Pravastatin: uses, side effects, dosage, interactions and cost

Pravastatin is a prescription-only generic drug (FDA approved) that belongs to statins family, medically called HMG CoA reductase inhibitors.. It comes in tablet form and with diet and physical exercises, it is mainly used to lower the bad cholesterol levels (LDL) in order to prevent stroke or heart attack. The commercial name of Pravastatin is PRAVACHOL® (no longer on the market).

What is Pravastatin used for?

Pravastatin oral tablet is mainly prescribed for the following uses:

• In adults, to lower high cholesterol levels blood, when diet and physical exercise are not enough to reach the result.
• In children, to treat hypercholesterolemia caused by an inherited condition called Heterozygous familial.
• To prevent heart and vascular disorders.
• To reduce the risk of a second heart attack or stroke in patients who already had these problems before or suffer from unstable angina.
• To reduce fat levels in patients who had organs transplant and are taking immunosuppressive drugs to avoid rejection.

How does Pravastatin work?

Pravastatin SODIUM reduces LDL levels in the bloodstream in two different ways.

1. First, it inhibits enzymes CYP3A4 that are crucial in the production of cholesterol by the liver. In this way, the liver itself is not able to produce excess quantity of bad cholesterol (LDL).
2. Second, it increases the ability of HDL to capture LDL and transport it to the liver for disposal.

Also, Pravastatin works differently from other statins in terms of absorption. In fact, most of Pravastatin oral tablet is metabolized in the stomach and not in the liver as for example Atorvastatin. This is why Pravastatin may interact with less drugs than other drugs of the same family or group.

Pravastatin reduces the production of VLDL (Very-Low-Density Lipoprotein). This lipoprotein type has more triglycerides than cholesterol if compared to LDL.

In summary, Pravastatin works by lowering both LDL and VLDL.

You should always remember that to lower cholesterol, medicines are just part of the therapy. In fact, patients should also change their lifestyle adding physical exercise and movement to the daily routine and, last but not least, following a healthier low-fat diet. This is especially true if you don’t want to depend on medicines all your life.

How long does it take for Pravastatin to work?

Pravastatin starts to work immediately as you take it and the power pick is reached 60 to 90 minutes after you take the tablet. However, that doesn’t mean your cholesterol drops as fast.

If you take Pravastatin as prescribed, it usually takes one to two weeks to show some result.

After up to 4 weeks, Pravastatin’s cholesterol-lowering effect peaks and continues as long as you take it.

How do I know if Pravastatin is working?

Before to start any statin therapy, take blood test to know exactly your cholesterol and triglyceride levels. After a month, you will redo the blood exam to compare your blood fat levels to the previous ones. Every month or so, you will undergo the same blood test to see if Pravastatin is doing its job. The blood test tells your doctor if the drug dosage is OK or he has to adjust it.

Lipid panel is the name of the blood test for cholesterol.

Checking your cholesterol levels at regular base is the key to keep the blood fat under control.

Blood tests apart, there are other exams you can undergo to check whether your liver and kidneys are working properly or not.

• Liver function tests: these tests check for liver damage or disease. Some of them evaluate how well the liver is working producing enzymes proteins and disposing waste product of the blood. If the liver is not working properly, the doctor has to lower the Pravastatin dosage.
• Kidney function tests: imaging tests, kidney biopsy, urine tests.

It is very important to monitor the cholesterol in the blood, kidney and liver functions while on statin. If you miss follow-ups the consequences for your health could be very serious or even irreversible.

Form and strengths

The information below refers to Pravastatin-containing products available in the United States.

You can find Pravastatin in form of oral tablet in the following strengths: 10 mg, 20 mg, 40 mg, 80 mg.

You cannot buy this statin as over-the-counter medicine. The only way you can have it is by medical prescription.

Pravastatin dosage

Your doctor will prescribe you the right drug dose which is based on your age, condition to treat, its severity and your overall health status.

Also, the drug quantity can be adjusted along the way depending on how you react to the first dose.

Adult dosage

Pravastatin dosage for adult people is the following:

• To treat high cholesterol levels in the blood. The common Pravastatin dose can range from 10 to 40 mg to be taken once daily, preferably in the evening.
• To prevent heart and vascular disorders. The usually prescribed dose is 40 mg in one shot better before to go to sleep.
• After an organ transplant to reduce blood fat levels. The starting dose is 20 mg of Pravastatin oral tablet in a single daily dose. If necessary, the doctor may increase the administered dose up to a maximum of 40 mg per day.

Children and adolescents (teenagers) dosage

Children and teenagers (8 to 18 years) with an inherited disorder called familial hypercholesterolemia that raises their blood cholesterol levels can also take Pravastatin at the following doses.

• Adolescents aged between 14 and 18 years. The dose usually used can vary from 10 to 40 mg of Pravastatin once a day.
• Children aged between 8 and 13 years. The usual dose is 10-20 mg of Pravastatin daily.
• Children age 0–7 years. So far there are not yet enough studies about Pravastatin usage in 8 years old children or younger. We highly recommend that you seek the advice of more than one specialist before giving statins to a child in this age group.

Dosage for the elderly (65 years and older)

After the age of 65 our body changes considerably. Metabolism slows down as well as recovery and healing times. In particular, the kidneys of older people may not work as before.

The kidneys work slowdown results in a longer stay of the medicine in the body as it is not disposed of quickly as it happens in younger people.

Usually, the initial dosage of Pravastatin for elderly is 10mg. Such a low dose avoids the risk of large amounts of drug accumulating in the body causing even more side effects.

CAUTION: You should NEVER exceed the maximum daily dose of 40 mg of Pravastatin.

Please, notice that this paragraph reports the most common Pravastatin dosages but not all.

How and when to take Pravastatin?

You should take Pravachol exactly as prescribed by your doctor.

You can take Pravastatin once a day swallowing the tablet whole with a half glass of water. Do not chew or break the tablet. If you have trouble swallowing drugs, ask your doctor for advice.

The right time to take Pravastatin SODIUM to lower cholesterol is before to go to sleep. In fact, the evening is the time of day when the liver produces most of cholesterol.

Pravachol does not upset the stomach so you can take it even on an empty stomach.

Do not take the drug after the expiration date.

Effectiveness

Based on several cardiology reports, Pravastatin oral tablet is an effective cholesterol-lowering medication. However, it may not be as effective as other statins like Atorvastatin.

A recent study found out that:

Doses of 20 mg/d lovastatin or Pravastatin or 10 mg/d Simvastatin generally reduce plasma LDL cholesterol levels by about 20% to 30%. Higher doses of these drugs can reduce LDL cholesterol levels by as much as 40%. Treatment with HMG-CoA reductase inhibitors also produces increases of about 5% to 10% in plasma HDL cholesterol and reductions of about 10% to 20% in triglycerides.

ahajournals.org

What are the Pravastatin side effects?

Many people who need to lower their cholesterol with statins worry because of Pravastatin side effects.

Let’s dispel some false myths.

Worldwide stats show that less than 10% of people on statin suffer because of mild symptoms caused by this type of drugs.

1 in 1,000 people assuming Pravastatin may have severe to dangerous side effect.

Most common Pravastatin side effects

• Muscle weakness.
• Joint pain.
• Headache.
• Dizziness.
• Sleep disorders.
• Digestive issues, abdominal pain.
• Heartburn.
• Nausea and/or vomiting.
• Constipation or diarrhea.
• Bloating.
• Skin disorders such as: rashes, itching, hives, hair loss and scalp changes.
• Fatigability (easy to get tired).
• Sexual dysfunctions.
• Generally feeling unwell (because of: runny nose, congestion, sore throat, low-grade fever and Cough).

Severe side effects of Pravastatin

The most serious problem that come out taking statins are related to muscles and liver.

Muscle issues. Pravastatin side effects that affect the muscle usually show up in two different variants. The difference in between them is the pain level. The mild one is called myopathy and when you have it you feel muscle pain. The most serious is known as rhabdomyolysis commonly called muscle breakdown.

Muscle pain is a symptom that shows up more frequently in elderly (over 65 years of age). The pain gets worse in patients with kidney disease or hypothyroidism (when the thyroid works less than it should do).

Liver problems. People on statin that causes liver problem usually loss their appetite and/or feel pain in the upper part of the stomach. Darker urine is another symptom too. Also, a clear sign of liver problem is jaundice. It is easy to spot this symptom as the skin, especially of the face, and the white part of the eyes get yellowish.

Very rare side effects

The following side effects have been reported to the FDA by patients taking Pravastatin SODIUM but there are not enough evidences to directly link them to the drug.

• Dysuria (painful urination due to the burning feeling).
• Pollakiuria (frequent urination during the day).
• Nocturia (frequent need to wake up at night to pee).
• Immune-mediated necrotizing myopathy which starts as constant muscle weakness.
• Tendon disorders and breakups.
• Eye Disorders (blurred or double vision).
• Depression.
• Memory loss.
• Nightmares.
• Diabetes mellitus (greater in case of additional risk factors).
• Dermatomyositis.
• Interstitial lung disease.

Side effects of Pravastatin in elderly (over 65)

People over 65 are more likely to experience side effects from Pravastatin oral tablet. This drug causes muscle problems, especially pain, so older people can fall easily due to their weak legs. This is especially true for women.

Memory loss and some head confusion is another symptom that affects older people more than younger.

A few elderlies also reported to their doctor symptoms like: diarrhea, nausea and/or constipation.

What are the long-term side effects of Pravastatin?

There are not specific long-term side effects caused by Pravastatin SODIUM. Instead, there are issues caused by this statin that can last for a life time. These issues accumulate over time and come out in the long term. For example: muscle breakdown, autoimmune reactions and liver damage.

How long does it take for side effects of Pravastatin to go away?

Some side effects (like the headache) caused by Pravastatin go away over time. In other words, the body gets used to this substance. Others, however, only go away when you stop taking the drug, usually, the next day.

The time the body takes to eliminate the side effects depends on the half-life of the drug. Pravastatin has a half-life between 2 and 5 hours. Therefore, our body needs at least 2 hours to eliminate half a dose of this statin.

Also, more severe consequences like muscle breakdown, kidney failure and liver damage may take weeks if not month to go improve. Very rarely, some issues caused by Pravastatin SODIUM can be lifelong.

Allergic reaction to Pravastatin

In very rare cases, Pravastatin and other drugs of the statin family, can trigger very serious allergic reactions. these reactions show up suddenly and can even lead to death if not promptly treated. In these cases, the allergic reaction is called anaphylaxis.

The Pravastatin allergic reaction symptoms include:

• Skin rash. Your skin gets itchy, swollen, peeling, red and, in rare cases, also blistered.
• Swelling of the face, throat or tongue that prevents proper breathing.
• Throat and/or chest tightness.
• Trouble breathing or just talking.

As reported in this clinical trials:

Adverse reactions occurred to only 2% of patients treated with Pravastatin oral tablet (any dose). If you have one or more of the symptoms listed above, don’t wait for them to get worse. Call your doctor immediately and let him know about your situation. Alternatively, call 911 or the emergency local service.

dailymed.nlm.nih.gov

Pravastatin interactions with other drugs

As it happens with other medication, Pravastatin also may have interactions with different drugs, food and beverage like alcohol. Some drugs may increase the statin effects and their adverse effects while some others will lower them.

Before to start to take Pravastatin SODIUM, let your doctor know about your health condition and history, the medicines you are currently on and those you just dismissed. Include in the list over-the-counter drugs, supplements and herbal remedies.

Here is a brief list of the most common medications Pravastatin may interact with. Please, notice that the list below is not complete so, we highly recommend you to talk to your doctor before to start the statin therapy.

Interaction with antibiotics.

• Clarithromycin (used to treat skin and respiratory system bacterial infections).
• Erythromycin (is a common antibiotic used to treat infections located in different parts of the body).
• Azithromycin.

Interaction with cholesterol-lowering drugs

Some cholesterol drugs may interact with Pravastatin. These include:

• Fibrates and fenofibrate. The medication groups may raise the risk of muscle breakdown.
• Bile acid sequestrants like cholestyramine or colestipol. These drugs limit the amount of Pravastatin that our body can absorb, reducing its effectiveness.
• Niacin and red yeast rice. Both are remedies for lowering blood cholesterol. However, if taken together with Pravastatin, the risk of muscle damage increase.

Interaction with immunosuppressant drug

• Cyclosporine. It is used to treat nephrotic syndrome, rheumatoid arthritis, Crohn’s disease, psoriasis and in case of organ transplant to prevent rejection. Cyclosporine increases the efficacy of Pravastatin SODIUM and its side effects like myopathy.

Interaction with gout medication

• Colchicine. This is the most common drugs to treat inflammatory arthritis, also called gout. It prevents gout attacks by reducing uric acid in the body. When taken with Pravastatin, Colchicine put you at higher risk of myopathy or rhabdomyolysis. If you have to take these two drugs together, your doctor may decrease your dose of Pravastatin.

