Drug Monograph

Pravastatin

Brand name: Pravachol (pravastatin sodium)

HMG-CoA reductase inhibitor (statin) — hydrophilic, non-CYP3A4 · Oral

Quick Facts

Pharmacokinetic Profile
Half-Life
~1.8 h (parent compound)
Metabolism
Sulfation / isomerization; NOT a clinically significant CYP3A4 substrate
Protein Binding
~50% (lowest among statins)
Bioavailability
~17% (absolute)
Active Form
Active drug — not a prodrug; hydrophilic
Clinical Information
Drug Class
HMG-CoA reductase inhibitor
Available Strengths
Pravachol 20 and 40 mg tablets; generic 10, 20, 40, 80 mg
Route & Timing
Oral, once daily, any time of day, with or without food
Maximum Dose
80 mg/day (moderate intensity)
Renal Adjustment
Severe CKD: start 10 mg, max 40 mg
Hepatic Status
Contraindicated in acute liver failure or decompensated cirrhosis
Pregnancy
Not contraindicated since May 2022 PI update; usually discontinued
Lactation
Not recommended
Schedule / Status
Rx only; not a controlled substance
Generic Available
Yes (since 2006); brand Pravachol approved 1991
Rx

Indications

IndicationApproved PopulationTherapy TypeStatus
Primary prevention — reduction of MI, revascularization, and CV mortalityAdults with elevated LDL-C without clinically evident CHDAdjunct to dietFDA Approved
Secondary prevention — reduction of coronary death, MI, revascularization, stroke or TIA, and slowing progression of coronary atherosclerosisAdults with clinically evident CHDAdjunct to dietFDA Approved
Primary hyperlipidemiaAdultsAdjunct to dietFDA Approved
Heterozygous familial hypercholesterolemia (HeFH)Pediatric patients ≥8 years (note: pravastatin uniquely approved from age 8, vs age 10 for most statins)Adjunct to dietFDA Approved
Hypertriglyceridemia (Fredrickson type IV)AdultsAdjunct to dietFDA Approved
Primary dysbetalipoproteinemia (Fredrickson type III)AdultsAdjunct to dietFDA Approved

Pravastatin is one of the most extensively studied statins, with cardiovascular outcome data spanning more than 47,600 patient-years across the WOSCOPS, CARE, LIPID, PROSPER, and ALLHAT-LLT trials. The Pravastatin Pooling Project (WOSCOPS + CARE + LIPID, >112,000 patient-years) established class-leading long-term safety. The 2018 AHA/ACC Cholesterol Guideline classifies pravastatin 40–80 mg as moderate intensity (LDL-C reduction ~30–37%) and pravastatin 10–20 mg as low intensity (<30%); no pravastatin dose meets the high-intensity threshold (≥50% LDL-C reduction). Despite this lower potency, pravastatin remains a useful agent because of its hydrophilic profile, lack of CYP3A4-driven interactions, and exceptional long-term tolerability — especially in transplant recipients, HIV patients on protease inhibitors, frail elderly patients, and those with recurrent statin-associated muscle symptoms on lipophilic statins.

Off-Label Uses

Statin selection in solid organ transplant recipients on cyclosporine — although the dose is capped at 20 mg, pravastatin and fluvastatin are the preferred statins in transplant patients due to minimal accumulation; supported by Olbricht 1997 transplant pharmacokinetic data. Evidence: moderate quality.

Lipid management in HIV patients on antiretroviral therapy — pravastatin and pitavastatin are preferred in HIV patients on ritonavir- or cobicistat-boosted regimens (most other statins are either contraindicated or carry meaningful interaction risk). Evidence: moderate quality (clinical guidelines).

Stroke prevention in elderly patients — extrapolation from PROSPER (n=5,804, 70–82 years) showing reduction in coronary events and modest stroke benefit. Evidence: moderate quality.

Pediatric HeFH from age 8 — pravastatin is FDA-approved from age 8, earlier than most other statins. Evidence: high quality (pivotal trial).

Dose

Dosing

Pravastatin is taken orally once daily, at any time of day, with or without food — a notable convenience advantage over short-half-life statins like simvastatin and lovastatin that require evening administration. Reassess LDL-C as early as 4 weeks after initiation or dose change. Maximum recommended dosage is 80 mg/day; if the patient is not at LDL-C goal on 80 mg, switch to a higher-intensity statin (atorvastatin 40–80 or rosuvastatin 20–40) rather than further escalation. Note that pravastatin 10–20 mg is classified as low intensity by the 2018 AHA/ACC guideline; only 40–80 mg meets moderate intensity.

