PRAVASTATIN
(pra-vah-stat'in)
Pravachol
Classifications: cardiovascular agent; antilipemic; hmg-coa reductase inhibitor (statin)
Prototype: Lovastatin
Pregnancy Category: X

Availability

10 mg, 20 mg, 40 mg, 80 mg tablets

Actions

Competitively inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes cholesterol biosynthesis. HMG-CoA reductase inhibitors (statins) increase serum HDL cholesterol levels and decrease serum LDL cholesterol, VLDL cholesterol, and plasma triglyceride levels.

Therapeutic Effects

It is effective in reducing total and LDL cholesterol in various forms of hypercholesterolemia.

Uses

Hypercholesterolemia (alone or in combination with bile acid sequestrants) and familial hypercholesterolemia.

Contraindications

Hypersensitivity to pravastatin; active liver disease or unexplained elevated liver function test; pregnancy (category X), lactation. Safety and efficacy in children <8 y are not established.

Cautious Use

Alcoholics, history of liver disease; renal impairment.

Route & Dosage

Hyperlipidemia
Adult: PO 10–80 mg q.d.
Child: PO 8–13 y, 20 mg q.d.

Administration

Oral

Give without regard to meals.
Give in the evening.

Adverse Effects (1%)

GI: Nausea, diarrhea, abdominal pain, vomiting, constipation, flatulence, heartburn, transient elevations in serum liver transaminase levels. Other: Fatigue, rhinitis, cough, transient elevations in CPK.

Interactions

Drug: May increase PT when administered with warfarin.

Pharmacokinetics

Absorption: Poorly absorbed from GI tract; 17% reaches systemic circulation. Onset: 2 wk. Peak: 4 wk. Distribution: 43–55% protein bound; does not cross blood–brain barrier; crosses placenta; distributed into breast milk. Metabolism: Extensive first-pass metabolism in liver; has no active metabolites. Elimination: 20% of dose excreted in urine, 71% in feces. Half-Life: 1.8–2.6 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Perform liver function tests at start of therapy and then at 12 wk. If normal at 12 wk, may change to semiannual monitoring. Monitor cholesterol levels throughout therapy.
Monitor coagulation studies with patients receiving concurrent warfarin therapy. PT may be prolonged.
Monitor CPK levels if patient experiences unexplained muscle pain.

Patient & Family Education

Report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever, to physician promptly.
Report signs of bleeding to physician promptly when taking concomitant warfarin therapy.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug