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pravastatin sodium

(prah va sta' tin)


Pravachol

Pregnancy Category X

Drug classes
Antihyperlipidemic
HMG-CoA reductase inhibitor

Therapeutic actions
Inhibits the enzyme HMG-CoA that catalyzes the first step in the cholesterol synthesis
pathway, resulting in a decrease in serum cholesterol, serum LDLs (associated with
increased risk of CAD), and either an increase or no change in serum HDLs (associated
with decreased risk of CAD).

Indications
• Prevention of first MI and reduction of death from CV disease in patients with
hypercholesterolemia at risk of first MI
• Adjunct to diet in the treatment of elevated total cholesterol and LDL cholesterol
with primary hypercholesterolemia (types IIa and IIb) in patients unresponsive to
dietary restriction of saturated fat and cholesterol and other nonpharmacologic
measures
• Slow the progression of coronary atherosclerosis in patients with clinically
evident CAD to reduce the risk of acute coronary events in hypercholesterolemia
patients
• Reduce the risk of stroke or TIA in patients with history of MI and normal
cholesterol levels
• Reduce the risk of recurrent MI and death from heart disease in patients with
history of MI and normal cholesterol levels
• Treatment of children > 8 yr with heterozygous familial hypercholesterolemia as
an adjust to diet and exercise.

Contraindications and cautions


• Contraindicated with allergy to pravastatin, fungal byproducts, pregnancy,
lactation.
• Use cautiously with impaired hepatic function, cataracts, alcoholism.

Available forms
Tablets—10, 20, 40, 80 mg

Dosages
ADULTS
Initially, 10–40 mg/day PO given once daily. Adjust dose q 4 wk based on response.
Maximum daily dose is 80 mg. Maintenance doses range from 40–80 mg/day in single hs
dose.
• Concomitant immunosuppressive therapy: 10 mg PO daily hs to a maximum of
20 mg/day.
PEDIATRIC PATIENTS
8–13 yr: 20 mg/day PO.
14–18 yr: 40 mg/day PO.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
10 mg PO once daily at bedtime; may increase up to 20 mg/day.

Pharmacokinetics
Route Onset Peak
Oral Slow 60–90 min

Metabolism: Hepatic; T1/2: 1.8 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Headache, blurred vision, dizziness, insomnia, fatigue, muscle cramps,
cataracts
• GI: Flatulence, abdominal pain, cramps, constipation, nausea, vomiting,
heartburn
• Hematologic: Elevations of CPK, alkaline phosphatase, and transaminases

Interactions
Drug-drug
• Possible severe myopathy or rhabdomyolysis with cyclosporine, erythromycin,
gemfibrozil, niacin
• Possible increased digoxin, warfarin levels if combined; monitor patient and
decrease dosage as needed
• Increased pravastatin levels with itraconazole; avoid this combination
• Decreased pravastatin levels if combined with bile acid sequestrants; space at
least 4 hr apart

Nursing considerations
Assessment
• History: Allergy to pravastatin, fungal byproducts; impaired hepatic function;
cataracts; pregnancy; lactation
• Physical: Orientation, affect, ophthalmologic exam; liver evaluation; lipid
studies, liver function tests

Interventions
• Caution patient that this drug cannot be used during pregnancy; advise patient to
use barrier contraceptives.
• Administer drug hs; highest rates of cholesterol synthesis are between midnight
and 5 AM.
• Arrange for periodic ophthalmologic exam to check for cataract development;
monitor liver function.

Teaching points
• Take drug at bedtime.
• This drug cannot be taken during pregnancy; using barrier contraceptives is
advised.
• Have periodic ophthalmic exams while you are using this drug.
• These side effects may occur: Nausea (eat frequent small meals); headache,
muscle and joint aches and pains (may lessen); sensitivity to sunlight (use
sunblock and wear protective clothing).
• Report severe GI upset, changes in vision, unusual bleeding or bruising, dark
urine or light-colored stools, muscle pain or weakness.

Adverse effects in Italic are most common; those in Bold are life-threatening.