They have found that is more effective to have a greater focus on "group discussions on work related issues", and discussion about "work and private life interface" and other personal needs with psychologists and workplace representatives.Jac JL van der Klink and Frank JH van Dijk suggest stress inoculation training, cognitive restructuring, graded activity and "time contingency" (progressing based on a timeline rather than patients comfort) are effective methods of treatment.Kakiashvili et al. said that "medical treatment of burnout is mostly symptomatic: it involves measures to prevent and treat the symptoms." They say the use of anxiolytics and sedatives to treat burnout related stress is effective, but does nothing to change the sources of stress. They say the poor sleep often caused by burnout (and the subsequent fatigue) is best treated with hypnotics and CBT (within which they include "sleep hygiene, education, relaxation training, stimulus control, and cognitive therapy"). They advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis dysfunction at the core of burnout. They also believe "vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction," noting the importance of specific nutrients. Omega-3 fatty acids may be helpful. DHA supplementation may also be useful for moderating norepinephrine. 11 beta-hydroxysteroid dehydrogenase (and potentially other metabolites of liquorice root extract) may help with lowered cortisol response.Salomonsson et al.
One study found that coenzyme Q10 was not reduced as much as with certain other statins (though this is unlikely given the inherent chemistry of the HMG-CoA reductase pathway that all statin drugs inhibit).As opposed to other statins, there is evidence that pitavastatin improves insulin resistance in humans, with insulin resistance assessed by the homeostatic model assessment (HOMA-IR) method.Hyperuricemia or increased levels of serum uric acid have been reported with pitavastatin. Metabolism and interactions
Most statins are metabolised in part by one or more hepatic cytochrome P450 enzymes, leading to an increased potential for drug interactions and problems with certain foods (such as grapefruit juice). The primary metabolism pathway of pitavastatin is glucuronidation. It is minimally metabolized by the CYP450 enzymes CYP2C9 and CYP2C8, but not by CYP3A4 (which is a common source of interactions in other statins). As a result, it is less likely to interact with drugs that are metabolized via CYP3A4, which might be important for elderly patients who need to take multiple medicines. History
Pitavastatin (previously known as itavastatin, itabavastin, nisvastatin, NK-104 or NKS-104) was discovered in Japan by Nissan Chemical Industries and developed further by Kowa Pharmaceuticals, Tokyo. Pitavastatin was approved for use in the United States by the FDA on 08/03/2009 under the trade name Livalo. Pitavastatin has been also approved by the Medicines and Healthcare products Regulatory Agency (MHRA) in UK on 17 August 2010. Zypitamag (pitavastatin magnesium), a pharmaceutical alternative to Livalo, was approved for use in the United States by the FDA in 2017.