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Pravastatin Disease Interactions

There are 6 disease interactions with pravastatin.

Major

HMG-CoA reductase inhibitors (applies to pravastatin) liver disease

Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism

The use of HMG-CoA reductase inhibitors is contraindicated in patients with active liver disease or unexplained, persistent elevations of serum transaminases. HMG-CoA reductase inhibitors are extensively metabolized by the liver. Decreased drug metabolism may lead to accumulation and increased risk of toxicity, including biochemical abnormalities of liver function and, rarely, jaundice, hepatitis, cirrhosis, fatty change in the liver, and fulminant hepatic necrosis. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. A lower initial dosage may be appropriate, and clinical monitoring of liver transaminase levels according to the individual product package labeling is recommended. Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, consideration should be given to a reduction in dosage or withdrawal of therapy.

References

  1. Wang-Iverson D, DeValut AR, Pan HY, et al. "Comparative pharmacokinetics and pharmacodynamics of pravastatin and lovastatin." J Clin Pharmacol 30 (1990): 1128-35
  2. Arnon R, Eisenberg S "Lovastatin-induced hepatitis." Isr J Med Sci 28 (1992): 101-2
  3. Mauro VF "Clinical pharmacokinetics and practical applications of simvastatin." Clin Pharmacokinet 24 (1993): 195-202
  4. MacDonald JL, Mauro VF "Simvastatin: a review of its pharmacology and clinical use." DICP 25 (1991): 257-64
  5. Bayne WF, Chen IW, Duncan CA, Duggan DE, Halpin RA, Schwartz MS, Stubbs RJ, Vickers S "The physiological disposition of lovastatin." Drug Metab Dispos 17 (1989): 166-73
  6. Amin RD, Saraheimo M, Brunner-Ferber F, Pentikainen PJ, Schwartz JI, Schwartz MS, Rogers JD "Comparative pharmacokinetics of lovastatin, simvastatin and pravastatin in humans." J Clin Pharmacol 32 (1992): 136-40
  7. Chando TJ, Didonato GC, Everett DW, Pan HY, Singhvi SM, Weinstein SH "Biotransformation of pravastatin sodium in humans." Drug Metab Dispos 19 (1991): 740-8
  8. Walker JF "Simvastatin: the clinical profile." Am J Med 87 (1989): s44-6
  9. Simons LA "Simvastatin in severe primary hypercholesterolemia: efficacy, safety, and tolerability in 595 patients over 18 weeks. The Principal Investigators." Clin Cardiol 16 (1993): 317-22
  10. McGovern ME, Mellies MJ "Long-term experience with pravastatin in clinical research trials." Clin Ther 15 (1993): 57-64
  11. "Lovastatin 5-year safety and efficacy study. Lovastatin Study Groups I through IV." Arch Intern Med 153 (1993): 1079-87
  12. Geddes JA "Cholestatic jaundice associated with lovastatin (mevacor) therapy." Can Med Assoc J 143 (1990): 13-4
  13. McQueen MJ "Cholestatic jaundice associated with lovastatin (Mevacor) therapy." Can Med Assoc J 142 (1990): 841-2
  14. Bilheimer DW "Long-term clinical tolerance of lovastatin and simvastatin." Cardiology 77 (1990): 58-65
  15. Frantz BM, Waclawski AP, Willard DA, Morrison RA, Pan HY, Singhvi SM "Disposition of pravastatin sodium (SQ 31,000), a tissue-selective HMG-CoA reductase inhibitor, in healthy subjects." Clin Res 36 (1988): a368
  16. "Product Information. Mevacor (lovastatin)." Merck & Company Inc (2002):
  17. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  18. "Product Information. Zocor (simvastatin)." Merck & Company Inc (2001):
  19. Fattu JM, Troendle AJ, Levy RI "A quarter century of drug treatment of dyslipoproteinemia, with a focus on the new HMG-CoA reductase inhibitor fluvastatin." Circulation 87 (1993): i45-53
  20. Fu E, Dain JG, Gorski J, Nicoletti J, Scallen TJ "Biotransformation of fluvastatin sodium in humans." Drug Metab Dispos 21 (1993): 567-72
  21. Tse FL, Troendle A, Jaffe JM "Pharmacokinetics of fluvastatin after single and multiple doses in normal volunteers." J Clin Pharmacol 32 (1992): 630-8
