pravastatin
Brand: Pravachol
Prototype: atorvastatin
Drug Class: statin
Drug Family: antilipemic
Subclass: HMG-CoA reductase inhibitor (fermentation-derived)
Organ Systems: cardiovascular
Mechanism of Action
Hydrophilic statin; not metabolized by CYP450 (sulfation via cytosol sulfotransferase); fewest drug interactions of all statins; modest LDL reduction.
HMG-CoA reductase
Indications
- hyperlipidemia
- ASCVD prevention
- transplant patients (fewer drug interactions)
Contraindications
- active liver disease
- pregnancy
Adverse Effects
Common
- myalgia
- GI upset
Serious
- rhabdomyolysis (rare)
- hepatotoxicity
Pharmacokinetics (ADME)
| Absorption | 17-34% oral bioavailability |
| Distribution | low (hydrophilic) |
| Metabolism | NOT CYP450 — cytosolic sulfation |
| Excretion | renal 20%, fecal 70% |
| Half-life | 1.3-2.7 hours |
| Onset | bedtime preferred |
| Peak | 1-1.5 hours |
| Duration | 24 hours |
| Protein Binding | 43-54% |
| Vd | low |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| cyclosporine | increases pravastatin levels via OATP1B1 | major |
| gemfibrozil | modest interaction — safer than others | moderate |
Nursing Considerations
- Fewest drug interactions (no CYP450 metabolism)
- Preferred in transplant patients on cyclosporine (lower interaction magnitude vs other statins)
- Moderate LDL lowering only
- CARE and LIPID trials: secondary prevention benefit
Clinical Pearls
- Only statin not metabolized by CYP450 — preferred in complex polypharmacy
- Hydrophilic — theoretically less muscle side effects
- Moderate intensity: 40-80 mg
Safety Profile
Pregnancy contraindicated
Lactation contraindicated
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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