Pharm

Pravastatin

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Pravastatin, Pravachol

  • See Also
  1. Hyperlipidemia
  2. Statin
  3. Statin-Induced Myopathy
  4. Atorvastatin
  5. Rosuvastatin
  6. Simvastatin
  7. Fluvastatin
  8. Lovastatin
  9. Pitavastatin
  • Indications
  1. See Hyperlipidemia Management for formal criteria
  2. See Statin
  3. Hyperlipidemia
  4. Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
  5. Pravastatin is a preferred Statin if risk of significant Drug Interactions (no P450 metabolism)
  • Contraindications
  1. See Statin
  2. Drug Interactions
    1. See Statin regarding Myopathy and hepatitis risk
  3. Pregnancy (Teratogen)
  4. Acute Liver Failure or decompensated Cirrhosis
  5. Avoid Pravastatin if Creatinine Clearance <60 ml/min (relative contraindication)
    1. If used, start dosing at 10 mg and titrate slowly
  • Mechanism
  1. See Statin
  • Efficacy
  1. See Statin
  2. Pravastatin 10 mg lowers LDL 19 to 22%
  3. Pravastatin 20 mg lowers LDL 24 to 29% (recommended starting dose)
  4. Pravastatin 40 mg lowers LDL 34%
  5. Pravastatin 80 mg lowers LDL 37 to 40%
  • Adverse Effects
  1. See Statin
  2. See Statin-Induced Myopathy
  • Safety
  1. Pregnancy Category X
  2. Contraindicated in Lactation
  • Pharmacokinetics
  1. See Statin
  2. Unlike other Statins, Pravastatin does not undergo first pass metabolism
  3. Pravastatin is only 50% Protein bound (unlike other Statins which are 90% Protein bound)
  4. Pravastatin is not metabolized by P450 system
    1. Safer to use in combination with other drugs
  5. Renal elimination occurs more with Pravastatin than other Statins
    1. Avoid Pravastatin if Creatinine Clearance <60 ml/min
    2. If Pravastatin is used, start dosing at 10 mg and titrate slowly
  • Dosing
  • Adult
  1. Specific LDL and HDL targets have been replaced with high-intensity Statin if 10 year Cardiovascular Risk >20%
  2. Low intensity Statin (age >75 years, or Statin intolerant)
    1. Pravastatin 40 to 80 mg orally daily
    2. Start with 10 mg (or use other Statin) if Creatinine Clearance <60 ml/min
  • Dosing
  • Child
  1. Ages 8 to 13 years
    1. Pravastatin 20 mg orally daily
  2. Ages 14 to 18 years
    1. Pravastatin 40 mg orally daily
  • Monitoring
  1. See Statin
  2. Liver transaminase testing (AST,ALT) is no longer routinely indicated as of March 2012
  • Drug Interactions (See Contraindications above)
  1. See Statin
  2. CYP3A4 Inhibitors
  3. CYP3A4/organic anion transporting polypeptide inhibitors
    1. Cyclosporine (10-20 fold increase in Statin serum levels)
      1. Avoid with Pravastatin
  4. CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
    1. Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
      1. Avoid with Pravastatin
  5. CYP3A4/CYP2C9 Inhibitor
    1. Warfarin (Increased INR and bleeding risk)
      1. Lower risk with Pravastatin (compared with other Statins)
  6. Other interactions
    1. Mibefradil (Posicor)
    2. Niacin
    3. Alcohol
      1. Increases risk of liver enzyme elevations
  • Resources
  1. See Statin
  2. Pravastatin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=dcf45e4f-b46e-6fbb-b67a-2ff619ab1780
  • References
  1. (2017) Presc Lett 24(11): 62
  2. (2012) Presc Lett 19(5): 25
  3. (2012) Presc Lett, Characteristics of Various Statins, #280502
  4. Carpenter (2019) Am Fam Physician 99(9):558-64 [PubMed]
  5. Chong (2001) Am J Med 111:390-400 [PubMed]
  6. Crouch (2001) Am Fam Physician 63(2):309-20 [PubMed]
  7. Gillett (2011) Am Fam Physician 83(6): 711-6 [PubMed]
  8. Jones (1998) Am J Cardiol 81:582-7 [PubMed]
  9. Sasaki (1998) Clin Ther 20:539-48 [PubMed]