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Patients taking the prescription drug pravastatin, which is a member of the statin family of cholesterol-lowering drugs, should be aware that it has clinically important interactions with many other prescription medications.
The Food and Drug Administration has approved pravastatin for, among other things, reducing the risk of heart attack, stroke and death due to coronary heart disease in adults who have known coronary heart disease (secondary prevention) and in adults without clinically...
Patients taking the prescription drug pravastatin, which is a member of the statin family of cholesterol-lowering drugs, should be aware that it has clinically important interactions with many other prescription medications.
The Food and Drug Administration has approved pravastatin for, among other things, reducing the risk of heart attack, stroke and death due to coronary heart disease in adults who have known coronary heart disease (secondary prevention) and in adults without clinically evident coronary heart disease (primary prevention).[1] The drug currently is marketed only in generic versions.
Drugs that increase risk of pravastatin toxicity[2],[3]
The Table, below, lists examples of oral drugs that, when taken concomitantly with pravastatin, increase the risk of pravastatin muscle toxicity. The list includes certain macrolide antibiotics, antiviral drugs for HIV infection or hepatitis C infection, other blood-lipid–lowering drugs, the antidepressant nefazodone (available in generic only) and the gout drug colchicine (COLCRYS, COL-PROBENECID, GLOPERBA, MITIGARE).
Most of these drugs, when used concomitantly with pravastatin, slow the removal of pravastatin from the body and can thereby increase pravastatin levels in the blood to toxic levels. For example, one study found that healthy volunteers who took 1,200 milligrams (mg) of the lipid-lowering fibrate drug gemfibrozil (LOPID) daily for three days and then took a single 40-mg dose of pravastatin on the third day on average had approximately twofold higher blood levels of pravastatin compared with volunteers who took a placebo for three days before taking the same dose of pravastatin.[4]
High blood levels of pravastatin increase the risk of myopathy (muscle damage). Symptoms of myopathy include muscle pain and weakness. In severe cases, this condition can progress to rhabdomyolysis, a life-threatening, muscle-destroying condition that can lead to sudden kidney failure and death. Patients who already have impaired kidney function or uncontrolled hypothyroidism (low thyroid hormone levels) and those who are age 65 or older or taking a high pravastatin dosage are also at increased risk of myopathy and rhabdomyolysis because of higher blood levels of pravastatin.
For some of the drugs listed in the table, such as colchicine and niacin (NIACOR), the exact mechanism by which the concomitant use of the drug with pravastatin further increases the risk of muscle injury is unclear.
Examples of Oral Drugs That Increase the Risk of Pravastatin Toxicity
| Generic Name | Brand Name(s) | Drug Class |
|---|---|---|
| atazanavir | EVOTAZ,† REYATAZ | Antiviral drug for HIV infection |
| bempedoic acid | NEXLETOL, NEXLIZET† | Cholesterol-lowering drug |
| clarithromycin* | BIAXIN XL, VOQUEZNA TRIPLE PAK† | Macrolide antibiotic |
| colchicine | COLCRYS, COL-PROBENECID,† GLOPERBA, MITIGARE | Gout drug |
| cyclosporine | GENGRAF, NEORAL, SANDIMMUNE | Immunosuppressant/organ-transplant drug |
| darunavir | PREZCOBIX,† PREZISTA, SYMTUZA† | Antiviral drug for HIV infection |
| erythromycin | E.E.S., E.E.S. 400, ERY-TAB, ERYC, ERYPED, ERYTHROCIN STEARATE | Macrolide antibiotic |
| fenofibrate** | ANTARA, FENOGLIDE, LIPOFEN, TRICOR, TRIGLIDE, TRILIPIX | Blood-lipid–lowering drug |
| gemfibrozil** | LOPID | Blood-lipid–lowering drug |
| glecaprevir | MAVYRET† | Antiviral drug for hepatitis C infection |
| nefazodone** | generic only | Antidepressant |
| niacin | NIACOR | Vitamin, blood-lipid–lowering drug |
| ritonavir | KALETRA,† NORVIR, PAXLOVID† | Antiviral drug for HIV infection |
| voxilaprevir | VOSEVI† | Antiviral drug for hepatitis C infection |
†Combination brand-name drug that contains one or more other active ingredients
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News
Other important interactions[5]
There are several other drugs that when taken concomitantly with pravastatin may result in reduced pravastatin blood levels, potentially decreasing its effectiveness in lowering blood cholesterol levels. Examples of such drugs include the cholesterol-lowering drugs cholestyramine (PREVALITE) and colestipol (COLESTID) as well as lanthanum carbonate (FOSRENOL), which is used to reduce high blood phosphate levels in patients with end-stage kidney disease. Concomitant use of the dietary supplement St. John’s wort also may result in reduced pravastatin blood levels.
What You Can Do
If you need treatment with pravastatin, review all your other medications with your doctor to assess your risk of potentially significant drug interactions. If you are taking certain medications that interact with pravastatin, you may need a lower dose of, or your doctor may advise you to stop, either pravastatin or the interacting drug. Be aware that other drugs not listed in this article also may have dangerous interactions with pravastatin.
References
[1] Bristol-Myers Squibb Company. Label: pravastatin (PRAVACHOL). May 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/019898s070lbl.pdf. Accessed July 7, 2022.
[2] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “pravastatin.” Accessed July 7, 2022.
[3] Bristol-Myers Squibb Company. Label: pravastatin (PRAVACHOL). May 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/019898s070lbl.pdf. July 7, 2022.
[4] Kyrklund C, Backman JT, Neuvonen M, Neuvonen PJ. Gemfibrozil increases plasma pravastatin concentrations and reduces pravastatin renal clearance. Clin Pharmacol Ther. 2003;73(6):538-544.
[5] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “pravastatin.” Accessed July 7, 2022.
