• Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias.
• Primary prevention of coronary heart disease (myocardial infarction, coronary revascularization, cardiovascular mortality) in asymptomatic patients with increased total and low-density lipiprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol.
• Secondary prevention of myocardial infarction, coronary revascularization, stroke, and overall mortality in patients with clinically evident coronary heart disease.

Contraindicated in:

• Hypersensitivity
• Active liver disease or unexplained persistent ↑ in AST and ALT
• OB: Avoid use during pregnancy (may cause fetal harm)
• Lactation: Avoid breastfeeding if treatment is necessary.

Use Cautiously in:

• History of liver disease
• Alcoholism
• Renal impairment
• Women of reproductive potential
• Pedi: Children <8 yr (safety and effectiveness not established).

CNS: amnesia, confusion, dizziness, headache, insomnia, memory loss, weakness.

EENT: rhinitis.

Resp: bronchitis.

CV: chest pain, peripheral edema.

GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, ↑ liver enzymes, nausea, pancreatitis.

GU: erectile dysfunction.

Derm: rash, pruritus.

Endo: hyperglycemia.

MS: RHABDOMYOLYSIS, arthralgia, arthritis, immune-mediated necrotizing myopathy, myalgia, myositis.
Misc: hypersensitivity reactions.

Drug-Drug:

• Cholesterol-lowering effect may be ↑ with bile acid sequestrants (cholestyramine, colestipol).
• Bioavailability may be ↓ by bile acid sequestrants; administer pravastatin 1 hr before or 4 hr after bile acid sequestrants.
• Risk of myopathy is ↑ by concurrentcyclosporine, fibrates, colchicine, erythromycin, clarithromycin, azithromycin, or large doses of niacin; concurrent use with gemfibrozil should be avoided; consider lower dose of pravastatin with niacin.
• May ↑ effects of warfarin.
• Levels may be significantly ↑ by azole antifungals (temporarily discontinue HMG-CoA reductase inhibitor, effect is less than with other statins).
• Saquinavir and ritonavir may ↓ levels and effectiveness.

(Generic available)

• Tablets: 10 mg; 20 mg; 40 mg; 80 mg;

• PO (Adults): 40 mg once daily at bedtime, may be ↑ after 4 wk, if needed to 80 mg once daily at bedtime); Concurrent cyclosporine therapy — Initiate therapy with 10 mg once daily at bedtime; may be ↑ after 4 wk, if needed, to 20 mg once daily at bedtime (max dose = 20 mg/day); Concurrent clarithromycin therapy — Dose should not exceed 40 mg/day.
• PO (Children 14–18 yrs): 40 mg once daily (max dose = 40 mg/day).
• PO (Children 8–13 yrs): 20 mg once daily (max dose = 20 mg/day).

Pravachol

• Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol.

• Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL cholesterol.
• Slows the progression of coronary atherosclerosis with resultant decrease in coronary heart disease-related events.

Therapeutic Classification: lipid-lowering agents

Pharmacologic Classification: hmg coa reductase inhibitors (statins)

Absorption: Poorly and variably absorbed following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Extensively metabolized by the liver, most during first pass; excreted in bile and feces. 20% excreted unchanged by the kidneys.

Half-life: 1.3–2.7 hr.

(cholesterol-lowering effect)

• Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Advise patient to avoid drinking more that 200 mL/day of grapefruit juice during therapy. Medication helps control but does not cure elevated serum cholesterol levels.
• Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
• Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
• Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare).
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Advise female patient to use effective contraception during therapy. Instruct female patients to notify health care professional promptly if pregnancy is planned or suspected. Advise patient to avoid breastfeeding during therapy.
• Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.

PRA-va-sta-tin