Pravastatin

Brand names

• Apo-Pravastatin
• Lin-Pravastatin
• Pravachol

Usage

To treat high cholesterol. Usually prescribed after first lines of treatment-including diet, weight loss, and exercise-fail to reduce total and low-density lipoprotein (LDL) cholesterol to acceptable levels. Also used as preventive medication in patients with known cardiovascular disease, with normal to high cholesterol.

How it works

Pravastatin blocks the action of an enzyme required for the manufacture of cholesterol, thereby interfering with its formation. By lowering the amount of cholesterol in the liver cells, pravastatin increases the formation of receptors for LDL, and thereby reduces blood levels of total and LDL cholesterol. In addition to lowering LDL cholesterol, pravastatin also modestly reduces triglyceride levels and raises HDL (the so-called good) cholesterol.

Side effects

Serious

Fever, unusual or unexplained muscle aches and tenderness. Seek medical help right away.

Common

Side effects occur in only 1 % to 2% of patients. These include constipation or diarrhea, dizziness, gas, headache, heartburn, nausea, skin rash, stomach pain, rise in liver enzymes (detectable by your doctor).

Less common

Insomnia.

Possible interactions

Other medicaments:

Pravastatin taken concurrently with:

• amprenavir (Agenerase) and ritonavir (Norvir) and perhaps other protease inhibitors may increase cerivastatin levels and the risk of muscle damage (myopathy).
• clofibrate (Atromid-S) has been associated with muscle damage (rhabdomyolysis).
• cyclosporine (Sandimmune) increases the risk for myopathy.
• erythromycin (various) may increase muscle damage risk.
• fluconazole (Diflucan) or itraconazole (Sporanox) or ketoconazole (Nizoral) will increase risk of myopathy. Extreme caution is advised.
• gemfibrozil (Lopid) may alter the absorption and excretion of pravastatin and may also increase risk of muscle damage (rhabdomyolysis); these medicaments should not be taken concurrently.
• niacin (various) increases muscle damage risk and may also increase homocysteine levels-a risk factor for heart disease.
• quinupristin/dalfopristin (Synercid) may increase the risk for myopathy by increasing cerivastatin blood levels.
• warfarin (Coumadin) can increase the risk of bleeding; more frequent INR (prothrombin time or protime) testing is indicated. Ongoing warfarin doses should be based on laboratory results.

The following medicament may decrease the effects of pravastatin:



• cholestyramine (Questran)-may reduce absorption of pravastatin; take pravastatin 1 hour before or 4 hours after cholestyramine.

Foods:

Follow a standard low-cholesterol diet.

Herbal medicines or minerals:

Garlic may inhibit blood-clotting (platelet) aggregation-something to consider if you are already taking a platelet inhibitor. The FDA has allowed one dietary supplement called Cholestin to continue to be sold. This preparation actually contains lovastatin. Since use of two HMG-CoA inhibitors may increase risk of rhabdomyolysis or myopathy, the combination is not advised.
Soy (milk, tofu, etc.) contains phytoestrogens, which has led to an FDA-approved health claim for reducing risk of heart disease (if there is at least 6.25 grains of soy protein per serving). Substituting soy for some of the meat in your diet can also help lower cholesterol. Because pravastatin can deplete co-enzyme Q10, supplementation may be needed.

Discontinuation:

Do not stop this medicament without your doctor's knowledge and help. There may be a significant increase in blood cholesterol levels following discontinuation of this medicament.