  22. "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals (2001):
  23. Kari PH, Ulm EH, Vyas KP, Duggan DE, Halpin RA, Hunninghake DB, Till AE "Biotransformation of lovastatin .5. species differences in invivo metabolite profiles of mouse, rat, dog, and human." Drug Metab Dispos 21 (1993): 1003-11
  24. Jokubaitis LA "Updated clinical safety experience with fluvastatin." Am J Cardiol 73 (1994): d18-24
  25. Davidson MH, on behalf of the FLUENT Investigators Group "Fluvastatin long-term extension trial (FLUENT): summary of efficacy and safety." Am J Med 96 Suppl (1994): 96 (suppl)
  26. Quion JAV, Jones PH "Clinical pharmacokinetics of pravastatin." Clin Pharmacokinet 27 (1994): 94-103
  27. Degott C, Pessayre D, Benhamou JP, Grimbert S "Acute hepatitis induced by HMG-coa reductase inhibitor, lovastatin." Dig Dis Sci 39 (1994): 2032-3
  28. Erkelens DW, Debruin TW, Schobben F, Sitsen A, Smit JW, Wijnne HJ "Effects of alcohol and fluvastatin on lipid metabolism and hepatic function." Ann Intern Med 122 (1995): 678-80
  29. Erkelens DW, Debruin TWA, Schobben F, Sitsen A, Smit JWA, Wijnne HJA "Effects of alcohol consumption on pharmacokinetics, efficacy, and safety of fluvastatin." Am J Cardiol 76 (1995): a89-96
  30. Black DM, Bakker-Arkema RG, Isaacsohn JL, Keilson LM, Miller VT, Brown WV, Davidson MH, Davignon J, Goldstein RJ, Shurzinske LJ, Weiss SR "Efficacy and safety of a new HMG-CoA reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia." JAMA 275 (1996): 128-33
  31. "Product Information. Lipitor (atorvastatin)." Parke-Davis (2001):
  32. Angerbauer R, Fey P, Karl W, Boberg M, Kanhai WK, Kern A, Ploschke J, Radtke M "Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P45 isozymes involved." Drug Metab Dispos 25 (1997): 321-31
  33. "Product Information. Baycol (cerivastatin)." Bayer (2001):
  34. Cilla DD Jr, Gibson DM, Posvar EL, Whitfield LR, Sedman AJ "Multiple-dose pharmacokinetics, pharmacodynamics, and safety of atorvastatin, an inhibitor of HMG-CoA reductase, in healthy subjects." Clin Pharmacol Ther 60 (1996): 687-95
  35. McTavish D, Lea AP "Atorvastatin. A review of its pharmacology and therapeutic potential in the management of hyperlipidaemias." Drugs 53 (1997): 828-47
  36. Cilla DD Jr, Gibson DM, Whitfield LR, Sedman AJ "Pharmacodynamic effects and pharmacokinetics of atorvastatin after administration to normocholesterolemic subjects in the morning an evening." J Clin Pharmacol 36 (1996): 604-9
  37. Cilla DD Jr, Posvar EL, Whitfield LR, Radulovic LL, Sedman AJ "Tolerance and pharmacokinetics of single-dose atorvastatin, a potent inhibitor of HMG-CoA reductase, in healthy subjects." J Clin Pharmacol 36 (1996): 728-31
  38. Fager G, Lennernas H "Pharmacodynamics and pharmacokinetics of the HMG-CoA reductase inhibitors. Similarities and differences." Clin Pharmacokinet 32 (1997): 403-25
  39. Ahr G, Unger S, Kawano K, Muck W "Inter-ethnic comparisons of the pharmacokinetics of the HMG-CoA reductase inhibitor cerivastatin." Br J Clin Pharmacol 45 (1998): 583-90
  40. Hartleb M, Rymarczyk G, Januszewski K "Acute cholestatic hepatitis associated with pravastatin." Am J Gastroenterol 94 (1999): 1388-90
  41. Bataille L, Horsmans Y, Nakad A, Sempoux C, Hamoir V "Atorvastatin-induced acute hepatitis with absence of cross-toxicity with simvastatin." Lancet 353 (1999): 1763-4
  42. "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic) (2010):
View all 42 references
Major

HMG-CoA reductase inhibitors (applies to pravastatin) rhabdomyolysis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Myopathy, Myoneural Disorder, Renal Dysfunction, Hypothyroidism

Severe myopathy, including rhabdomyolysis with acute renal failure secondary to myoglobinuria, has been reported rarely with the use of HMG-CoA reductase inhibitors. The myopathy may be dose-related and is characterized by muscle aches and/or weakness in conjunction with increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.

References

  1. Hartung H-P, Toyka K, Schalke BB, Schmidt B "Pravastatin-associated inflammatory myopathy." N Engl J Med 327 (1992): 649-50
  2. Pierce LR, Gross TP, Wysowski DK "Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy." JAMA 264 (1990): 71-5
  3. Walker JF "Simvastatin: the clinical profile." Am J Med 87 (1989): s44-6
  4. Simons LA "Simvastatin in severe primary hypercholesterolemia: efficacy, safety, and tolerability in 595 patients over 18 weeks. The Principal Investigators." Clin Cardiol 16 (1993): 317-22
  5. McGovern ME, Mellies MJ "Long-term experience with pravastatin in clinical research trials." Clin Ther 15 (1993): 57-64
  6. Witztum JL, Reaven P "Lovastatin, nicotinic acid, and rhabdomyolysis." Ann Intern Med 109 (1988): 597-8
  7. "Lovastatin 5-year safety and efficacy study. Lovastatin Study Groups I through IV." Arch Intern Med 153 (1993): 1079-87
  8. Corpier CL, Suki WN, Jones PH, et al. "Rhabdomyolysis and renal injury with lovastatin use. Report of two cases in cardiac transplant recipients." JAMA 260 (1988): 239-41
  9. Alivizatos PA, East C, Farmer JA, Grundy SM, Jones PH "Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation." N Engl J Med 318 (1988): 47-8
  10. Munson J, Illingworth DR, Hosenpud J, Norman DJ "Myolysis and acute renal failure in a heart-transplant recipient receiving lovastatin." N Engl J Med 318 (1988): 46-7
  11. Mueller BA, Wallace CS "Lovastatin-induced rhabdomyolysis in the absence of concomitant drugs." Ann Pharmacother 26 (1992): 190-2
  12. Bilheimer DW "Long-term clinical tolerance of lovastatin and simvastatin." Cardiology 77 (1990): 58-65
  13. "Product Information. Mevacor (lovastatin)." Merck & Company Inc (2002):
  14. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  15. "Product Information. Zocor (simvastatin)." Merck & Company Inc (2001):
  16. Abadia R, Agnus D, Chariot P, Charpentier C, Gherardi RK, Danan C "Simvastatin-induced rhabdomyolysis followed by a MELAS syndrome." Am J Med 94 (1993): 109-10
  17. McDonagh J, Winocour P, Walker DJ "Musculoskeletal manifestations during simvastatin therapy." Br J Rheumatol 32 (1993): 647-8
  18. Fattu JM, Troendle AJ, Levy RI "A quarter century of drug treatment of dyslipoproteinemia, with a focus on the new HMG-CoA reductase inhibitor fluvastatin." Circulation 87 (1993): i45-53
  19. "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals (2001):
  20. Fernandezzatarain G, Villatoro J, Calvo C, Garcia H, Navarro V "Rhabdomyolysis and acute renal failure associated with lovastatin." Nephron 66 (1994): 483-4
  21. Jokubaitis LA "Updated clinical safety experience with fluvastatin." Am J Cardiol 73 (1994): d18-24
  22. Lees AM, Lees RS "Rhabdomyolysis from the coadministration of lovastatin and the antifungal agent itraconazole." N Engl J Med 333 (1995): 664-5
  23. Ahmand S "Lovastatin-induced myopathy in a hypothyroid patient." J Fam Pract 41 (1995): 227-8
  24. Cook TJ, Miettinen T, Haghfelt T, Pyorala K, Thorgeirsso, Kjekshus J, Berg K, Faergeman O, Musliner TA, Olsson AG, Pedersen TR "Safety and tolerability of cholesterol lowering with simvastatin during 5 years in the scandinavian simvastatin survival study." Arch Intern Med 156 (1996): 2085-92
  25. Black DM, Bakker-Arkema RG, Isaacsohn JL, Keilson LM, Miller VT, Brown WV, Davidson MH, Davignon J, Goldstein RJ, Shurzinske LJ, Weiss SR "Efficacy and safety of a new HMG-CoA reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia." JAMA 275 (1996): 128-33
  26. "Product Information. Lipitor (atorvastatin)." Parke-Davis (2001):
  27. Dubufvereijken PWG, Spooren PFMJ, Vandoormaal JJ, Vanpuijenbroek EP "Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil." J Intern Med 240 (1996): 403-4
  28. "Product Information. Baycol (cerivastatin)." Bayer (2001):
  29. Fisher KA, Grunden JW "Lovastatin-induced rhabdomyolysis possibly associated with clarithromycin and azithromycin." Ann Pharmacother 31 (1997): 859-63
  30. Iliadis EA, Rosenson RS "Long-term safety of pravastatin-gemfibrozil therapy in mixed hyperlipidemia." Clin Cardiol 22 (1999): 25-8
  31. van Puijenbroek EP, Du Buf-Vereijken PW, Spooren PF, van Doormaal JJ "Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil." J Intern Med 240 (1996): 403-4
  32. Alvarez JM, Goldstein J, Rawdanowiz TJ "Rhadbdomyolysis after coronary artery bypass grafting in a patient receiving simvastatin." J Thorac Cardiovasc Surg 116 (1998): 654-5
  33. Kindred LH, Pogson GW, Carper BG "Rhabdomyolysis and renal failure associated with cerivastatin-gemfibrozil combination therapy." Am J Cardiol 83 (1999): 1146
  34. "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc (2003):
  35. "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic) (2010):
View all 35 references
Major

Pravastatin (applies to pravastatin) renal dysfunction

Major Potential Hazard, Moderate plausibility.