Clinical ScenarioStarting DoseMaintenance DoseMaximum DoseNotes
ASCVD primary prevention — adults with elevated LDL-C and high CV risk40 mg40–80 mg80 mg/day40 mg dose used in WOSCOPS (~31% reduction in coronary events over 4.9 yr)
Per AHA/ACC 2018: 40–80 mg = moderate intensity
ASCVD secondary prevention — established CHD, post-MI, post-stroke, or PAD40 mg40–80 mg80 mg/day40 mg dose used in CARE and LIPID; if LDL-C goal not met on 80 mg, switch to high-intensity statin
Pravastatin generally not first-line for high-risk secondary prevention; consider it primarily when high-intensity statins are not tolerated
Primary hyperlipidemia — adults40 mg40 mg80 mg/dayPer VOYAGER/pivotal data: ~28% LDL-C reduction at 40 mg, ~37% at 80 mg
Heterozygous familial hypercholesterolemia (HeFH) — pediatric 8–13 years20 mg20 mg20 mg/dayDoses >20 mg not studied in this age group
Pivotal pediatric study (n=214, ages 8–18) supports use; safety similar to placebo
Heterozygous familial hypercholesterolemia (HeFH) — pediatric 14–18 years40 mg40 mg40 mg/dayDoses >40 mg not studied in this age group; counsel adolescent females on contraception
Hypertriglyceridemia / primary dysbetalipoproteinemia40 mg40–80 mg80 mg/dayModest TG reduction (~10–20%); consider fenofibrate or icosapent ethyl if TG remain elevated
Gemfibrozil should be avoided per current PI

Population-Specific Adjustments

PopulationStarting / Recommended DoseMaximum DoseNotes
Severe renal impairment10 mg once daily (use generic; Pravachol 10 mg no longer marketed)40 mg/dayMild–moderate renal impairment requires no dose adjustment
Severe CKD = 69% higher AUC of inactive metabolite
Concomitant cyclosporine10 mg once daily (use generic 10 mg)20 mg/dayCyclosporine raises pravastatin AUC by ~282%; pravastatin is nonetheless a preferred statin in transplant recipients due to its safety profile
Concomitant clarithromycin or erythromycinStandard initiation40 mg/dayClarithromycin raises pravastatin AUC by ~110%. Azithromycin has minimal effect and is the preferred macrolide alternative
SLCO1B1 *5 carriers (poor or decreased OATP1B1 function)Standard initiation; cautious titrationConsider keeping at ≤40 mg/dayPer CPIC 2022 guidance: increased exposure may translate to higher SAMS risk if dose >40 mg/day. If higher potency needed, consider alternative statin or combination therapy
Concomitant darunavir/ritonavirCautious initiationUse lowest effective dose; monitor for muscle symptomsDarunavir/ritonavir raises pravastatin AUC by ~81%. Pravastatin remains a preferred statin in HIV patients (most other statins are worse choices)
Concomitant boceprevir (HCV protease inhibitor)Cautious initiationUse lowest effective dose; monitorBoceprevir raises pravastatin AUC by ~63%
Mild-moderate hepatic impairmentCautious initiationNo specific maximum stated; large interindividual variabilityAUC varied 18-fold in cirrhotic patients vs 5-fold in healthy controls. Acute liver failure or decompensated cirrhosis is a contraindication
Elderly (≥65 years)Standard initiation; consider 20–40 mg startStandard maximaAUC ~25–50% higher in elderly subjects but no accumulation; PROSPER demonstrated CV benefit in patients aged 70–82
Clinical Pearl — Why Pravastatin Stands Apart

Pravastatin is the only major statin that is both hydrophilic and not a clinically significant CYP3A4 substrate. The hydrophilic profile reduces extrahepatic tissue penetration (less brain and muscle exposure), and the bypass of CYP3A4 metabolism eliminates the largest source of statin drug-drug interactions. These properties make pravastatin a genuinely useful tool when other statins are problematic — for example in transplant recipients on cyclosporine, HIV patients on ritonavir-boosted antiretrovirals, patients on chronic azole antifungal therapy, and patients with recurrent muscle symptoms on lipophilic statins. The trade-off is lower potency: no pravastatin dose reaches high-intensity LDL-C reduction (≥50%).

Clinical Pearl — Bedtime vs Any Time of Day

The current Pravachol PI states pravastatin can be taken at any time of day. Older labelling and pharmacokinetic studies have shown that bedtime dosing decreases systemic bioavailability by ~60% but is associated with a marginally greater (not statistically significant) lipid-lowering effect, suggesting greater hepatic extraction. Practically, if a patient prefers evening dosing for habit reasons it is acceptable, but morning dosing is no longer discouraged.

PK

Pharmacology

Mechanism of Action

Pravastatin is a reversible, competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in hepatic cholesterol biosynthesis. Unlike simvastatin and lovastatin, pravastatin is administered as the active β-hydroxyacid form — no hepatic activation step is required. Reduced intracellular cholesterol upregulates LDL receptors on hepatocyte surfaces, accelerating clearance of LDL particles from circulation. Net effects are dose-dependent reductions in LDL-C (~22% at 10 mg, ~28% at 40 mg, and ~37% at 80 mg), apolipoprotein B, non-HDL-C, and total cholesterol, with smaller reductions in triglycerides (~10–20%) and modest increases in HDL-C (~5–10%). Pravastatin is a substrate of the OATP1B1 hepatic uptake transporter, which mediates its concentration in the liver and accounts for its clinically relevant interactions with cyclosporine, gemfibrozil, and certain antiretrovirals.

Pravastatin’s hydrophilicity (partition coefficient 0.59 at pH 7.0) limits passive diffusion into peripheral tissues, including skeletal muscle and the central nervous system, which contributes to its low rates of myopathy and absence of significant cognitive complaints. Crucially, pravastatin is not metabolized by CYP3A4 to a clinically significant extent: its major biotransformation pathways are isomerization to 6-epi pravastatin and the 3α-hydroxyisomer (SQ 31,906) and enzymatic ring hydroxylation to SQ 31,945. This metabolic profile spares pravastatin from the dense network of CYP3A4-mediated interactions that complicate simvastatin, atorvastatin, and lovastatin therapy.

ADME Profile

ParameterValueClinical Implication
AbsorptionTmax 1–1.5 h; absolute bioavailability ~17%; oral absorption ~34%; food reduces AUC ~31% and Cmax ~49% but lipid-lowering efficacy is similar with or without foodNo food restrictions; can be taken any time of day
DistributionPlasma protein binding ~50% (lowest among statins); hydrophilic — limited penetration into peripheral tissues including muscle and brainLess extrahepatic exposure than lipophilic statins; contributes to favorable myopathy profile
MetabolismIsomerization to 6-epi pravastatin and 3α-hydroxyisomer (SQ 31,906; 1/10 to 1/40 the activity of parent); enzymatic ring hydroxylation to SQ 31,945 (inactive); hepatic extraction ratio 0.66; not a clinically significant CYP3A4 substrateCleanest interaction profile of any statin — grapefruit juice, azole antifungals (other than fluconazole at high doses), and CYP3A4 inhibitor calcium channel blockers do not require dose adjustment
Elimination~20% urinary excretion, ~70% fecal excretion; t½ ~1.8 h (parent), ~77 h (total radioactivity); 47% renal vs 53% non-renal clearance after IV administrationSevere renal impairment requires dose reduction; mild–moderate renal impairment does not
SE

Side Effects

Pravastatin has one of the most extensively studied long-term safety profiles of any statin. The Pravastatin Pooling Project combined data from WOSCOPS, CARE, and LIPID — accumulating >112,000 person-years of randomized, placebo-controlled exposure to pravastatin 40 mg daily — and showed no excess of non-cardiovascular serious adverse events, no excess cancers, equivalent rates of liver function abnormalities (1.4% vs 1.4% placebo), and no cases of severe myopathy. Frequencies below are drawn from the FDA Pravachol PI Tables 1 and 2.

≥10% Very Common (Long-Term Trials, 47,613 Patient-Years)
Adverse EffectPravastatin 40 mg (N=10,764)Placebo (N=10,719)
Musculoskeletal pain24.9%24.4%
Upper respiratory tract infection21.2%20.2%
Musculoskeletal traumatism10.2%9.6%
Chest pain10.0%9.8%

Note: rates in long-term trials reflect background population incidence over 4–5 years of follow-up rather than drug attribution. Differences vs placebo are small (≤1 percentage point) for all very common reactions.

1–10% Common
Adverse EffectIncidence (Short-Term Trials)Clinical Note
Nausea / vomiting7.4% (vs placebo 7.1%)Mild and usually transient; may improve if taken with food
Diarrhea6.7% (vs placebo 5.6%)Usually mild; rule out alternative causes if persistent
Headache6.3% (vs placebo 4.6%)Generally mild; usually resolves within weeks
Upper respiratory infection5.9% (vs placebo 5.8%)Background rate; not drug-attributable
Rash4.5% (vs placebo 1.4%)Most cases mild; discontinue if severe or systemic features develop
Asymptomatic CK elevation4.1% (vs placebo 3.6%)Most attributable to non-cardiac CK fraction; not by itself an indication to stop
Asymptomatic ALT elevation2.9% (vs placebo 1.2%)Persistent elevation >3× ULN occurs in ~1% of pravastatin AND placebo patients per long-term trials; rarely clinically significant
Cough2.5% (vs placebo 1.7%)Usually mild and transient
Myalgia2.3% (vs placebo 1.2%)Real-world rates are higher; pravastatin has the lowest myopathy rate among major statins
Influenza2.0% (vs placebo 0.7%)Background rate
γ-GT elevation2.0% (vs placebo 1.2%)Asymptomatic; not by itself an indication to discontinue
New-onset diabetes (statin class effect)~1–2% excess riskHbA1c and fasting glucose may rise modestly; CV benefit substantially outweighs glycemic risk
Serious Serious Adverse Effects
Adverse EffectEstimated FrequencyTypical OnsetRequired Action
Myopathy (CK >10× ULN with symptoms)<0.1% in clinical trialsFirst few monthsDiscontinue; rechallenge with lower dose or alternate statin only after resolution
RhabdomyolysisVery rare (no cases in WOSCOPS+CARE+LIPID pooled, >112,000 patient-years)Weeks–monthsStop drug immediately; check CK and renal function; aggressive hydration; avoid all statins until resolved
Immune-mediated necrotizing myopathy (IMNM)Very rare (~2 per million person-years across statin class)Months–years; persists or worsens after stoppingPermanent discontinuation; check anti-HMGCR antibody; refer to neurology / rheumatology for immunosuppressive therapy
Fatal and non-fatal hepatic failureRare (post-marketing)Weeks–monthsDiscontinue if jaundice or hyperbilirubinemia; evaluate for other causes
Hypersensitivity (anaphylaxis, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS)Rare (post-marketing)Days–weeksPermanent discontinuation; avoid all statins after anaphylaxis or severe cutaneous reaction
Cognitive impairment (memory loss, confusion — usually reversible)Rare (post-marketing, statin class label)Days to years; resolution typically within weeks of stoppingTrial of discontinuation if temporally related; not a contraindication to future statin therapy
Interstitial lung disease, peripheral neuropathy, thrombocytopenia, pancreatitis (statin class)Very rare (post-marketing)Months–yearsDiscontinue if temporally related and other causes excluded
Lupus-like syndrome, polymyalgia rheumatica, dermatomyositis, vasculitis, hemolytic anemia (statin class, post-marketing)Very rareMonths–yearsDiscontinue and refer to rheumatology for evaluation
Discontinuation Discontinuation Rates
Short-term placebo-controlled trials (median 14 weeks)
3.3% vs 1.2% placebo
Top reasons: hepatic transaminase elevation, nausea, anxiety / depression, dizziness
Long-term outcome trials (median 261 weeks / ~5 years)
8.1% vs 9.3% placebo
Notable: discontinuation rates were lower on pravastatin than placebo over ~5 years in 21,483 high-risk patients
Reason for DiscontinuationContextComment
Mild non-specific gastrointestinal complaintsMost common reason in long-term trialsOften settles with continued therapy or food administration
Hepatic transaminase elevation~1% develop persistent ALT/AST >3× ULN (similar to placebo in long-term trials)Many cases resolve with continued therapy or after brief interruption
NauseaTop short-term-trial reasonUsually mild; may improve with food
Myalgia / muscle symptomsLowest rate among major statinsOften manageable; pravastatin is a common rescue option for patients intolerant to lipophilic statins
HypersensitivityPermanent discontinuation indicatedSwitch class if needed

