Pravastatin: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 25, 2023.

1. How it works

• Pravastatin may be used for the treatment of high cholesterol or to lower triglycerides.
• Pravastatin works by blocking an enzyme, called HMG-CoA reductase, in the liver that makes different types of lipids (this is the collective term for fats and cholesterol). Pravastatin also boosts the breakdown of lipids.
• Pravastatin belongs to the class of medicines known as statins. Pravastatin is also known as an HMG-CoA reductase inhibitor.

2. Upsides

• Pravastatin in conjunction with dietary measures is used to treat high cholesterol in people at increased risk of cardiovascular disease if initial dietary measures fail to lower cholesterol.
• Reduces total cholesterol, LDL-C, apolipoprotein B, and triglyceride levels. Increases HDL-C.
• May treat primary dysbetalipoproteinemia (Fredrickson Type III) in those who do not adequately respond to diet.
• Used alongside diet, exercise, and lifestyle modification to treat heterozygous familial hypercholesterolemia (HeFH) in children and adolescent patients 8 years old and over if diet alone fails to lower LDL-C to recommended levels.
• Pravastatin is also used to lower the risk of coronary events (including heart attacks, strokes, and angina) in patients at high risk of these events - such as people with pre-existing coronary heart disease, diabetes, peripheral vessel disease, a previous history of stroke and stroke-like events or heart attack, or with multiple risk factors (such as older age, smoking, high blood pressure, low HDL-C, family history of heart disease).
• Grapefruit products or juice have little effect on blood levels of pravastatin.
• Generic pravastatin is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Diarrhea, rhinitis, tiredness, headache, nausea. Pravastatin is generally well tolerated; discontinuation rates due to adverse effects have been similar to placebo (a nonactive pill).
• Muscle pain, tenderness, or weakness - initially needs further investigation to rule out more serious muscle effects (such as rhabdomyolysis - the destruction of muscle cells). People aged older than 65, taking certain medications (for example cyclosporine or colchicine), who drink more than two alcoholic drinks per day, or with kidney disease appear more at risk. Discontinue pravastatin if markedly elevated CPK levels occur or myopathy is diagnosed or suspected.
• Temporarily withhold pravastatin treatment in any patient experiencing a condition predisposing to the development of renal failure secondary to rhabdomyolysis such as sepsis, low blood pressure, major surgery, trauma, severe metabolic, endocrine, or electrolyte disorders, or uncontrolled epilepsy.
• Pravastatin, like other statins, may affect liver function, manifesting as changes in liver function tests or jaundice (yellowing of the skin) requiring dosage reduction or discontinuation. Liver function tests are recommended before starting therapy and at periodic intervals throughout therapy.
• May not be suitable for those with liver or kidney disease. In those with severe kidney disease, a starting dose of 10mg is recommended. May adversely affect endocrine function in some people.
• Dosages greater than 20mg have not been studied in children aged 8 to 13 years. The recommended dosage is 40mg in children aged 14 to 18 years; higher dosages have not been studied in this population.
• Rarely, has been associated with memory loss, forgetfulness, amnesia, memory impairment, and confusion. These symptoms typically resolve with discontinuation.
• May interact with several other medications including clarithromycin, colchicine, cyclosporine, gemfibrozil, other fibrates, niacin, and paroxetine.
• May be used in conjunction with bile acid resins, such as cholestyramine or colestipol. Pravastatin should be given at least one hour before or at least 4 hours after the resin.
• A lower dosage is recommended in people taking immunosuppressive agents such as cyclosporine. Begin with 10mg at bedtime and cautiously titrate to 20 mg/day. Higher dosages are not recommended.
• Do not take pravastatin during pregnancy, and women who are taking it should not breastfeed. If taken during pregnancy, pravastatin may interfere with the synthesis of steroids and cell membranes in the fetus.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Pravastatin is effective at lowering cholesterol; however, it may not be as effective as atorvastatin. Grapefruit products do not affect pravastatin to the same extent as atorvastatin.

5. Tips

• Take once daily, with or without food. May be taken at any time of the day (morning or night); however, it is best to be consistent with the time you take your tablets.
• The dosage of pravastatin needs to be individualized but initially should start at 40 mg/day and be guided by the results of cholesterol tests taken 4 weeks later. Take pravastatin exactly as directed by your doctor. Do not increase or decrease the dosage without his or her advice.
• Seek prompt medical advice if you have any acute muscle pain, tenderness, or weakness that persists after discontinuing pravastatin, particularly if accompanied by sickness or fever. Also report any unexplained fatigue, shortness of breath, unexplained cough, weight loss, abdominal pain, dark urine, or yellowing of the skin.
• Take once daily. Grapefruit juice has less of an effect on pravastatin compared to atorvastatin. May be taken with or without food.
• Pravastatin should be used alongside lifestyle measures to lower cholesterol. Adhere to the TLC diet, designed by the National Cholesterol Education Program (NCEP), or a similar diet, while taking pravastatin. Plan to exercise regularly and stop smoking if you smoke. Try to avoid second-hand smoke.
• The dosage needs to be individualized but initially should start low, depending on your age and pre-existing conditions, and be guided by the results of cholesterol tests taken at least 4 weeks later.
• Pravastatin should not be taken during pregnancy or while breastfeeding. Ensure you use effective contraception while taking pravastatin if you are a woman of childbearing age and talk to your doctor if you intend to become pregnant before you become pregnant.

6. Response and effectiveness

• Peak levels of pravastatin are seen within one to one and a half hours following administration; however, it may take one to two weeks of regular dosing before improvements in your cholesterol levels are seen, and up to four weeks before the maximal cholesterol-lowering effects of pravastatin are apparent.  
• Pravastatin is considered moderately potent at reducing LDL cholesterol.

7. Interactions

Medicines that interact with pravastatin may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with pravastatin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with pravastatin include:

• amiodarone
• antacids containing magnesium or aluminum
• antifungals, such as itraconazole, ketoconazole, posaconazole, or voriconazole
• bile acid sequestrants such as colestipol or cholestyramine
• carbamazepine
• cimetidine
• clopidogrel
• colchicine (may enhance adverse muscle effects)
• fusidic acid
• niacin
• other lipid-lowering drugs such as gemfibrozil and fenofibrate
• other strong CYP3A4 inhibitors, such as clarithromycin, cyclosporine, atazanavir, or ritonavir
• red yeast rice
• warfarin.

Taking erythromycin, cyclosporine, niacin, or fibrates with pravastatin increases the risk of myopathy.

Note that this list is not all-inclusive and includes only common medications that may interact with pravastatin. You should refer to the prescribing information for pravastatin for a complete list of interactions.

References

• Pravastatin. Revised: 03/2023. NorthStar RxLLC. https://www.drugs.com/pro/pravastatin.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use pravastatin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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