Names and pronunciation
(pra′va-sta-tin) Pravachol
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Drug reference
(pra′va-sta-tin) Pravachol
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Func. class.: Antilipemic
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Chem. class.: HMG-CoA reductase enzyme
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Do not confuse: Pravachol/Prevacid/propranolol
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ACTION: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
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USES: As an adjunct for primary hypercholesterolemia (types IIa, IIb, III, IV), to reduce the risk for recurrent MI, atherosclerosis, primary/secondary CV events, stroke, TIAs
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CONTRAINDICATIONS: Preg nancy, breastfeeding, hypersensitivity, active hepatic disease Precautions: Past hepatic disease, alco- holism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, renal disease
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SIDE EFFECTS CNS: Headache, dizziness, fatigue, confusion CV: Chest pain EENT: Lens opacities GI: Nausea, constipation, diarrhea, flatus, abdominal pain, heartburn, hepatic dys- function, pancreatitis, hepatitis GU: Renal failure (myoglobinuria) INTEG: Rash, pruritus MS: Muscle cramps, myalgia, myositis, rhabdomyolysis RESP: Common cold, rhinitis, cough, URI
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INTERACTIONS myopathy, rhabdomyolysis Increase: risk—erythromycin, niacin, cycloSPO- RINE, gemfibrozil, clofibrate, clarithromy- cin, itraconazole, protease inhibitors Decrease: bioavailability of pravastatin— bile acid sequestrants Drug/Herb Increase: adverse reactions—red yeast rice Increase: hepatotoxicity—eucalyptus Decrease: effect—St. John’s wort Drug/Lab Test Increase: CK, LFTs Altered: thyroid function tests
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DOSAGE AND ROUTES • Adult: PO 40 mg/day at bedtime (range 10-80 mg/day); start at 10 mg/day if pa- tient also taking immunosuppressants or has significant renal/hepatic disease • Adolescent 14-18 yr: PO 40 mg/day • Child 8-13 yr: PO 20 mg/day Renal dose • Adult: PO 10-20 mg daily at bedtime, increase at 4-wk intervals
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Available forms: Tabs 10, 20, 40, 80 mg
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Administer: • Without regard to meals, at bedtime • Give 4 hr after bile acid sequestrants • Store in cool environment in tight con- tainer protected from light
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Assess: • Fasting lipid profile: LDL, HDL, triglyc- erides, cholesterol at baseline, q12wk, then q6mo when stable; obtain diet his- tory • Hepatic studies: baseline, then when clinically indicated; LFTs may increase • Renal studies: I&O in those with com- promised renal system P • Rhabdomyolysis: muscle tenderness, pain; obtain CPK if clinically indicated; therapy should be discontinued • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: decrease in LDL total cholesterol, triglycerides; increase in HDL
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blood work will be necessary dur- ing treatment • To report blurred vision, severe GI symptoms, dizziness, headache, muscle pain, weakness, fever • That regimen will continue: low-cho- lesterol diet, exercise program; that if taking a product like cholestyramine, to take this product at least 1 hr prior to or 4 hr after the bile acid resin • To report suspected, planned preg- nancy; not to use product during preg- nancy; not to breastfeed • Hepatic disease: to notify pre- scriber of lack of appetite, yellow sclera/skin, dark urine, abdominal pain, weakness
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PHARMACOKINETICS Peak 1-11/2 hr; metabolized by liver; protein binding 50%; excreted in urine 20%, feces 70%, breast milk; crosses placenta; half-life 1.25-2.25 hr
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• Adult: PO 40 mg/day at bedtime (range 10-80 mg/day); start at 10 mg/day if pa- tient also taking immunosuppressants or has significant renal/hepatic disease
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• Adolescent 14-18 yr: PO 40 mg/day
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• Child 8-13 yr: PO 20 mg/day Renal dose
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• Adult: PO 10-20 mg daily at bedtime, increase at 4-wk intervals
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