Pediatric data (24-month controlled trial in 214 HeFH patients ages 8–18.5; 53% female): adverse-reaction profile generally similar to placebo with influenza and headache the most common reactions in both groups. No detectable effect on growth or sexual maturation; doses >40 mg/day not studied in this population.

Pravastatin and Statin-Associated Muscle Symptoms (SAMS) — Practical Notes

Pravastatin’s hydrophilicity, low protein binding (~50%), and minimal CYP3A4 metabolism translate into one of the lowest myopathy risk profiles among statins. In the Pravastatin Pooling Project (WOSCOPS + CARE + LIPID, >112,000 patient-years), no cases of severe myopathy were reported, and only 3 pravastatin and 7 placebo patients had medication withdrawn for CK elevation. This makes pravastatin an evidence-based first choice when re-trialing statin therapy in a patient with documented intolerance to lipophilic statins (simvastatin, atorvastatin, lovastatin). Consider every-other-day dosing as a further dose-reduction strategy in highly intolerant patients.

Int

Drug Interactions

Pravastatin has the cleanest drug-interaction profile of any major statin. Because it is not metabolized by CYP3A4 to a clinically significant extent, the long list of interactions that complicates simvastatin and atorvastatin therapy (azole antifungals, macrolide antibiotics, calcium channel blockers, grapefruit juice, cobicistat-containing antiretrovirals) does not apply to pravastatin in the same way. The clinically relevant interactions are mediated by the OATP1B1 hepatic uptake transporter (cyclosporine, gemfibrozil, certain antiretrovirals), additive muscle toxicity (fibrates, niacin, colchicine), or absorption interference (bile acid sequestrants, antacids).

