[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Statins](https://durgical.com/en/pharmacology/classes/statins/) › Pravastatin [Pharmacology](https://durgical.com/en/pharmacology/) · [Statins](https://durgical.com/en/pharmacology/classes/statins/) # Pravastatin A water-soluble statin that is not metabolized by CYP enzymes, so it has fewer drug interactions. It lowers LDL and prevents heart attacks. Updated 2026-11-01 - Class: [Statins](https://durgical.com/en/pharmacology/classes/statins/) - Enzyme: HMG-CoA reductase - ATC code: C10AA03 - WHO Model List of Essential Medicines ✂**HMG-CoA reductase**Pravastatin ⓘ The figure shows compactin (mevastatin), the fungal statin from which pravastatin is derived, in the HMG-CoA pocket of human HMG-CoA reductase; pravastatin occupies the same site. **Target in 3D:** HMG-CoA reductase. PDB structure 1HW8 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1HW8) · Drag to rotate · pinch to zoom ## Mechanism of action Pravastatin is an open-ring hydroxy acid that competitively inhibits HMG-CoA reductase in the liver. Less cholesterol synthesis activates SREBP-2, which raises LDL receptors on hepatocytes and increases LDL clearance from the blood. Being hydrophilic, it depends on active uptake into hepatocytes. - Taken up into hepatocytes and blocks HMG-CoA reductase - Liver cholesterol synthesis falls - More LDL receptors clear LDL from the blood - Fewer coronary events ## Pharmacokinetics **Absorption** Oral, already in its active form; absolute bioavailability about 17% because of first-pass uptake by the liver. **Metabolism** Not metabolized to any appreciable extent by CYP enzymes; it is converted by isomerization and ring hydroxylation. **Elimination** Both routes: after an intravenous dose about half is cleared by the kidney and half by bile and biotransformation. **Half-life** Short: about 1.8 hours for the parent drug. ## Indications - High LDL cholesterol and prevention of coronary events [Atherosclerosis and dyslipidaemia →](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - Heterozygous familial hypercholesterolemia in children and adolescents [Familial hypercholesterolemia →](https://durgical.com/en/conditions/familial-hypercholesterolemia/) - Secondary prevention after myocardial infarction [Myocardial Infarction (Heart Attack) →](https://durgical.com/en/conditions/myocardial-infarction/) ## Adverse effects ### Common - Muscle aches - Headache, nausea, diarrhea - Raised liver transaminases - Rises in HbA1c and fasting glucose ### Serious (rare, important) - Myopathy and rhabdomyolysis (rare) - Immune-mediated necrotizing myopathy (rare) - Liver injury (rare) ## Contraindications - Acute liver failure or decompensated cirrhosis - Hypersensitivity to pravastatin or an excipient ## Key interactions **Gemfibrozil** Increased myopathy risk; the combination is avoided. **Cyclosporine** Raises pravastatin exposure; the dose is restricted. **Clarithromycin, erythromycin** Raise pravastatin exposure (through transporters, not CYP3A4); the dose is limited. **Other fibrates, niacin** Add to the muscle risk; benefit is weighed against risk. ## What is monitored - Lipid panel before and some weeks after starting - Liver enzymes at baseline and when clinically indicated - Creatine kinase if there are muscle symptoms ## Administration and safety - Oral tablet once daily; its short half-life is why it was traditionally given in the evening. - With a bile acid sequestrant, pravastatin is given at least 1 hour before or 4 hours after it. - Lower starting doses are used in severe kidney impairment. ## Nursing care - Before: lipid panel, liver enzymes and a medication review. - Ask about muscle pain, weakness or dark urine. - Teach daily adherence alongside diet and exercise. - Ask about pregnancy plans. ## Pregnancy and breastfeeding Stopped when pregnancy is recognized, with case-by-case weighing in very high-risk patients; not used while breastfeeding. ## Memory aid «Prava-statin = Pure statin»: water-soluble and ignored by CYP enzymes, it is the statin of choice when the medication list is long. ## Test yourself Think of the answer, then tap the question to see it. ## Why does pravastatin have fewer CYP3A4 interactions than simvastatin? It is not metabolized to any appreciable extent by CYP enzymes; it is cleared by isomerization, hydroxylation and excretion. ## Why does clarithromycin still raise pravastatin levels? Through transporters (OATP uptake), not CYP3A4, so the pravastatin dose is limited. ## Which statin is used for heterozygous familial hypercholesterolemia from childhood? Pravastatin is one of the statins labelled for children and adolescents with heterozygous FH. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/pravastatin/) ## Related drugs - [Rosuvastatin](https://durgical.com/en/pharmacology/rosuvastatin/) - [Simvastatin](https://durgical.com/en/pharmacology/simvastatin/) - [Lovastatin](https://durgical.com/en/pharmacology/lovastatin/) ## Related conditions - [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - [Familial hypercholesterolemia](https://durgical.com/en/conditions/familial-hypercholesterolemia/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) [← Back to the class: Statins](https://durgical.com/en/pharmacology/classes/statins/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Pravastatin: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a692025.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - PRAVASTATIN SODIUM tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=be592e98-8a17-4c18-99b8-0f3a67000e2d) (DailyMed (U.S. National Library of Medicine), 2026); [COMPLEX OF THE CATALYTIC PORTION OF HUMAN HMG-COA REDUCTASE WITH COMPACTIN (ALSO KNOWN AS MEVASTATIN)](https://www.rcsb.org/structure/1HW8) (RCSB Protein Data Bank, 2001); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 37 (McGraw Hill, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/pravastatin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/pravastatin/