How Pravastatin works
Pravastatin inhibits the production of cholesterol. Cholesterol has several functions in the human and animal organism:
- It is an essential component of every cell membrane in the body and ensures its stability and flexibility.
- It is the starting material for the production of various hormones (including male and female sex hormones such as testosterone and estrogen) and bile acids (important for fat digestion).
Various hereditary diseases, diabetes, alcohol addiction, obesity as well as a poor diet can lead to hypercholesterolemia – a too high cholesterol level in the blood.
In the long run, this can lead to arteriosclerosis, i.e. “vascular calcification” (deposition of fats such as cholesterol and blood cells in the vessels). Over time, the deposits can become so large that they occlude a vessel. Depending on the location of the blockage, this may lead to a heart attack or stroke.
Statins such as pravastatin inhibit the body’s own production of cholesterol in the liver. As a result, not only is less cholesterol released into the blood. The cholesterol already present in the blood also decreases because the liver absorbs it more (among other things, to form bile acids).
Absorption, breakdown and excretion
Approximately one-third of the ingested dose reaches the liver, the site of action of pravastatin.
Pravastatin is partially broken down in the liver. About one-quarter of the active ingredient is excreted in the urine, and the remainder is excreted in the bile with the stool. After about two hours, half of the ingested drug is excreted.
When is pravastatin used?
Pravastatin is used to treat high blood cholesterol levels when these have not been reduced by non-drug measures such as diet, exercise and weight reduction.
Furthermore, it can be used to prevent vascular occlusion in patients with risk factors (such as diabetes) as well as after a heart attack to prevent further vascular occlusion. In addition, pravastatin is used after organ transplants to regulate blood lipid levels.
Statins such as pravastatin must be taken long-term to maintain the cholesterol-lowering effect over the long term.
How pravastatin is used
Pravastatin is taken once daily in the evening – either with a meal or independently. Usual dosages are 10, 20 or 40 milligrams of pravastatin per day. To support therapy, patients should follow a lipid-lowering diet (including reducing consumption of animal fats).
If therapy with pravastatin alone is not sufficient, the physician may additionally prescribe other lipid-lowering medications. These include anion-exchange resins such as colestyramine and other lipid-lowering agents such as ezetimibe, bempedoic acid, fibrates, and PSCK9 inhibitors (such as alirocumab, evolocumab).
What are the side effects of pravastatin?
Possible side effects include dizziness, headache, sleep disturbances, visual disturbances, indigestion, abdominal pain, nausea, vomiting, constipation, diarrhea, itching, skin rash, urinary disturbances, sexual dysfunction, and fatigue. These side effects show up in one in one hundred to one thousand patients.
During therapy, special attention must be paid to muscle and joint pain. If these occur frequently or over a longer period of time, the treating physician must be informed. Serious complications, such as kidney failure, may occur.
What should be considered when taking Pravastatin?
Contraindications
Pravastatin must not be taken by:
- hypersensitivity to the active substance or to any of the other components of the drug
- acute liver disease
Drug interactions
When pravastatin is combined with the anion exchanger colestyramine, the intakes should be staggered: Pravastatin should be taken at least one hour before or at least four hours after colestyramine.
In organ transplant patients receiving the immunosuppressant ciclosporin to prevent rejection, pravastatin blood levels should be monitored closely at the start of therapy. This is because ciclosporin may increase the absorption of pravastatin into the body.
The effect of vitamin K antagonists (anticoagulants such as warfarin and phenprocoumon) should be monitored closely, especially at the beginning and after discontinuation of therapy with pravastatin.
Concurrent use of colchicine (gout medication), macrolides (antibiotics such as erythromycin, clarithromycin), or fusidic acid (antibiotic) increases the risk of muscle disorders (myopathies).
Age Limit
Safety and efficacy of pravastatin in children younger than eight years of age have not been established. Therefore, the statin should not be given at this age.
Pregnancy and Lactation
Pravastatin is contraindicated in pregnancy and lactation according to the manufacturer’s instructions.
However, since the safety of pravastatin has not been conclusively proven and, as a rule, no disadvantages for the mother are to be expected from interrupting therapy for the duration of pregnancy, the active substance should not be newly prescribed during pregnancy and existing therapy should be interrupted.
For breastfeeding, experts also recommend refraining from taking lipid-lowering agents such as pravastatin.
How to obtain medicines containing pravastatin
Medicines containing the cholesterol-lowering drug pravastatin are available on prescription in Germany, Austria, and Switzerland in any dosage.
How long has pravastatin been known?
Pravastatin was developed from a natural cholesterol-lowering agent in the fungus Penicillium citrinum, which was discovered in the 1970s. In Germany, the active ingredient came onto the market as the third statin after lovastatin and simvastatin in 1991.
Patent protection has since expired, and there are many inexpensive generics containing the active ingredient pravastatin.
