Pravastatin

Indications & Dose:

Adjunct to diet for primary hypercholesterolaemia or combined (mixed) hyperlipidaemias in patients who have not responded adequately to dietary control

% BY MOUTH

% Adult: 10–40 mg daily, dose to be taken at night, dose to be adjusted at intervals of at least 4 weeks

Prevention of cardiovascular events in patients with previous myocardial infarction or unstable angina Adjunct to diet to prevent cardiovascular events in patients with hypercholesterolaemia

% BY MOUTH

% Adult: 40 mg daily, dose to be taken at night Reduction of hyperlipidaemia in patients receiving immunosuppressive therapy following solid-organ transplantation 

% BY MOUTH

% Adult: Initially 20 mg daily, then increased if necessary up to 40 mg daily, dose to be taken at night, close medical supervision is required if dose is increased to maximum dose

Contraindications:

Active liver disease, unexplained persistent elevated liver function tests

Side Effects:

CNS: Dizziness, headache

CV: Chest pain

GI: Abdominal pain, anorexia, cholestatic jaundice,

cirrhosis, constipation, fatty changes in liver,

flatulence, heartburn, hepatitis, increased serum

transaminase levels, nausea, pancreatitis, vomiting

GU: Erectile dysfunction, loss of libido

MS: Arthralgia, localized pain, myalgia, myopathy, rhabdomyolysis

SKIN: Alopecia, photosensitivity, pruritus, rash

MISC: Fatigue, gynecomastia

Cautions:

Precautions:

History of liver disease, renal function impairment, elderly, children < 18 yr, alcoholism; risk factors predisposing to the development of renal failure secondary to rhabdomyolysis (severe acute infection, trauma, hypotension, uncontrolled seizure disorder, severe metabolic disorders, electrolyte imbalance)

PREGNANCY AND LACTATION: Pregnancy category X: small amounts excreted in breast milk; should probably not be used by women who are nursing

Interaction:

Azole antifungals (fluconazole, itraconazole, ketoconazole, miconazole): Increased plasma pravastatin levels via inhibition of metabolism with increased risk of rhabdomyolysis 

Cholestyramine: Reduced bioavailability of pravastatin

Clarithromycin: Increased plasma pravastatin levels via inhibition of metabolism with increased risk of rhabdomyolysis

Clofibrate: Small increased risk of myopathy with combination

Colestipol: Reduced bioavailability of pravastatin

Cyclosporine: Concomitant administration increases risk fo severe myopathy or rhabdomyolysis

Danazol: Increased plasma pravastatin levels via inhibition of metabolism with increased risk of rhabdomyolysis 

Erythromycin: Increased pravastatin levels via inhibition of metabolism with increased risk of rhabdomyolysis 

Fluoxetine: Increased pravastatin levels via inhibition of metabolism with increased risk of rhabdomyolysis

 Gemfibrozil: Small increased risk of myopathy with combination, especially at high doses of statin 

Isradipine: May decrease pravastatin plasma concentrations

Niacin: Concomitant administration increases risk of severe myopathy or rhabdomyolysis 

Nefazodone: May inhibit hepatic metabolism of pravastatin with risk of rhabdomyolysis

 Troleandomycin: Increased pravastatin levels via inhibition of metabolism with increased risk of  rhabdomyolysis

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: