Key takeaways

Pravastatin is prescribed to lower cholesterol and reduce the risk of heart disease, requiring diet and exercise changes alongside medication.
Common side effects of pravastatin include muscle pain, flu-like symptoms, chest pain, and headaches, with serious side effects like liver and muscle damage.
Pravastatin side effects can start early in treatment, with many improving over time or after discontinuation, but some serious effects may have long-term consequences.
To minimize side effects, patients should provide a complete medical history, follow dosing instructions, keep follow-up appointments, and limit alcohol consumption.

For people with high cholesterol levels, high fat levels, or other risk factors for cardiovascular or heart disease, the generic drug pravastatin (brand name Pravachol) is prescribed to reduce LDL cholesterol, lower triglyceride levels, slow the progression of atherosclerosis, and decrease the risk of heart attack and stroke. To succeed, however, pravastatin therapy also requires changes in diet and exercise. Pravastatin belongs to a class of drugs called statins, but healthcare professionals may refer to them as HMG-CoA reductase inhibitors. That’s because pravastatin and other statins (such as simvastatin) block or inhibit a liver enzyme that synthesizes cholesterol, helping to reduce cholesterol and fats. Although most people take statins without a problem, there are some important side effects to be aware of.

Common side effects of pravastatin

Muscle pain is the most common complaint in people taking pravastatin, both in clinical trials and clinical practice. Pravastatin’s common side effects include:

Muscle pain
Upper respiratory infection
Muscle inflammation
Chest pain
Flu-like symptoms
Fatigue
Cough
Skin rash
Dizziness
Diarrhea
Nausea and vomiting
Headache
Elevated muscle enzymes
Elevated liver enzymes
Elevated blood sugar
Confusion or memory problems
Acid indigestion

Serious side effects of pravastatin

Pravastatin’s most serious side effects include:

Liver damage
Kidney damage
Muscle damage (rhabdomyolysis)
Autoimmune damage and death of muscle tissues
Swollen pancreas
Blood disorders
Lung disease
Tendon rupture
Lupus-like symptoms
Severe allergic reactions

Flu-like symptoms

In clinical trials, the incidence of flu symptoms among participants taking pravastatin was 9%—about 1 in 11 people. In some cases, these flu symptoms are not caused by infection but are a reaction to the medication. If flu symptoms are experienced, talk to the prescribing healthcare provider. This is to make sure the medication is not affecting the liver or muscles.

Chest pain

Chest pain is a common side effect of pravastatin. Approximately 10% of clinical trial participants experienced chest pain, but so did 9.8% of participants not taking pravastatin. Chest pain can be a symptom of a serious heart problem, so always talk to a healthcare professional.

Muscle pain

Muscle pain is the most common side effect of pravastatin, affecting 1% to 6% of pravastatin users. Some muscle pain may just be bothersome, but it could also be a symptom of muscle damage. Tell the prescribing healthcare provider immediately if you are experiencing new or worsening muscle pain or weakness while taking pravastatin.

Headache

Headache occurred in 3.5% to 7.5% of participants who took pravastatin in clinical trials . However, 4.6% of participants not taking pravastatin also complained of headaches. If headaches are bothersome or getting worse, get medical advice from a healthcare professional.

How soon do side effects start?

Pravastatin begins working with the first dose, though it may take some time for cholesterol and fat levels to change. Some of the common side effects can occur early in treatment such as muscle pain, fatigue, and dizziness. Some side effects may take weeks or months to occur, particularly serious side effects such as liver problems or serious muscle damage. Allergic reactions can happen right after the first dose, but severe skin reactions may occur later in treatment.

How long do pravastatin side effects last?

Many common side effects of pravastatin improve over time, but some may not. Most side effects, however, typically go away after the drug has been discontinued. It takes the body about two hours to clear half a dose of pravastatin, so many side effects will feel better the day after the drug is stopped. Some side effects, such as liver damage or muscle damage, may take weeks or months to improve. Others, such as some rare but serious side effects, may have lifelong consequences.

What are the long-term side effects of pravastatin?

Pravastatin therapy is intended to last for months or years—even for a lifetime. While there are no side effects specifically caused by long-term use, some of pravastatin’s severe side effects can be cumulative if the drug is continued. These include liver damage, autoimmune reactions, and muscle damage.

Pravastatin contraindications

People who have a known allergy to pravastatin will not be prescribed this drug. Because of pravastatin’s possible effects on the liver and muscles, pravastatin is also contraindicated in people with:

Muscle disease
Active liver disease or elevated liver enzymes

The FDA has prohibited the use of pravastatin in pregnancy and breastfeeding because of the risk to the fetus or the nursing infant. People who may become pregnant are advised to use birth control while taking pravastatin, and the drug will be stopped if they become pregnant.

Children

Pravastatin has been tested in children and is FDA-approved to treat children 8 years of age and older for congenital high cholesterol (hypercholesterolemia). In clinical trials, children taking pravastatin experienced roughly the same rate of side effects as adults. Female teens of reproductive age are advised to use birth control because of the possible hazards to a fetus.

Seniors

People 65 and older experience most side effects at the same rate as younger adults. However, muscle problems are more common in older adults, so extra caution is needed when taking pravastatin.

Pravastatin warnings

As with all prescription drugs, pravastatin may cause more problems in some people than others. Here are the issues to consider.

Cautions

Pravastatin may worsen some pre-existing conditions, so it’s used with caution and extra monitoring in people with:

Liver problems in the past
Chronic alcohol abuse
Kidney disease
Diabetes
Underactive thyroid

Abuse and dependence

Drug abuse and physical dependence are not considered risks of pravastatin treatment. There are no withdrawal symptoms when the drug is discontinued. However, cholesterol levels will rapidly rise unless another cholesterol-lowering drug is substituted.

Overdose

Call a poison control center or contact a healthcare professional if an overdose of pravastatin is suspected. The maximum dosage is 80 mg per day for adults, but the daily dosage may vary based on age and other health conditions. Never exceed the dosage prescribed by a healthcare professional.

Pravastatin interactions

Some drugs interfere with the body’s ability to break down pravastatin, increasing the risk of serious side effects such as muscle and liver problems. These drugs include:

Macrolide antibiotics, especially clarithromycin and erythromycin
Some HIV/AIDS drugs
Some cancer drugs
The immune suppressant cyclosporine

Some cholesterol drugs can cause side effects when combined with pravastatin. These include fibrates like gemfibrozil or fenofibrate. These drugs increase the risk of muscle damage when taken with pravastatin. Bile acid sequestrants like cholestyramine and colestipol will interfere with the body’s ability to absorb pravastatin, decreasing its therapeutic benefits. Niacin is another cholesterol treatment that is avoided with pravastatin. Niacin (vitamin B3) is used to raise “good” cholesterol (HDL), but there’s an increased risk of muscle damage when it’s taken with pravastatin. This may also occur with red yeast rice, a supplement sometimes taken to improve cholesterol levels.

How to avoid pravastatin side effects

Most people won’t have adverse effects with pravastatin, but there are also ways to decrease this risk..

1. Give the prescriber a complete medical history

To avoid side effects, make sure the prescriber knows about all medical conditions past and present. Some may increase the risk for side effects when taking pravastatin. The prescriber will especially need to know about:

Liver disease
Kidney disease
Diabetes
Hypothyroidism
Muscle pain or muscle weakness
Pregnancy and pregnancy plans or potential
Breastfeeding or breastfeeding plans

Drug interactions can worsen the side effects of pravastatin, so tell the prescribing healthcare provider about all prescription drugs, over-the-counter medications, and supplements that are being taken.

2. Take pravastatin as instructed

Follow all the directions when taking pravastatin. This pill should be taken once per day at night. If a dose is missed, take it when it’s remembered. However, if it’s almost time for the next dose, then skip the missed dose to avoid taking too much medicine at once. Just take the next dose as scheduled.

3. Keep all follow-up appointments

To avoid serious side effects, the healthcare provider will schedule regular follow-up visits and blood tests. These follow-up visits and tests can help spot problems before they become serious. During these visits, tell the healthcare provider about any side effects, particularly muscle pain or weakness.

4. Don’t drink too much alcohol

An occasional drink is okay, but drinking too much alcohol raises the risk of hurting the liver when taking pravastatin.

How to treat side effects of pravastatin

Minor side effects caused by pravastatin can be managed with a few home solutions or over-the-counter medications. However, other side effects may be symptoms of a more serious problem so will need medical attention.

Flu symptoms

Flu symptoms may be a sign of the flu, but it could also be a side effect of pravastatin. Contact the prescribing healthcare provider if you’re taking pravastatin and you feel feverish or have body aches. A blood test may be needed to make sure everything is okay.

Muscle problems

Stop taking pravastatin and contact the prescriber if muscles start to hurt or become weak. It may not be serious, but the healthcare provider will need to do blood tests to see if there’s a problem. Symptoms include weakness, aches, and pain, especially in the legs, hips, shoulders, and back. You may find it hard to lift your arms or climb stairs. Severe muscle damage can damage the kidneys, so immediate medical help is needed if muscle problems are accompanied by dark urine, blood in the urine, or fever.

Liver problems

Discontinue the medicine and contact a healthcare provider if there are signs of liver problems such as:

Dark urine
Pale or clay-colored stools
Loss of appetite
Stomach pain
Tiredness
Yellowing of the skin or eyes

Allergic reactions

A variety of allergic reactions to pravastatin are possible, including severe allergic reactions, swelling, and skin reactions. These may be potentially fatal, so stop taking pravastatin and immediately get medical help if you experience:

Hives
Trouble breathing
Swelling of the face, mouth, throat, or neck
Low blood pressure
Lightheadedness
Fainting
Racing heartbeats
Skin blisters
Skin pain
Peeling skin
Fever
Burning eyes
Sore mouth and throat

Sources

Flu-like response on statins, Medical Science Monitor
Pravastatin, Epocrates
Pravastatin sodium drug summary, Prescriber’s Digital Reference
Pravastatin sodium tablet prescribing information, U.S. National Library of Medicine