II. Indications
- See Hyperlipidemia Management for formal criteria
- See Statin
- Hyperlipidemia
- Primary of vascular disease progression (e.g. CAD, CVA, DM, CKD, PAD)
- Pravastatin is a preferred Statin if risk of significant Drug Interactions (no P450 metabolism)
III. Contraindications
- See Statin
- Drug Interactions
- Pregnancy (Teratogen)
- Acute Liver Failure or decompensated Cirrhosis
- Avoid Pravastatin if Creatinine Clearance <60 ml/min (relative contraindication)
- If used, start dosing at 10 mg and titrate slowly
IV. Mechanism
- See Statin
V. Efficacy
- See Statin
- Pravastatin 10 mg lowers LDL 19 to 22%
- Pravastatin 20 mg lowers LDL 24 to 29% (recommended starting dose)
- Pravastatin 40 mg lowers LDL 34%
- Pravastatin 80 mg lowers LDL 37 to 40%
VI. Adverse Effects
- See Statin
- See Statin-Induced Myopathy
VII. Safety
- Pregnancy Category X
- Contraindicated in Lactation
VIII. Pharmacokinetics
- See Statin
- Unlike other Statins, Pravastatin does not undergo first pass metabolism
- Pravastatin is only 50% Protein bound (unlike other Statins which are 90% Protein bound)
- Pravastatin is not metabolized by P450 system
- Safer to use in combination with other drugs
- Renal elimination occurs more with Pravastatin than other Statins
- Avoid Pravastatin if Creatinine Clearance <60 ml/min
- If Pravastatin is used, start dosing at 10 mg and titrate slowly
IX. Dosing: Adult
- Specific LDL and HDL targets have been replaced with high-intensity Statin if 10 year Cardiovascular Risk >20%
- Low intensity Statin (age >75 years, or Statin intolerant)
- Pravastatin 40 to 80 mg orally daily
- Start with 10 mg (or use other Statin) if Creatinine Clearance <60 ml/min
X. Dosing: Child
- Ages 8 to 13 years
- Pravastatin 20 mg orally daily
- Ages 14 to 18 years
- Pravastatin 40 mg orally daily
XI. Monitoring
XII. Drug Interactions (See Contraindications above)
- See Statin
- CYP3A4 Inhibitors
-
CYP3A4/organic anion transporting polypeptide inhibitors
- Cyclosporine (10-20 fold increase in Statin serum levels)
- Avoid with Pravastatin
- Cyclosporine (10-20 fold increase in Statin serum levels)
-
CYP2C9, CYP2C19/oragnic anion transporting polypeptide inhibitors
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- Avoid with Pravastatin
- Gemfibrozil (2-3 fold increase in Statin serum levels, >13 fold increase in Rhabdomyolysis risk)
- CYP3A4/CYP2C9 Inhibitor
- Other interactions
- Mibefradil (Posicor)
- Niacin
- Alcohol
- Increases risk of liver enzyme elevations
XIII. Resources
- See Statin
- Pravastatin (DailyMed)
XIV. References
- (2017) Presc Lett 24(11): 62
- (2012) Presc Lett 19(5): 25
- (2012) Presc Lett, Characteristics of Various Statins, #280502
- Carpenter (2019) Am Fam Physician 99(9):558-64 [PubMed]
- Chong (2001) Am J Med 111:390-400 [PubMed]
- Crouch (2001) Am Fam Physician 63(2):309-20 [PubMed]
- Gillett (2011) Am Fam Physician 83(6): 711-6 [PubMed]
- Jones (1998) Am J Cardiol 81:582-7 [PubMed]
- Sasaki (1998) Clin Ther 20:539-48 [PubMed]
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Related Studies
| pravastatin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PRAVASTATIN SODIUM 10 MG TAB | Generic | $0.07 each |
| PRAVASTATIN SODIUM 20 MG TAB | Generic | $0.06 each |
| PRAVASTATIN SODIUM 40 MG TAB | Generic | $0.08 each |
| PRAVASTATIN SODIUM 80 MG TAB | Generic | $0.17 each |