Pravastatin sodium

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.