Pravastatin: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 29, 2019.
1. How it works
- Pravastatin may be used for the treatment of high cholesterol.
- 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.
- 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.
- Pravastatin is also used to lower the risk of coronary events (includes heart attack, stroke, 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.
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.
- 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 prior to starting therapy and at periodic intervals throughout therapy.
- May not be suitable in those with liver or kidney disease. May adversely affect endocrine function in some people.
- Rarely, has been associated with memory loss, forgetfulness, amnesia, memory impairment, and confusion. These symptoms typically resolve with discontinuation.
- May interact with a number of other medications including clarithromycin, colchicine, cyclosporine, gemfibrozil, other fibrates, niacin, and paroxetine.
Notes: 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. For a complete list of all side effects, click here.
- 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.
- 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.
- Dosage needs to be individualized but initially should start at 40mg/day 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 actually 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.
Medicines that interact with pravastatin may either decrease its effect, affect how long it works for, 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:
- antacids containing magnesium or aluminum
- antifungals, such as itraconazole, ketoconazole, posaconazole, or voriconazole
- bile acid sequestrants such as colestipol or cholestyramine
- colchicine (may enhance adverse muscle effects)
- fusidic acid
- other lipid-lowering drugs such as gemfibrozil and fenofibrate
- other strong CYP3A4 inhibitors, such as clarithromycin, cyclosporine, atazanavir or ritonavir
- red yeast rice
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.
- Pravastatin. Revised: 09/2019. Drugs.com https://www.drugs.com/ppa/pravastatin.html
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.
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