Major Cyclosporine
MechanismProfound OATP1B1 inhibition; pravastatin AUC ↑282%, Cmax ↑327%
EffectMarkedly increased pravastatin exposure; potential for myopathy
ManagementStart pravastatin 10 mg once daily; do not exceed 20 mg/day. Pravastatin is nonetheless a preferred statin in transplant recipients due to overall favorable safety
FDA PI
Major Gemfibrozil
MechanismOATP1B1 and glucuronidation interference plus additive intrinsic muscle toxicity (PK interaction is mild but pharmacodynamic combination is high-risk)
EffectIncreased risk of myopathy and rhabdomyolysis
ManagementAvoid concomitant use. Use fenofibrate as an alternative when a fibrate is needed
FDA PI
Major Clarithromycin
MechanismOATP1B1 inhibition; pravastatin AUC ↑110%, Cmax ↑128%
EffectApproximately doubled pravastatin exposure; increased myopathy risk
ManagementDo not exceed pravastatin 40 mg/day during clarithromycin course. Azithromycin is a preferred alternative with minimal pharmacokinetic effect
FDA PI
Major Erythromycin
MechanismOATP1B1 inhibition (similar to clarithromycin)
EffectIncreased pravastatin exposure
ManagementDo not exceed pravastatin 40 mg/day during erythromycin course
FDA PI
Major Darunavir / ritonavir
MechanismOATP1B1 inhibition; pravastatin AUC ↑81%, Cmax ↑63%
EffectIncreased pravastatin exposure
ManagementCautious initiation; use lowest effective dose; monitor for myopathy. Pravastatin remains a preferred statin in HIV patients on ritonavir-boosted antiretrovirals
FDA PI
Major Boceprevir (HCV protease inhibitor)
MechanismOATP1B1 inhibition; pravastatin AUC ↑63%, Cmax ↑49%
EffectModestly increased pravastatin exposure
ManagementCautious initiation; use lowest effective pravastatin dose; monitor
FDA PI
Moderate Lopinavir / ritonavir (Kaletra)
MechanismOATP1B1 inhibition; pravastatin AUC ↑33%, Cmax ↑26%
EffectModest rise in pravastatin levels
ManagementNo specific dose cap required, but start low and monitor for muscle symptoms
FDA PI
Moderate Niacin (lipid-modifying ≥1 g/day)
MechanismAdditive skeletal muscle toxicity (no clinically meaningful PK interaction; pravastatin AUC ↓3.6%)
EffectIncreased risk of myopathy and rhabdomyolysis
ManagementCarefully weigh benefit vs risk; HPS2-THRIVE showed no CV benefit from niacin add-on. Monitor for myopathy especially during dose titration
FDA PI
Moderate Fenofibrate (and other non-gemfibrozil fibrates)
MechanismAdditive muscle toxicity (no significant PK interaction with pravastatin)
EffectModest myopathy risk; safer than gemfibrozil
ManagementAcceptable when both agents are clinically indicated; counsel on muscle symptoms
FDA PI
Moderate Colchicine
MechanismAdditive myotoxicity
EffectIncreased risk of myopathy / rhabdomyolysis, especially with chronic use or renal impairment
ManagementUse lowest effective colchicine dose; counsel on muscle symptoms; check CK if symptoms develop
FDA PI
Moderate Bile acid sequestrants (cholestyramine, colestipol)
MechanismReduced absorption; cholestyramine ↓pravastatin AUC ~40%; colestipol ↓pravastatin AUC ~47%
EffectSubstantial reduction in pravastatin levels; reduced LDL-C lowering effect if not separated
ManagementTake pravastatin at least 1 hour before or 4 hours after the bile acid sequestrant. Combination is otherwise additive for LDL-C reduction
FDA PI
Minor Cimetidine
MechanismPravastatin AUC ↑30%, Cmax ↑10%
EffectModest increase in pravastatin exposure; not clinically significant
ManagementNo dose adjustment required
FDA PI
Minor Antacids (aluminum / magnesium)
MechanismReduced absorption; pravastatin AUC ↓28%
EffectModest reduction in pravastatin levels
ManagementSeparate by ≥1 hour if practical; no formal restriction
FDA PI
Minor Warfarin
MechanismModest effect; warfarin AUC ↑17%, mean prothrombin time ↑0.4 sec
EffectSlight prolongation of INR
ManagementMonitor INR more closely on initiation, dose change, or discontinuation. Significantly less interaction than with rosuvastatin or fluvastatin
FDA PI
Minor Verapamil
MechanismPravastatin AUC ↑31%, Cmax ↑42%
EffectModest increase in pravastatin exposure (no clinical significance)
ManagementNo dose adjustment required (in striking contrast to simvastatin, where verapamil mandates a 10 mg cap)
FDA PI
Minor Grapefruit juice
MechanismPravastatin AUC ↓1.8%, Cmax ↑3.7% (negligible)
EffectNo clinically significant effect
ManagementNo dietary restriction needed (a meaningful advantage over simvastatin / atorvastatin / lovastatin)
FDA PI
Minor Itraconazole
MechanismPravastatin AUC ↑11%, Cmax ↑17%
EffectNo clinically significant effect (in striking contrast to simvastatin, which is contraindicated)
ManagementNo dose adjustment required
FDA PI
Mon

Monitoring

  • Lipid Panel Baseline; reassess as early as 4 weeks; then 4–12 weeks after dose change; then annually
    Routine
    Confirm percent LDL-C reduction (~28% expected at 40 mg, ~37% at 80 mg). If >50% reduction is needed (high-intensity goal), switch to atorvastatin 40–80 mg or rosuvastatin 20–40 mg rather than escalate pravastatin. Adherence is a more common reason for inadequate response than non-response.
  • ALT / AST Baseline; thereafter only if symptoms
    Trigger-based
    Routine periodic LFTs are no longer recommended. Repeat if patient develops jaundice, fatigue, abdominal pain, dark urine, or unexplained nausea. Discontinue if ALT/AST >3× ULN with symptoms or hyperbilirubinemia. Pravastatin is contraindicated in acute liver failure or decompensated cirrhosis.
  • Creatine Kinase (CK) Baseline only in high-risk patients; otherwise only if symptoms
    Trigger-based
    High-risk = age ≥65, hypothyroidism, renal impairment, prior statin myopathy, concomitant cyclosporine, or concomitant clarithromycin. Check if patient develops myalgia, weakness, or dark urine. Stop if CK >10× ULN with symptoms.
  • Medication Reconciliation Every visit and at every new prescription
    Routine
    Check for new OATP1B1 inhibitors (cyclosporine, gemfibrozil, clarithromycin, ritonavir-boosted antiretrovirals, boceprevir) and additive myotoxic agents (fibrates, niacin, colchicine). Pravastatin’s interaction profile is much cleaner than other statins, but the OATP1B1-mediated interactions still matter.
  • HbA1c / Fasting Glucose Baseline; periodically if at risk for diabetes
    Routine
    Modest excess incidence of new-onset diabetes (mostly in patients with prediabetes). CV benefit greatly outweighs glycemic risk; do not stop the statin if A1c rises into diabetic range.
  • Renal Function Baseline; per overall comorbidity profile
    Routine
    Estimate CrCl/eGFR before initiation and recheck if clinical change. Severe renal impairment requires starting at 10 mg with maximum 40 mg/day.
  • TSH If unexplained myalgia or rising CK
    Trigger-based
    Unrecognized hypothyroidism is a major contributor to apparent statin intolerance and CK rise; treat the thyroid before declaring statin intolerance.
  • INR (if on warfarin) Stable INR before pravastatin initiation; closer monitoring on dose change
    Trigger-based
    Pravastatin causes a small but real INR prolongation. Effect is meaningfully smaller than with rosuvastatin or fluvastatin.
  • Adherence Check Every clinical visit
    Routine
    Approximately half of patients discontinue statins within 1 year of initiation. Open, non-judgemental questioning (“How often do you forget?”) yields more accurate information than yes/no adherence questions.
  • Pregnancy Status In females of reproductive potential, periodically
    Trigger-based
    FDA removed the pregnancy contraindication from the Pravachol PI in May 2022 (following the July 2021 class-wide statement). Statins are generally discontinued during planned or confirmed pregnancy unless benefits clearly outweigh risk. Effective contraception is recommended during therapy.
CI

