Also indexed as: Pravachol
About pravastatin
Pravastatin is a member of the HMG-CoA reductase inhibitor family of drugs, also called
“statins,” such as lovastatin and
simvastatin. Pravastatin blocks a key step in
the body’s production of cholesterol and is used to lower cholesterol levels in people
with hypercholesterolemia (high
cholesterol).
Helpful Products
Try these helpful products which may be beneficial if taken with this medicine
- CoQ10
- Supplementing with 30 to 100 mg of coenzyme Q10 per day may maintain adequate blood levels
of this heart-healthy nutrient
- Cholesterol-lowering margarine
- Using margarines containing sitostanol (Benecol), which is made from pine tree wood pulp
and naturally occurring unsaturated sterols obtained from soybean oil (Take Control), can help
lower LDL (“bad”) cholesterol
These recommendations are not comprehensive and are not intended to
replace the advice of your doctor or pharmacist. Continue reading the full article for more
information on interactions with vitamins, herbs, and foods.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Coenzyme Q10
|
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Milk thistle*
|
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Fish oil (EPA)
Sitostanol
|
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
Red yeast rice
|
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Vitamin A
Vitamin B3 (niacin)
|
| Reduced drug
absorption/bioavailability |
None known
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Coenzyme
Q10
In double-blind trials, treatment with pravastatin and other HMG-CoA reductase inhibitors has
resulted in depleted blood levels of coenzyme Q10 (CoQ10).1 2
Supplementation with 90–100 mg CoQ10 per day has been shown to prevent reductions in
blood levels of CoQ10 due to simvastatin,
another drug in the same category as pravastatin.3 4 However, some
investigators have questioned whether it is worthwhile or necessary for individuals taking
HMG-CoA reductase inhibitors to supplement with CoQ10.5 Until more is known, people
taking pravastatin should ask a doctor about supplementation with 30–100 mg CoQ10 per
day.
Fish
oil
The omega-3 fatty acid EPA present in fish oil may improve the cholesterol and triglyceride-lowering effect of pravastatin. In a
preliminary trial, people with high cholesterol who had been taking pravastatin for about
three years were able to significantly lower their triglyceride levels and raise their levels
of HDL (“good”) cholesterol by supplementing with either 900 mg or 1,800 mg of EPA
for three months in addition to pravastatin.6 The authors of the study concluded
that the combination of pravastatin and EPA may prevent coronary heart disease better than
pravastatin alone.
Vitamin B3
(niacin)
Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin
plus niacin to lower cholesterol.7 Niacin was added over a two week period, to a
maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin was
continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in
significantly reduced cholesterol levels. Others have also shown that the combination of
pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin
alone.8 However, large amounts of niacin taken with pravastatin might cause serious
muscle disorders (myopathy or rhabdomyolysis).9 Individuals taking pravastatin
should consult a doctor before taking niacin.
Sitostanol
A synthetic molecule related to
beta-sitosterol, sitostanol, is available in a special margarine and has been shown to lower cholesterol levels. In one study, supplementing
with 1.8 grams of sitostanol per day for six weeks enhanced the cholesterol-lowering effect of
various statin drugs.10
Vitamin
A
A study of 37 people with high cholesterol treated with diet and HMG-CoA reductase inhibitors
found serum vitamin A levels increased over two years of therapy.11 It remains
unclear whether this moderate increase suggests that people taking lovastatin have a
particular need to restrict vitamin A supplementation.
Interactions with Herbs
Milk
thistle (Silybum marianum)
One of the possible side effects of pravastatin is liver toxicity. Although no clinical
studies substantiate its use with pravastatin, a milk thistle extract standardized to
70–80% silymarin may reduce the potential liver toxicity of pravastatin. The suggested
use is 200 mg of the extract three times daily.
Red yeast rice
(Monascus purpureas)
A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been
shown to effectively lower cholesterol and triglycerides in people with moderately elevated
levels of these blood lipids.12 This extract contains small amounts of naturally
occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used by people who
are currently taking a statin medication.
Interactions with Foods and Other Compounds
Food
Pravastatin may be taken with or without food.13
Grapefruit
juice
While grapefruit juice is known to increase levels of lovastatin14 and some other statin drugs,
this interaction does not occur between grapefruit juice and pravastatin.15 It
appears, therefore, that people taking pravastatin can safely consume grapefruit or grapefruit
juice.
References:1. Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum
coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med
1997;18(suppl):S137–44.
2. Ghirlanda G, Oradei A, Manto A, et al. Evidence of plasma
CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled
study. J Clin Pharmacol 1993;33:226–9.
3. Bargossi AM, Grossi G, Fiorella PL, et al. Exogenous CoQ10
supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors.
Molec Aspects Med 1994;15(suppl):s187–93.
4. Miyake Y, Shouzu A, Nishikawa M, et al. Effect of treatment with
3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on serum coenzyme Q10 in diabetic
patients. Arzneimittelforschung 1999;49:324–9.
5. Paloma’ki A, Malminiemi K, Solakivi T, Malminiemi O. Ubiquinone
supplementation during lovastatin treatment: Effect of LDL oxidation ex vivo. J Lipid
Res 1998;39:1430–7.
6. Nakamura N, Hamazaki T, Ohta M, et al. Joint effects of HMG-CoA
reductase inhibitors and eicosapentaenoic acids on serum lipid profile and plasma fatty acid
concentrations in patients with hyperlipidemia. Int J Clin Lab Res
1999;29:22–5.
7. Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin
and pravastatin improves the lipid profile in diabetic patients without compromising glycemic
control. Ann Pharmacother 1997;31:677–82.
8. O’Keefe JH Jr, Harris WS, Nelson J, Windsor SL. Effects of
pravastatin with niacin or magnesium on lipid levels and postprandial lipemia. Am J
Cardiol 1995;76:480–4.
9. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A
reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
10. Goldberg AC, Ostlund RE Jr, Bateman JH, et al. Effect of plant stanol
tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J
Cardiol 2006;97:376–9.
11. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout
two years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
12. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a
proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr
1999;69:231–6.
13. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic
Agents, HMG-CoA Reductase Inhibitors. In Facts and Comparisons Drug Information. St.
Louis, MO: Facts and Comparisons, Sep 1998, 172.
14. Kantola T, Kivisto KT, Neuvonen PJ. Grapefruit juice greatly
increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther
1998;63:397–402.
15. Lilja JJ, Kivisto KT, Neuvonen PJ. Grapefruit juice increases serum
concentrations of atorvastatin and has no effect on pravastatin. Clin Pharmacol Ther
1999;66:118–27.