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]
Images: Related links to external sites (from Bing)
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 |
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 |