Contraindications & Cautions

Absolute Contraindications (per current FDA Pravachol PI, May 2022)

  • Acute liver failure or decompensated cirrhosis.
  • Hypersensitivity to pravastatin or any excipient in the formulation (anaphylaxis, angioedema, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported).

Note on label history: Pregnancy and lactation contraindications were removed from the Pravachol label in the May 2022 revision, reflecting the FDA July 2021 class-wide drug safety communication. Older Pravachol labels and some generic labels may still list these as contraindications, but the most current authoritative US PI does not.

Relative Contraindications (Specialist Input Recommended)

  • Pregnancy — although the FDA removed the contraindication in 2021–2022, statins are still typically discontinued during planned or confirmed pregnancy. Continued use is reasonable only in established ASCVD or HoFH where lipid-lowering benefit clearly outweighs theoretical fetal risk; document the explicit risk-benefit discussion.
  • Lactation — pravastatin is present in human milk; breastfeeding is not recommended during therapy. If therapy is required postpartum, use formula or switch to a different agent if appropriate.
  • Severe renal impairment — start at 10 mg/day; maximum 40 mg/day with close monitoring for myopathy.
  • History of statin-induced rhabdomyolysis or immune-mediated necrotizing myopathy — IMNM is a permanent contraindication to all statins; uncomplicated SAMS may permit cautious rechallenge with pravastatin specifically (it is the most common rescue option for patients intolerant to lipophilic statins).
  • Concomitant gemfibrozil — current PI states pravastatin is “not recommended” with gemfibrozil due to additive myotoxicity. Use fenofibrate as an alternative.

Use with Caution

  • Age ≥65 years — frailty, polypharmacy, and lower muscle mass raise myopathy risk; consider starting at 20–40 mg. PROSPER demonstrated CV benefit at 40 mg in patients aged 70–82.
  • Hypothyroidism — treat first; untreated hypothyroidism amplifies myopathy risk and may itself elevate CK.
  • Concomitant cyclosporine, clarithromycin, erythromycin, or HIV/HCV protease inhibitors — observe specific dose caps (cyclosporine 20 mg max; clarithromycin/erythromycin 40 mg max). These interactions are clinically meaningful but pravastatin remains a preferred statin in transplant and HIV patients given the alternatives.
  • Concomitant fibrates (especially fenofibrate), niacin (≥1 g/day), or colchicine — additive myotoxicity; counsel on muscle symptoms.
  • Diabetes risk factors (prediabetes, metabolic syndrome) — small excess diabetes incidence; CV benefit nonetheless outweighs risk.
  • Major surgery, sepsis, severe trauma, or other acute serious medical conditions — temporarily withhold pravastatin in any patient at high risk of rhabdomyolysis.
  • Pediatric patients <8 years — efficacy and safety not established below age 8.
  • SLCO1B1 *5 carriers (poor or decreased OATP1B1 function) — consider keeping pravastatin at ≤40 mg/day per CPIC 2022 guidance. If higher potency is needed, consider an alternative statin or combination therapy.
  • Substantial chronic alcohol use or prior liver disease — increased risk of hepatic injury.
FDA Class-Wide Regulatory Warning Myopathy and Rhabdomyolysis — Statin Class Effect

All HMG-CoA reductase inhibitors carry a class-wide warning regarding myopathy and rhabdomyolysis. Pravastatin has the lowest myopathy risk among statins (clinical-trial myopathy rate <0.1% with no severe cases reported in the WOSCOPS+CARE+LIPID pooled analysis), but the warning still applies. Risk factors include age ≥65 years, uncontrolled hypothyroidism, renal impairment, female sex, low body weight, and concomitant interacting drugs (especially cyclosporine, gemfibrozil, clarithromycin, ritonavir).

Counsel every patient to promptly report unexplained muscle pain, tenderness, weakness, or dark urine. Discontinue immediately if rhabdomyolysis is suspected or if CK rises >10× ULN with symptoms. Temporarily withhold pravastatin in any patient with an acute serious condition predisposing to rhabdomyolysis (sepsis, hypotension, dehydration, major surgery, severe metabolic or electrolyte disorder, uncontrolled seizures).

