid Sequestrants
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
4
Description:
These drugs can bind to lovastatin in the gut and prevent its absorption, reducing its effectiveness.
Actionable advice:
Lovastatin is best taken at least 1 hour before or 4 hours after a bile acid sequestrant.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
either lovastatin or niacin in combination with a bile acid sequestrant for 2.5 years
Label source:
Primary literature (direct): Elmberger PG, Kalén A, Lund E, Reihnér E, Eriksson M, Berglund L, Angelin B, Dallner G. "Effects of pravastatin and cholestyramine on products of the mevalonate pathway in familial hypercholesterolemia." J Lipid Res. 1991;32(6):935-940. Randomized double-blind study in 12 heterozygous FH patients (n=6/arm): (i) Cholestyramine 24 g/day × 12 wk: LDL-C -32%, lathosterol +125%; (ii) Pravastatin 10→20 mg b.i.d. × 12 wk: LDL-C -27%, lathosterol -46%, ubiquinone -29%; (iii) Combination pravastatin 20 mg b.i.d. + cholestyramine 24 g/day × 12 wk: LDL-C -23%, ubiquinone -23%, lathosterol −2% (lathosterol rebound vs pravastatin alone, indicating reduced reductase-inhibition signal when BAS is co-administered — consistent with reduced statin bioavailability). Class effect: applies to lovastatin (same HMG-CoA reductase inhibitor class, same gut-binding mechanism). Supplementary verbatim from FDA Lovastatin Label, FATS section: "either lovastatin or niacin in combination with a bile acid sequestrant for 2.5 years in hyperlipidemic subjects significantly reduced the frequency of progression... of coronary atherosclerotic lesions" — label endorses the combination clinically. AIM timing advice (lovastatin 1 h before or 4 h after BAS) derives from cholestyramine/colestipol prescribing information (class PK knowledge).
Action type:
separate
Target id:
/condition/renal-impairment
Target name:
Severe Renal Impairment (CrCl < 30 mL/min)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Poor kidney function can lead to higher levels of lovastatin in the body, increasing the risk of muscle damage.
Actionable advice:
This is best used with caution; doses above 20 mg/day require careful monitoring by a physician.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
creatinine clearance 10 to 30 mL/min
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/condition/geriatric
Target name:
Older Adults (Age >65)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Individuals over 65 are at a greater risk of developing statin-associated myopathy.
Actionable advice:
It is worth being vigilant for muscle-related side effects and reporting them promptly to a doctor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
approximately 45% higher in elderly patients between 70 to 78 years of age
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/intervention/saint-johns-wort
Target name:
St. John's Wort
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
St. John's Wort induces the CYP3A4 enzyme, which can speed up the breakdown of lovastatin and reduce its cholesterol-lowering effect.
Actionable advice:
St. John's Wort is best avoided while on lovastatin to ensure the medication remains effective.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Exact phrase from label:
Label source:
FDA label: Lovastatin (effective 2025-08-04) (mechanism class inference; SJW is well-established potent CYP3A4 inducer; lovastatin is CYP3A4 substrate)
Action type:
avoid
Target id:
/intervention/ranolazine
Target name:
Ranolazine
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ranolazine is a moderate CYP3A4 inhibitor and may increase lovastatin levels, raising the risk of myopathy.
Actionable advice:
If taking ranolazine, your lovastatin dose may need to be limited and monitored.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
risk of myopathy, including rhabdomyolysis, may be increased by concomitant administration of ranolazine
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
adjust_with_prescriber
Target id:
/dietary/alcohol-acute
Target name:
Alcohol (Acute Consumption)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chronic heavy alcohol consumption can increase the risk of liver damage, and this risk is compounded when taking medications like lovastatin that are processed by the liver.
Actionable advice:
Alcohol intake is best limited, and heavy or chronic use is best avoided while taking lovastatin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
substantial quantities of alcohol
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
avoid
Target id:
/intervention/amlodipine
Target name:
Amlodipine
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Amlodipine is a weak CYP3A4 inhibitor that may slightly increase lovastatin levels, potentially increasing the risk of myopathy at higher doses.
Actionable advice:
If taking amlodipine, your lovastatin dose should generally not exceed 40 mg/day.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Exact phrase from label:
Label source:
FDA label: Lovastatin (effective 2025-08-04) (mechanism class inference; amlodipine is weak CYP3A4 inhibitor; lovastatin is CYP3A4 substrate)
Action type:
informational_none
Target id:
/intervention/coenzyme-q10
Target name:
Coenzyme Q10 (CoQ10)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Lovastatin blocks the production of CoQ10 along with cholesterol; supplementation may help replenish CoQ10 levels and potentially reduce muscle-related side effects, though evidence is mixed.
Actionable advice:
Consider discussing CoQ10 supplementation with your doctor to potentially mitigate muscle symptoms.
Validation status:
validated_via_expert_review
Evidence tier:
tier_c
Evidence basis:
expert_review_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
All randomized controlled trials showed improvement in statin-associated myopathy with CoQ10
Label source:
Primary literature: CoQ10 in statin-associated myopathy
Action type:
informational_none
Target id:
/biomarker/alanine-aminotransferase
Target name:
Liver Function Tests (ALT/AST)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Lovastatin can cause asymptomatic elevations in liver transaminases (ALT, AST), indicating potential liver stress.
Actionable advice:
Your doctor should perform baseline and periodic liver function tests as clinically indicated.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
liver enzyme tests be obtained prior to initiating therapy
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor
Target id:
/biomarker/creatine-kinase
Target name:
Creatine Kinase (CK)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
In cases of muscle pain or weakness (myopathy), lovastatin can cause significant elevations in creatine kinase levels.
Actionable advice:
Your doctor may measure CK levels if you develop muscle symptoms while taking lovastatin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
creatine kinase
Label source:
FDA label: Lovastatin (effective 2025-08-04)
Action type:
monitor