Pravastatin

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient pravastatin is a cholesterol-lowering drug from the group of statins, which are also called HMG-CoA reductase inhibitors due to their function in the body. HMG-CoA reductase is an enzyme that produces the building blocks for cholesterol in the liver. The enzyme inhibition means that less cholesterol is formed, which has a positive influence on the health of the cardiovascular system. Here you can read everything you need to know about the effects and use of pravastatin, side effects and interactions.

This is how pravastatin works

The active ingredient pravastatin inhibits the production of the natural substance cholesterol. Cholesterol has different tasks in the human and animal organism:

• It is an essential part of every cell membrane in the body and ensures its stability and flexibility.
• It is the starting material for the manufacture of male and female sex hormones such as testosterone and estrogen.

Various hereditary diseases, diabetes, alcohol addiction, obesity and an improper diet can lead to hypercholesterolemia - a high level of cholesterol in the blood. In the long run, this can lead to arteriosclerosis, ie "vascular calcification" (actually a deposit of fats such as cholesterol and blood cells in the vessels. Over time, the deposits can become so large that they close a vessel. Depending on the location, this leads to a heart attack or stroke.

Statins like pravastatin inhibit the body's production of cholesterol in the liver. As a result, not only is less cholesterol released into the blood. The cholesterol already in the blood also drops because the liver absorbs it more (among other things to produce bile acids).

Absorption, breakdown and excretion of cholesterol

After ingestion, pravastatin is quickly absorbed into the blood through the intestines, but only about a fifth of the dose ingested reaches the mainstream bloodstream. The highest blood levels are measured about an hour after ingestion. About a third of the dose ingested reaches the liver, where pravastatin works. About a quarter of the active substance is excreted in the urine, the rest in the bile with the stool. Pravastatin is partially broken down in the liver. After about two hours, half of the ingested active ingredient is excreted.

When is pravastatin used?

The cholesterol-lowering drug pravastatin is used to treat high blood cholesterol levels when previously non-drug measures such as diet, exercise and weight loss have not been successful. It can be used both to prevent vascular occlusion in patients with risk factors (such as diabetes) and to prevent further vascular occlusion after a heart attack. It is also used after organ transplants to regulate blood lipid levels.

Statins like pravastatin have to be taken for a long time in order to maintain the cholesterol-lowering effect over the long term.

This is how pravastatin is used

The active ingredient pravastatin is taken once a day in the evening - either with or without a meal. Usual dosages are 10, 20, or 40 milligrams of pravastatin per day. To support the therapy, a lipid-lowering diet should still be adhered to: low in animal fats (high in cholesterol).

Pravastatin starts to work in about a week and reaches its maximum effectiveness after about a month. If necessary, the dosage must then be adjusted.

If therapy with pravastatin alone is not sufficient, a so-called anion exchange resin such as cholestyramine can also be given. It binds bile acids in the intestine, so that they are not (as usual) reabsorbed into the blood. This stimulates the formation of new bile acids from cholesterol - the cholesterol level drops.

What are the side effects of pravastatin?

Possible side effects of pravastatin include dizziness, headache, sleep disorders, visual disturbances, indigestion, abdominal pain, nausea, vomiting, constipation, diarrhea, itching, rash, urination disorders, sexual function disorders and fatigue. These pravastatin side effects may occur in one in one hundred to one thousand patients.

Special attention must be paid to muscle and joint pain during therapy. If these occur more often or over a longer period of time, the attending physician must be notified. This can lead to serious complications such as kidney failure.

What should be considered when taking pravastatin?

Just like statins, fibrates (gemfibrozil, fenofibrate) are used against excessively high blood lipid and cholesterol levels. However, the two groups of active ingredients should not be taken together because they both have a potentially muscle-damaging effect and this effect could be intensified in combination.

If pravastatin is combined with the anion exchanger cholestyramine, the intake should be staggered: Pravastatin should be taken at least one hour before or at least four hours after cholestyramine.

In organ transplant patients who receive the immunosuppressant cyclosporine to counteract the rejection reaction, the pravastatin blood level should be closely monitored at the start of therapy. Ciclosporin could increase the uptake of pravastatin in the body.

Because of a potential risk to the fetus, pravastatin must not be used during pregnancy. Since the active ingredient passes into breast milk even in small amounts, breastfeeding must be stopped if necessary before starting therapy with pravastatin.

Children with certain genetic diseases can be treated with pravastatin in reduced doses from the age of eight. No dose adjustment is necessary in elderly patients. In patients with moderate or severe renal or hepatic impairment, therapy should be started with a low starting dose and the response should be monitored.

How to get medication with pravastatin

Medicines containing the cholesterol-lowering drug pravastatin require a prescription in every dose.

How long has pravastatin been known?

Pravastatin was made from a natural cholesterol lowering agent found in the fungus Penicillium citrinum, which was discovered in the 1970s, developed by the pharmaceutical company Sankyo Pharma. In Germany, the active ingredient came on the market as the third statin after Lovastatin and Simvastatin in 1991. The patent protection has now expired and there are many inexpensive generics with the active ingredient pravastatin.

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