FDA Class-Wide Regulatory Update Statin Use During Pregnancy — FDA Communication of July 20, 2021

The FDA requested removal of the contraindication against statin use in pregnancy from the labelling of all statins. The Pravachol label was updated accordingly in May 2022. The change does not endorse routine use; it allows individualized risk-benefit decisions, particularly for women with HoFH, established ASCVD, or very high CV risk.

Most patients should still discontinue pravastatin on confirmation of pregnancy. Lactation remains a reason to defer therapy because of measurable infant exposure (pravastatin is present in human milk); patients who require ongoing statin therapy postpartum should not breastfeed.

FDA Class-Wide Regulatory Warning Immune-Mediated Necrotizing Myopathy (IMNM)

Rare reports of IMNM, an autoimmune myopathy, have been associated with statin use, including pravastatin, with reports of recurrence when the same or a different statin was administered. IMNM is characterized by proximal muscle weakness and elevated CK that persist despite statin discontinuation, positive anti-HMG-CoA reductase antibody, muscle biopsy showing necrotizing myopathy, and improvement with immunosuppressive therapy.

Discontinue pravastatin if IMNM is suspected, refer to neurology or rheumatology for confirmatory testing, and avoid all statins in confirmed cases.

Pt

Patient Counselling

Purpose of Therapy

Pravastatin lowers LDL (“bad”) cholesterol by reducing the liver’s production of cholesterol. Lower LDL means less plaque buildup inside arteries, which reduces the chance of heart attacks, strokes, and the need for procedures such as stents or bypass surgery. The benefit accumulates over years — most patients are taking it for prevention rather than for symptom relief, so they may not “feel” anything different. Lifestyle measures (diet, exercise, weight control, smoking cessation) act on the same arteries and add to the benefit.

How to Take

Take one tablet once a day. Pravastatin can be taken at any time of day, with or without food — it does not need to be taken in the evening like some other statins. Pick a time that fits your daily routine and stick with it. If a dose is missed, take it as soon as remembered the same day; if it is almost time for the next dose, skip the missed one and continue normally. Do not double up. Unlike some other statins, grapefruit juice does not meaningfully interact with pravastatin, so dietary restrictions are not required. Do not stop the medicine without speaking to the prescriber, even if cholesterol numbers look good — stopping is when the protection fades.

Muscle Pain or Weakness
Tell patient Pravastatin is one of the most muscle-friendly statins, but muscle aches still happen occasionally. Mild aches in the first few weeks are common and often unrelated to the medicine. Stay hydrated, especially during exercise. Severe weakness or pain that affects walking or stair-climbing is not normal.
Call prescriber Severe or persistent muscle pain, unexplained weakness, fatigue out of proportion to activity, or dark / cola-colored urine. Seek same-day care for the dark-urine combination.
Other Medicines, Including Over-the-Counter and Herbal
Tell patient Always tell every healthcare provider — including dentists and pharmacists — that pravastatin is on the list. Pravastatin has a much cleaner interaction profile than most other statins, but a few interactions still matter: cyclosporine after transplant, gemfibrozil (a cholesterol drug), and certain antibiotics (clarithromycin, erythromycin) all require dose changes. If using cholestyramine or colestipol, take pravastatin at least 1 hour before or 4 hours after.
Call prescriber Before starting any new prescription, especially antibiotics, antifungals, HIV / hepatitis medications, or new heart medications.
Grapefruit and Diet
Tell patient Grapefruit and grapefruit juice are safe with pravastatin — there are no dietary restrictions specific to this medicine. Pravastatin can also be taken with or without food. (This is different from some other statins, where grapefruit must be avoided.)
Call prescriber If switching from another statin and uncertain about diet rules; if any new dietary supplement is being considered.
“I Feel Fine — Why Am I Taking This?”
Tell patient High cholesterol does not cause symptoms. The medication’s job is to prevent a future heart attack or stroke, not to make today feel different. Stopping it because nothing feels different is the most common cause of preventable cardiovascular events in clinic populations.
Call prescriber Before stopping or skipping doses for any reason. New side effects, planned pregnancy, planned surgery, or any new prescription from another clinician.
Pregnancy Plans
Tell patient If pregnancy is being planned, the prescriber will usually pause the statin before conception. If pregnancy is discovered while taking it, contact the clinic — do not panic. Recent FDA review of cohort data did not show a clear pattern of birth defects from inadvertent first-trimester exposure, but stopping is still the standard approach for most patients. Pravastatin is present in breast milk, so breastfeeding is not recommended during therapy.
Call prescriber Before trying to conceive, on missed period, or on a positive home pregnancy test. Also before breastfeeding.
Alcohol
Tell patient Light to moderate alcohol use is generally compatible. Heavy or daily drinking raises the chance of liver irritation and is best avoided while on this medicine.
Call prescriber Yellowing of the skin or eyes, persistent abdominal pain, very dark urine, or unusual fatigue — any of these warrant prompt evaluation regardless of alcohol intake.
Diabetes Risk
Tell patient Statins very slightly raise the chance of being diagnosed with diabetes, mainly in people who were already on the borderline. The protection from heart attacks and strokes is far larger than this small risk, so the medicine is still recommended.
Call prescriber Increased thirst, frequent urination, unexplained weight loss, or persistently elevated home blood-sugar readings (if monitoring is being done).
If Switching from Another Statin Due to Side Effects
Tell patient Pravastatin is a common choice when other statins (such as atorvastatin or simvastatin) cause muscle aches or other side effects. It works the same way but is processed by the body differently, so many patients tolerate it after another statin failed. Give it a fair trial of at least 4 weeks before judging.
Call prescriber If muscle symptoms recur on pravastatin, or if previous side effects from another statin reappear despite the switch.
Ref

