Pravastatin

• High cholesterol (hyperlipidemia)
• Cardiovascular disease prevention
• Coronary artery disease - secondary prevention
• Mixed dyslipidemia
• High triglycerides (hypertriglyceridemia)
• Slowing atherosclerosis progression

Pravastatin is a statin medication (HMG-CoA reductase inhibitor) used to lower cholesterol and reduce cardiovascular disease risk. Unlike most other statins, pravastatin is not extensively metabolized by the cytochrome P450 system, giving it a favorable drug interaction profile.

How Pravastatin Works

Pravastatin inhibits HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis in the liver. This reduces intracellular cholesterol, leading to upregulation of LDL receptors and increased clearance of LDL cholesterol from the blood. The medication also has anti-inflammatory effects on blood vessel walls.

Pharmacokinetic Advantages

Pravastatin is hydrophilic (water-soluble), resulting in lower muscle penetration and potentially reduced myopathy risk compared to lipophilic statins. It is not significantly metabolized by CYP3A4, reducing drug interactions. It does not require hepatic activation, being administered as an active compound.

Available Formulations

Pravastatin sodium tablets are available in:

• 10 mg
• 20 mg
• 40 mg
• 80 mg

The brand name is Pravachol, though generic versions are widely available.

Medical Uses

Pravastatin is FDA-approved for:

• Primary hyperlipidemia and mixed dyslipidemia
• Hypertriglyceridemia
• Primary prevention of cardiovascular disease
• Secondary prevention in patients with established coronary heart disease
• Slowing progression of atherosclerosis

Dosing Information

Adults typically start at 40 mg once daily. The dose range is 10-80 mg daily, with 80 mg providing maximum LDL reduction. For children aged 8-13 years, the dose is 20 mg daily; for adolescents 14-18, 40 mg daily. The medication can be taken at any time of day.

Efficacy

Pravastatin is considered a moderate-intensity statin. At 40 mg daily, it reduces LDL cholesterol by approximately 30-35%. For patients requiring greater LDL reduction (>50%), higher-intensity statins like atorvastatin or rosuvastatin may be preferred.

Important Safety Information

Common side effects include muscle pain, headache, and gastrointestinal symptoms. Rare but serious adverse effects include rhabdomyolysis (severe muscle breakdown) and hepatotoxicity. Liver function tests should be monitored. Patients should report unexplained muscle pain, especially with fever or weakness.

Drug Interactions

Due to minimal CYP450 metabolism, pravastatin has fewer drug interactions than other statins. However, cyclosporine significantly increases pravastatin levels and the combination requires dose limitation. Gemfibrozil increases myopathy risk. Colestipol and cholestyramine can reduce pravastatin absorption.

Special Populations

Pravastatin is contraindicated during pregnancy and breastfeeding due to potential harm to fetal development. Women of childbearing potential should use effective contraception. Elderly patients may require dose adjustment. Severe renal or hepatic impairment requires caution.

Learn more at MedlinePlus