Interaction with alcohol

Can I drink alcohol while taking Pravastatin? This is the most asked question by people with high cholesterol who like beer and wine. Studies show that you can drink alcohol while on Pravastatin but with moderation. There are no direct risks connected with the intake of alcohol and this type of statin.

You should keep in mind that both alcohol and statins can damage the liver at different levels.

Also, alcohol increase the calories intake you consume and this makes you to gain weight. The more weight the more cholesterol in your blood.

A good reason to quit alcohol is because it raises triglycerides which are another type of fat in your blood.

So, here is the conclusion. You can drink alcohol with Pravastatin SODIUM but the less the better.

Interaction with grapefruit juice

As reported by this article on harvard.edu, not all statins interact with grapefruit in the same way. Pravastatin, in fact, is not affected by this fruit juice.

Pravastatin warnings

People with certain ongoing health conditions or in situations like breastfeeding or pregnant women should pay more attention before to take statins.

If your situation doesn’t appear in the list below, it doesn’t mean you are excluded. We encourage you to talk to your doctor and let him know about any aspect of your health mentioning current and past treatments.

Here are the most common Pravastatin warnings.

Warnings for people with ongoing kidney issues

If you already suffer due to kidney problems, chances are your body cannot disposal Pravastatin as normal people. Over time, therefore, you may have high levels of this drug in your system. The bigger the quantity the higher the risk of side effects.

Let your doctor know about the kidney problem you are suffering from or you had in the past. Usually, people with this condition get a smaller dosage of Pravastatin.

Warnings for people with active liver conditions

If you already have liver problems and take statin, your condition can worsen to severe liver failure.

Tell your doctor about your liver problems and if you had them in the past. The healthcare provider will carefully consider whether or not to prescribe Pravastatin SODIUM.

Warnings for people with hypothyroidism

Hypothyroidism, also called underactive thyroid, is a condition that appear when your thyroid gland doesn’t produce enough hormones which control the body temperature, weight, heart rate and growth.

Usually, drugs such as levothyroxine used to treat the underactive thyroid lower the cholesterol levels without the need for Pravastatin. In this way, it is also possible to avoid Pravastatin side effects (muscle breakdown, kidney failure, liver damage).

As reported in this article published on drugs.com:

“…No interactions were found between Pravastatin and levothyroxine…

drugs.com

Warning for pregnant women

The use of Pravastatin during pregnancy is not recommended. If you become pregnant while on statins since a while, stop them right away and call to your doctor to find a different medication to lower lipid levels in your blood stream.

To lower cholesterol during pregnancy, it is better to use bile acid sequestrants because they do not harm the baby. Even this method doesn’t come without side effects. You may feel constipation and have high triglycerides. Before taking any action, you should talk to your doctor asking for an advise.

Warning for women who are breastfeeding

Pravastatin passes into breast milk so avoid taking this statin while breastfeeding.

Warnings for elderly

Side effects of Pravastatin SODIUM are more frequent and severe for people over 65 years of age. Especially problems related to the leg muscles (muscle breakdown).

Pravastatin guidelines

Here is a vademecum (guidelines) about how to deal with statins while you are on them.

What if I miss a dose?

Take the medicine as soon as possible. Skip the missed dosage in case it is almost time for the next one. Caution, you should never take two doses at the same time.

What should I do if I overdose?

If you think you took a double dose of Pravastatin SODIUM, call immediately your doctor and let him know about that. if you feel bad, call 911. You may also call the Poison Help line at 1-800-222-1222.

How to store Pravastatin?

There are no particular indications for storage of this statin. You should store Pravastatin at room temperature which means between 15 and 30 degrees Celsius or 59 and 86 degrees Fahrenheit. Choose a dry place, away from light, moisture and out of reach of children.

Pravastatin price without insurance

• Pravastatin 10 mg price from $22.50 for 90 tablets.
• Pravastatin 20 mg price from $18.95 for 30 tablets.
• Pravastatin 40 mg price from $20.50 for 30 tablets.
• Pravastatin 80 mg price from $34.55 for 20 tablets.

Conclusion

Pravastatin oral tablet is a well tolerated by most of patients effective drug for lowering blood cholesterol and triglyceride levels to prevent stroke and heart attack. This statin has fewer side effects if compared with other drugs of the same family.

To get faster and better result, it is extremely important to follow your doctor’s directions, have a healthier lifestyle, add exercise to your daily routine and switch to a diet low in fat and sugar.