II. 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)

III. 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

IV. Mechanism

  1. See Statin

V. 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%

VI. Adverse Effects

VII. Safety

  1. Pregnancy Category X
  2. Contraindicated in Lactation

VIII. 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

IX. 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

X. 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

XI. Monitoring

  1. See Statin
  2. Liver transaminase testing (AST,ALT) is no longer routinely indicated as of March 2012

XII. 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

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Related Studies

Cost: Medications

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

Ontology: Pravastatin (C0085542)

Definition (NCI) A synthetic lipid-lowering agent. Pravastatin competitively inhibits hepatic hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase, the enzyme which catalyzes the conversion of HMG-CoA to mevalonate, a key step in cholesterol synthesis. Pravastatin lowers plasma cholesterol and lipoprotein levels, and modulates immune responses by suppressing MHC II (major histocompatibility complex II) on interferon gamma-stimulated, antigen-presenting cells such as human vascular endothelial cells. (NCI04)
Definition (NCI_NCI-GLOSS) The active ingredient in a drug used to lower the amount of cholesterol in the blood and to prevent stroke and heart attack. It is also being studied in the treatment of cancer and other conditions. Pravastatin blocks an enzyme that helps make cholesterol in the body. It may also make tumor cells more sensitive to anticancer drugs. It is a type of HMG-CoA reductase inhibitor, a type of statin, and a type of chemosensitizer.
Definition (MSH) An antilipemic fungal metabolite isolated from cultures of Nocardia autotrophica. It acts as a competitive inhibitor of HMG CoA reductase (HYDROXYMETHYLGLUTARYL COA REDUCTASES).
Definition (PDQ) A synthetic lipid-lowering agent. Pravastatin competitively inhibits hepatic hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase, the enzyme which catalyzes the conversion of HMG-CoA to mevalonate, a key step in cholesterol synthesis. Pravastatin lowers plasma cholesterol and lipoprotein levels, and modulates immune responses by suppressing MHC II (major histocompatibility complex II) on interferon gamma-stimulated, antigen-presenting cells such as human vascular endothelial cells. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=424450&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=424450&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29375" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017035
SnomedCT 96305006, 373566006
LNC LP171630-9
English Eptastatin, Pravastatin, 1-Naphthaleneheptanoic acid, 1,2,6,7,8,8a-hexahydro-beta,delta,6-trihydroxy-2-methyl-8-(2-methyl-1-oxobutoxy)-, (1S-(1alpha(betaS*,deltaS*),2alpha,6alpha,8beta(R*),8aalpha))-, HMG-CoA reductase inhibitors pravastatin, pravastatin (medication), Pravastatin [Chemical/Ingredient], [1S-[1alpha(betaS*,deltaS*),2alpha,6alpha,8beta(R*),8aalpha]]-1,2,6,7,8,8a-Hexahydro-beta,!d,6-trihydroxy-2-methyl-8-(2-methyl-1-oxobutoxy)-1-naphthaleneheptanoic Acid, pravastatin, PRAVASTATIN, Pravastatin (product), Pravastatin (substance), PRAV
Swedish Pravastatin
Czech eptastatin, pravastatin
Finnish Pravastatiini
Russian EPTASTATIN, PRAVASTATIN, ПРАВАСТАТИН, ЭПТАСТАТИН
Italian Eptastatina, Pravastatina
Polish Prawastatyna, Eptastatyna
Japanese エプタスタチン, プラバスタチン
Spanish pravastatina (producto), pravastatina (sustancia), pravastatina, pravastatin, Eptastatin, Pravastatina
French Eptastatine, Pravastatine
German Eptastatin, Pravastatin
Portuguese Eptastatina, Pravastatina