Fluvastatin
HMG-CoA reductase inhibitor · “The perioperative protector”
The Clinical Case
Male, 68 yo. Elective abdominal aortic aneurysm repair scheduled. LDL 3.2 mmol/L. On warfarin and phenytoin for epilepsy. Anaesthetist requests a statin with minimal CYP3A4 burden, citing a randomised trial demonstrating perioperative cardiac protection with this specific drug in vascular surgery. Which statin is metabolised primarily by CYP2C9?
The Answer
Played on: 5 Jan 2026 · 19 Jan 2026 · 2 Feb 2026 · 16 Feb 2026 · 2 Mar 2026 · 16 Mar 2026 · 30 Mar 2026 · 13 Apr 2026 · 27 Apr 2026 · 11 May 2026 · 25 May 2026 · 8 Jun 2026 · 22 Jun 2026 · 6 Jul 2026 · 20 Jul 2026 · 3 Aug 2026 · 17 Aug 2026
Clinical Pearl
CYP2C9: Primary metabolism via CYP2C9 (not CYP3A4) — interacts with warfarin, phenytoin, fluconazole; avoids the CYP3A4 interaction burden of simvastatin/lovastatin
All Hints
CYP2C9: Primary metabolism via CYP2C9 (not CYP3A4) — interacts with warfarin, phenytoin, fluconazole; avoids the CYP3A4 interaction burden of simvastatin/lovastatin
Perioperative: DECREASE-"III": perioperative statin therapy in vascular surgery reduced MACE — pleiotropic effect, independent of LDL
Half-life & dosing: Short half-life ~3 h → optimally dosed in the evening (like pravastatin, simvastatin); XL 80 mg formulation improves tolerability
Efficacy: Modest LDL reduction (~25–30%); niche role when multiple CYP3A4 comedications are present
Practical: Often overlooked — offers a unique pharmacokinetic niche in complex polypharmacy patients
Think you can beat today's puzzle?
A new clinical case every day. 6 guesses to name the drug.
Play today's Med Wordle — #240 →