Pravastatin Dosage

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Usual Adult Dose for Hyperlipidemia

Initial dose: 40 mg once daily.
Maintenance dose: 40 to 80 mg once daily.

Usual Adult Dose for Myocardial Infarction - Prophylaxis

Initial dose: 40 mg once daily.
Maintenance dose: 40 to 80 mg once daily.

Usual Adult Dose for Revascularization Procedures - Prophylaxis

Initial dose: 40 mg once daily.
Maintenance dose: 40 to 80 mg once daily.

Usual Adult Dose for Ischemic Stroke - Prophylaxis

Initial dose: 40 mg once daily.
Maintenance dose: 40 to 80 mg once daily.

Usual Pediatric Dose for Heterozygous Familial Hypercholesterolemia

8 to 13 years: 20 mg orally once daily
14 to 18 years: 40 mg orally once daily

Renal Dose Adjustments

Significant renal dysfunction: Initial dose: 10 mg once daily. Dosage increases should be done with careful monitoring for adverse reactions.

Liver Dose Adjustments

10 mg once daily. Dosage increases should be done with careful monitoring for adverse reactions.

Dose Adjustments

Adjustments in dosage should be made in intervals of 4 weeks or more.

For patients taking immunosuppressive drugs such as cyclosporine concomitantly with pravastatin, therapy should begin with 10 mg of pravastatin once daily at bedtime and titration to higher doses should be done with caution. Most patients treated with this combination received a maximum pravastatin dose of 20 mg daily.

The lipid-lowering effects of pravastatin on Total- and LDL-cholesterol are enhanced when combined with a bile-acid-binding resin. When administering a bile-acid-binding resin (e.g., cholestyramine, colestipol) and pravastatin, the pravastatin should be given either 1 hour before or at least 4 hours following the resin.

Precautions

The safety and effectiveness of pravastatin in pediatric patients less than 8 years of age have not been determined.

Dialysis

Data not available

Other Comments

Cholesterol levels should be monitored periodically with consideration given to reducing the dosage if cholesterol levels fall significantly below the targeted range.

It has been suggested that prior to initiating statin therapy, all patients should have a baseline serum creatine kinase (CK) enzyme level measured and if at any time after initiating therapy a patient complains of muscle soreness, tenderness, or pain another CK level should be drawn for comparison. If elevated, the drug should be discontinued.

The results of one study indicate that withdrawal of HMG-CoA reductase inhibitors (statins; atorvastatin, fluvastatin, pravastatin, simvastatin) during the perioperative period in patients with acute coronary syndromes is associated with an increased risk for perioperative adverse cardiac events (i.e., increase postoperative troponin release and the combination of myocardial infarction and cardiovascular death). Patients receiving statins with extended-release formulations (i.e., fluvastatin) appeared to be associated with more favorable outcomes. Other studies appear to confirm these findings.

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