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Pitavas Plus

Contains:

  • Pitavastatin Calcium equivalent to Pitavastatin 2 mg

  • Ezetimibe IP 10 mg
    Therapeutic Class: Lipid-Lowering Agent (Statin + Cholesterol Absorption Inhibitor)
    Schedule: Schedule H (Prescription Drug)

PITAVAS PLUS is a dual-mechanism lipid-lowering therapy combining Pitavastatin, an HMG-CoA reductase inhibitor (statin), and Ezetimibe, a selective intestinal cholesterol absorption inhibitor.

This combination works synergistically:

  • Pitavastatin inhibits endogenous cholesterol synthesis in the liver

  • Ezetimibe blocks dietary and biliary cholesterol absorption at the intestinal brush border

Together, they provide greater LDL-C reduction than either agent alone and effectively reduce total cholesterol, non-HDL-C, ApoB, and LDL particle number.

Usage of PITAVAS PLUS

  • Primary hypercholesterolemia not adequately controlled by statin alone

  • Familial hypercholesterolemia (heterozygous type)

  • Mixed dyslipidemia with high LDL-C and borderline triglycerides

  • Statin-sparing strategy in patients prone to statin-induced muscle symptoms

  • Atherosclerotic cardiovascular disease (ASCVD) risk reduction when intensified LDL-C control is needed

Common Side Effects

  • Headache

  • Diarrhea or abdominal discomfort

  • Myalgia or muscle cramps

  • Elevated liver enzymes (usually transient)

  • Rare: Rhabdomyolysis, hypersensitivity reactions

Note: The combination is generally well tolerated and muscle-related side effects are less frequent with Pitavastatin than with other statins.

Precautions

  • Liver dysfunction: Monitor liver enzymes before and during therapy

  • Muscle symptoms: Check creatine kinase (CK) if unexplained pain or weakness develops

  • Avoid in pregnancy and lactation – Category X

  • Use with caution in elderly patients or those with renal impairment

  • In moderate hepatic impairment, monitor closely

  • Ezetimibe should not be used in moderate to severe liver disease

Drug Interactions

  • Bile acid sequestrants: Can reduce Ezetimibe absorption – separate dosing by ≥4 hours

  • Cyclosporine: May increase systemic exposure of both components

  • Fibrates (especially gemfibrozil): Risk of gallstones and myopathy

  • Warfarin: Monitor INR when Ezetimibe is added

  • Minimal CYP450 involvement – Pitavastatin is safer in polypharmacy settings

Dosage and Administration

  • Once daily, preferably in the evening

  • Can be taken with or without food

  • Regular monitoring of lipid profile, LFTs, and CK (if symptomatic) recommended

Storage

  • Store in a cool, dry place, below 25°C

  • Protect from light and moisture

Patient Counselling Tips

  • Stress the importance of adherence, even when lipid levels improve

  • Report muscle pain, tenderness, or weakness immediately

  • Encourage low-fat diet and exercise to enhance lipid control

  • Avoid alcohol to reduce liver-related risks

  • Discuss all other medications and supplements to avoid interactions

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