PravastatinPravastatin Sodium

About Pravastatin

Pravastatin blocks HMG-CoA reductase, the liver enzyme that makes cholesterol, so the liver pulls more LDL cholesterol out of the blood. Its label covers reducing the risk of heart attack, procedures to reopen heart arteries and cardiovascular death in adults with raised LDL, lowering LDL alongside diet in adults, and lowering LDL in children aged eight and older with heterozygous familial hypercholesterolemia. Adults usually start at 40 mg once a day, up to 80 mg; children aged 8 to 13 take 20 mg and those aged 14 to 18 take 40 mg. With severe kidney impairment it starts at 10 mg and stays at or below 40 mg.

Muscle and joint pain, nausea, upper respiratory infections, diarrhea and headache are the common side effects. The warnings cover muscle damage (myopathy and, rarely, rhabdomyolysis, which can injure the kidneys), an immune-mediated muscle disease that can persist after stopping, liver injury, and small rises in blood sugar and HbA1c. It is not used in acute liver failure or decompensated cirrhosis, it is stopped when pregnancy is recognized, and breastfeeding is not recommended while taking it. There is no boxed warning.

The label handles interactions through dose caps rather than bans. Gemfibrozil is to be avoided with it. With cyclosporine, pravastatin starts at 10 mg and does not go above 20 mg a day; with clarithromycin or erythromycin it does not go above 40 mg. Niacin, other fibrates and colchicine raise the risk of muscle problems and call for monitoring, and bile acid binders such as cholestyramine are taken at least one hour after or four hours before it. The current label does not discuss the cytochrome P450 enzymes or grapefruit at all; it describes pravastatin as a substrate of the liver transporter OATP1B1, whose inhibitors raise its levels.

Taking Pravastatin

How to take it

Once a day, at the same time each day, with or without food. Keep to the low-fat, low-cholesterol diet your prescriber recommends. If you take cholestyramine or colestipol, take pravastatin at least one hour before or four hours after it.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue as usual. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, protected from light and moisture, out of reach of children.

Interactions to know about

Gemfibrozil is avoided with it. Cyclosporine caps the dose at 20 mg a day and clarithromycin or erythromycin at 40 mg. Niacin, other fibrates and colchicine add to the risk of muscle damage. Report unexplained muscle pain or weakness, dark urine, yellowing skin or unusual tiredness promptly, and ask the prescriber about alcohol if you drink regularly.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Pravastatin differs from pharmacy to pharmacy

Pravastatin is a commodity generic with many makers, so a pharmacy’s quote is mostly its dispensing fee and markup, and the same strength can be quoted very differently by a chain, an independent and a mail-order pharmacy. Strengths are not priced in proportion to the milligrams, so a 40 mg dose written as one tablet rather than two 20 mg tablets changes the quote.

Because it is taken for years, the difference between pharmacies compounds, and a ninety-day fill carries one dispensing fee instead of three.

Ways to pay less for Pravastatin without insurance

• Ask whether pravastatin is on the pharmacy’s flat-price generic list; it is on many.
• Ask for a ninety-day supply once the dose is settled, written as a single tablet strength.
• If you were prescribed Pravachol by name, ask the prescriber to write it as pravastatin so there is no question about substitution.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Pravastatin

1. 1.Do any of my medicines, such as cyclosporine, gemfibrozil, clarithromycin, niacin or colchicine, change the dose I should take?
2. 2.Which muscle symptoms should I report straight away?
3. 3.When will my cholesterol and liver tests be checked?
4. 4.Is it safe if I am planning a pregnancy or breastfeeding?

Related medications