Pravastatin is partially eliminated by the kidney. Drug and/or metabolite accumulation may occur in patients with significant renal impairment, which may increase the risk of adverse effects, including hepatic and musculoskeletal toxicities. Therapy with pravastatin should be administered cautiously in patients with severely impaired renal function. A lower initial dosage may be appropriate, accompanied by close clinical monitoring.

References

  1. Wang-Iverson D, DeValut AR, Pan HY, et al. "Comparative pharmacokinetics and pharmacodynamics of pravastatin and lovastatin." J Clin Pharmacol 30 (1990): 1128-35
  2. DeVault A, Pan H, Shapiro B, Halstenson CE, Keane W, Triscari J "Single-dose pharmacokinetics of pravastatin and metabolites in patients with renal impairment." J Clin Pharmacol 32 (1992): 124-32
  3. Frantz BM, Waclawski AP, Willard DA, Morrison RA, Pan HY, Singhvi SM "Disposition of pravastatin sodium (SQ 31,000), a tissue-selective HMG-CoA reductase inhibitor, in healthy subjects." Clin Res 36 (1988): a368
  4. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  5. Quion JAV, Jones PH "Clinical pharmacokinetics of pravastatin." Clin Pharmacokinet 27 (1994): 94-103
  6. Fager G, Lennernas H "Pharmacodynamics and pharmacokinetics of the HMG-CoA reductase inhibitors. Similarities and differences." Clin Pharmacokinet 32 (1997): 403-25
  7. Kjartansdottir T, Johannsson M, Sigurbjornsson S, Kristinsson J, Sigurdsson G "A pharmacokinetic evaluation of pravastatin in middle-aged and elderly volunteers." Eur J Drug Metab Pharmacokinet 23 (1998): 13-8
View all 7 references
Moderate

HMG-CoA reductase inhibitors (applies to pravastatin) cognitive impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder

Cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) have been observed in patients receiving statins. The reports are usually not serious, and reversible upon statin discontinuation. Caution is recommended when using these agents in patients with cognitive impairment.

References

  1. "Product Information. Mevacor (lovastatin)." Merck & Company Inc (2002):
  2. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  3. "Product Information. Zocor (simvastatin)." Merck & Company Inc (2001):
  4. "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals (2001):
  5. "Product Information. Lipitor (atorvastatin)." Parke-Davis (2001):
  6. "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc (2003):
View all 6 references
Moderate

HMG-CoA reductase inhibitors (applies to pravastatin) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Increases in HbA1c and fasting serum glucose levels have been reported with the use of certain HMG-CoA reductase inhibitors. Caution should be exercised when using these agents in diabetic patients and close monitoring is recommended.

References

  1. "Product Information. Mevacor (lovastatin)." Merck & Company Inc (2002):
  2. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  3. "Product Information. Zocor (simvastatin)." Merck & Company Inc (2001):
  4. "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals (2001):
  5. "Product Information. Lipitor (atorvastatin)." Parke-Davis (2001):
  6. "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc (2003):
  7. "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic) (2010):
View all 7 references
Moderate

HMG-CoA reductase inhibitors (applies to pravastatin) renal disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Some HMG-CoA reductase inhibitors such as fluvastatin, have not been studied in patients with severe renal impairment or end-stage renal disease. Some others such as pitavastatin and simvastatin, require a dose reduction when used in this group of patients. Caution and close monitoring is advised when using these drugs in patients with renal impairment.

References

  1. "Product Information. Mevacor (lovastatin)." Merck & Company Inc (2002):
  2. "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb (2001):
  3. "Product Information. Zocor (simvastatin)." Merck & Company Inc (2001):
  4. "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals (2001):
  5. "Product Information. Lipitor (atorvastatin)." Parke-Davis (2001):
  6. "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc (2003):
  7. "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic) (2010):
View all 7 references

Pravastatin drug interactions

There are 157 drug interactions with pravastatin.

Pravastatin alcohol/food interactions

There is 1 alcohol/food interaction with pravastatin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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