What is pravastatin, and how does it work (mechanism of action)?
Pravastatin is an oral drug for lowering the
cholesterol in the blood that contributes to the formation of plaques in the
walls of arteries that obstruct the flow of blood, known as arteriosclerotic
vascular disease. Obstruction of the flow of blood to the heart causes
heart
attacks. Obstruction of flow to the brain causes
strokes. Pravastatin has been
shown to reduce the occurrence of heart attacks, strokes and death caused by
arteriosclerotic vascular disease. It belongs to a class of drugs called HMG-CoA
reductase inhibitors, commonly called "statins." Other statins include
simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor), rosuvastatin
(Crestor) and fluvastatin (Lescol). Statins reduce cholesterol by inhibiting an
enzyme in the liver (HMG-CoA reductase) that is necessary for the production of
cholesterol. In the blood, statins lower total and LDL ("bad") cholesterol as
well as triglycerides. LDL cholesterol is believed to be an important cause of
arteriosclerotic vascular disease. Lowering LDL cholesterol levels slows
progression or reduces the size of cholesterol-containing plaques in the
arteries of the heart and brain as well as other tissues. Statins also increase
HDL ("good") cholesterol, and higher levels of HDL cholesterol are associated
with reduced arteriosclerotic vascular disease. Raising HDL cholesterol levels
may slow the progression of arteriosclerotic vascular disease.
Scientists have discovered that inflammation of the coronary arteries also
may contribute to arteriosclerotic vascular disease. Inflammation is associated
with elevated levels of a protein called C-reactive protein in the blood. This
C-reactive protein can be measured by a test, referred to as the
"highly-sensitive" C-reactive protein test (Hs-CRP). Elevated levels of Hs-CRP
predict the occurrence of heart attacks, strokes, and death. In fact, Hs-CRP is
a better predictor of heart attacks, strokes, and death than cholesterol levels.
Statins reduce the levels of Hs-CRP, and it has been suggested that statins may
reduce arteriosclerotic vascular disease by reducing inflammation in addition to
lowering levels of cholesterol. Pravastatin was approved by the FDA in October
1991.
What brand names are available for pravastatin?
Pravachol, Pravigard PAC (discontinued)
Is pravastatin available as a generic drug?
Yes
Do I need a prescription for pravastatin?
Yes
What are the side effects of pravastatin?
Like most statins, the most common side effects of
pravastatin are:
The most serious potential side effects are liver damage and muscle
inflammation or breakdown. Serious liver damage with statins is rare, however.
More often, statins cause abnormalities of liver tests. Abnormal tests usually
return to normal even if a statin is continued, but if the abnormal test is
greater than three times the upper limit of normal, the statin usually is
stopped. Liver tests should be measured before therapy is started and whenever
there is a medical concern.
Inflammation of the muscles caused by statins can
lead to a serious breakdown of muscle cells called rhabdomyolysis. When used
alone, statins cause rhabdomyolysis in less than one percent of patients.
Rhabdomyolysis causes the release of proteins from muscle (myoglobin) into the
blood. Myoglobin can cause kidney failure and even death. To prevent the
development of rhabdomyolysis, patients taking statins, including pravastatin,
should contact their health care professional immediately if they develop
unexplained muscle pain, weakness, or tenderness.
Since pravastatin prevents
heart attacks, strokes and death, its benefit usually outweighs its serious but
rare side effects. Other important side effects include post-marketing reports such as:
- memory loss,
- forgetfulness,
- amnesia,
- confusion, and
- memory impairment.
Symptoms may start one
day to years after starting treatment and resolve within a median of three weeks
after stopping the statin.
What is the dosage for pravastatin?
The dose range of pravastatin is 10-80 mg daily. The usual
starting dose in adults is 40 mg once daily. The maximum dose is 80 mg per day.
The starting dose for patients with major liver or kidney dysfunction is 10 mg
daily.
The dose for children (8-13 years old) is 20 mg daily, and the dose for
adolescents (14-18 years old) is 40 mg daily.
Which drugs or supplements interact with pravastatin?
Bile acid sequestrants such as cholestyramine (Questran)
may reduce the absorption of pravastatin from the intestine and thereby reduce
its effects. Therefore, pravastatin should be taken one hour before or four
hours after bile acid sequestrants. The use of pravastatin with nicotinic acid,
gemfibrozil (Lopid) or other drugs that cause liver or muscle problems may
increase the risk of muscle problems.
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Is pravastatin safe to take if I’m pregnant or breastfeeding?
Statins should not be used by
pregnant women because they
impair fetal development.
A small amount of pravastatin is excreted in
breast
milk. Because of the risk of toxicity to the infant, nursing mothers should not
nurse while taking pravastatin.
What else should I know about pravastatin?
What preparations of pravastatin are available?
Tablets: 10, 20, 40, and 80 mg
How should I keep pravastatin stored?
Pravastatin
should be stored at room temperature, between 15-30 C (58-86 F).