Sources

Regulatory (PI / Drug Safety Communications)
  1. PRAVACHOL (pravastatin sodium) US Prescribing Information. Bristol-Myers Squibb; revised May 2022. Accessed via FDA Drugs@FDA. accessdata.fda.gov/drugsatfda_docs/label/2022/019898s070lbl.pdf Authoritative source for FDA-approved indications, dosing, contraindications, drug interactions (Tables 3 & 5), and adverse-reaction frequencies (Tables 1 & 2) cited in this monograph. Notable May 2022 update: removal of pregnancy and lactation contraindications.
  2. FDA Drug Safety Communication: FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy. July 20, 2021. fda.gov The 2021 labeling change removing the pregnancy contraindication for the entire statin class; reflected in the May 2022 Pravachol revision.
Key Clinical Trials
  1. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia (West of Scotland Coronary Prevention Study, WOSCOPS). N Engl J Med. 1995;333(20):1301-1307. doi:10.1056/NEJM199511163332001 Landmark primary prevention trial; 6,595 men with LDL-C 156–254 mg/dL randomized to pravastatin 40 mg or placebo for ~4.9 years; ~31% reduction in coronary events.
  2. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels (CARE). N Engl J Med. 1996;335(14):1001-1009. doi:10.1056/NEJM199610033351401 Secondary prevention trial in 4,159 post-MI patients with average cholesterol; established that statin benefit extends to patients without overt hypercholesterolemia.
  3. Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349-1357. doi:10.1056/NEJM199811053391902 9,014 patients with prior MI or unstable angina; 6.1 years follow-up; demonstrated reductions in CHD death, MI, stroke, and total mortality.
  4. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623-1630. doi:10.1016/S0140-6736(02)11600-X 5,804 men and women aged 70–82 randomized to pravastatin 40 mg or placebo for 3.2 years; established CV benefit specifically in the elderly population.
  5. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: ALLHAT-LLT. JAMA. 2002;288(23):2998-3007. doi:10.1001/jama.288.23.2998 Open-label trial in 10,355 hypertensive patients aged ≥55 with moderate hypercholesterolemia; pravastatin 40 mg vs usual care; modest benefit attributed to small lipid difference between groups.
Pooled Analyses and Long-Term Safety
  1. Pfeffer MA, Keech A, Sacks FM, et al. Safety and tolerability of pravastatin in long-term clinical trials: prospective Pravastatin Pooling (PPP) Project. Circulation. 2002;105(20):2341-2346. doi:10.1161/01.CIR.0000017634.00171.24 Combined WOSCOPS, CARE, and LIPID data (>112,000 person-years); foundation for the long-term safety statements in this monograph, including the absence of severe myopathy cases at 40 mg.
Guidelines
  1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625 Primary US guideline; classifies pravastatin 40–80 mg as moderate intensity and 10–20 mg as low intensity. No pravastatin dose meets high intensity (≥50% LDL-C reduction).
  2. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455 European framework with lower LDL-C targets in very-high-risk patients; supports preferential use of high-intensity statins over pravastatin in these populations.
  3. Newman CB, Preiss D, Tobert JA, et al. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39(2):e38-e81. doi:10.1161/ATV.0000000000000073 Comprehensive class-wide safety review used here for myopathy framing, observational vs RCT muscle-symptom rates, and diabetes risk discussion.
Pharmacokinetics / Pharmacogenetics / Special Populations
  1. Hatanaka T. Clinical pharmacokinetics of pravastatin: mechanisms of pharmacokinetic events. Clin Pharmacokinet. 2000;39(6):397-412. doi:10.2165/00003088-200039060-00002 Comprehensive PK review establishing pravastatin’s hydrophilic profile, OATP1B1 dependence, and absence of clinically significant CYP3A4 metabolism.
  2. Cooper KJ, Martin PD, Dane AL, Warwick MJ, Schneck DW, Cantarini MV. The effect of erythromycin on the pharmacokinetics of rosuvastatin and pravastatin. Eur J Clin Pharmacol. 2003;59(1):51-56. doi:10.1007/s00228-003-0571-9 Source for pravastatin–macrolide interaction quantification supporting the 40 mg dose cap with clarithromycin or erythromycin.
  3. Cooper-DeHoff RM, Niemi M, Ramsey LB, et al. The Clinical Pharmacogenetics Implementation Consortium Guideline for SLCO1B1, ABCG2, and CYP2C9 genotypes and Statin-Associated Musculoskeletal Symptoms. Clin Pharmacol Ther. 2022;111(5):1007-1021. doi:10.1002/cpt.2557 Pharmacogenomic guidance for SLCO1B1 *5 carriers; supports the cautious dosing recommendation for poor/decreased OATP1B1 function patients.