HMG-CoA reductase inhibitor (hydrophilic statin) Pregnancy: Contraindicated during pregnancy and breastfeeding. Administer to women of childbearing potential only when they are unlikely to conceive and have been informed of the potential risk; discontinue immediately if pregnancy occurs or is planned.

Pravastatin sodium

Brand names: Lipostat

Pravastatin is a hydrophilic HMG-CoA reductase inhibitor (statin) used to lower cholesterol and reduce cardiovascular risk in primary and secondary prevention.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10-40 mg

Route: Oral

Frequency: Once daily (preferably in the evening), with or without food

Max: 40 mg daily

Hypercholesterolaemia: recommended dose range 10-40 mg once daily; therapeutic response seen within a week and full effect within four weeks - adjust dose to lipid response. Maximum daily dose 40 mg. Cardiovascular prevention: the only studied starting/maintenance dose in outcome trials was 40 mg daily. After organ transplantation on immunosuppressive therapy: start 20 mg/day, adjust up to 40 mg under close medical supervision. With ciclosporin (with or without other immunosuppressants): begin 20 mg once daily, titrate to 40 mg with caution. Give either 1 hour before or at least 4 hours after a bile acid-binding resin. Children/adolescents 8-18 years with heterozygous familial hypercholesterolaemia: 10-20 mg once daily (8-13 years) or 10-40 mg daily (14-18 years) - not a per-kg dose; no data under 8 years.

Dose adjustments

Renal

A starting dose of 10 mg a day is recommended in patients with moderate or severe renal impairment (or significant hepatic impairment); adjust according to lipid response under medical supervision.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active liver disease, including unexplained persistent elevations of serum transaminases exceeding 3 x the upper limit of normal
Pregnancy and lactation

Side effects

Nervous system: dizziness, headache, sleep disturbance, insomnia (uncommon)
Gastrointestinal: dyspepsia/heartburn, abdominal pain, nausea/vomiting, constipation, diarrhoea, flatulence (uncommon)
Skin: pruritus, rash, urticaria, scalp/hair abnormality including alopecia (uncommon)
Musculoskeletal: myalgia, muscle cramps, muscle weakness, elevated CK; very rarely rhabdomyolysis
Very rare: hypersensitivity (anaphylaxis, angioedema), pancreatitis, jaundice/hepatitis, hepatic failure

Interactions

Ciclosporin: increased pravastatin exposure and myopathy/rhabdomyolysis risk - begin 20 mg once daily and titrate with caution
Fibrates: combination not recommended (increased risk of muscular toxicity)
Niacin (nicotinic acid) and erythromycin/clarithromycin (macrolides): increased risk of myopathy
Bile acid-binding resins (colestyramine, colestipol): give pravastatin 1 hour before or at least 4 hours after the resin

Clinical monograph

How it works

It competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis, upregulating LDL receptors and lowering circulating LDL-cholesterol.

Prescribing in practice

Advise patients to report unexplained muscle pain, tenderness or weakness promptly because of the risk of myopathy and rhabdomyolysis.
It is contraindicated in active liver disease and in pregnancy and breastfeeding.
Pravastatin is largely independent of CYP3A4 metabolism, so it has fewer interactions with strong CYP3A4 inhibitors than some other statins.

Monitoring

Check liver function before starting and as clinically indicated, and a lipid profile to assess response; check creatine kinase if muscle symptoms occur.

Counselling the patient

Report any unexplained muscle aches, tenderness or weakness.
It can usually be taken at any time of day, with or without food.
Avoid use in pregnancy and tell your clinician if you may be pregnant.

Evidence & guidelines

Statins reduce major cardiovascular events across primary and secondary prevention, supporting their use in line with NICE lipid-modification guidance.

Reference: NICE NG181; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways