Pravastatin vs. Lipitor: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Pravastatin and Lipitor (atorvastatin) are prescription medications used to treat high cholesterol. Cholesterol levels that are higher than normal can increase the risk of heart disease, vascular disease, heart attacks, and strokes. Cholesterol is primarily produced in the liver through the HMG‐CoA reductase enzyme.

Pravastatin and atorvastatin are drugs that are classified as HMG-CoA reductase inhibitors. Also known as statin drugs, pravastatin and atorvastatin inhibit, or block, the HMG-CoA reductase enzyme, which leads to decreased cholesterol production in the liver. The use of statins also increases the amount of LDL (low-density lipoprotein) receptors in the liver, which helps lower levels of LDL, or the bad type of cholesterol, in the blood.

Both pravastatin and atorvastatin work in similar ways, but they have some differences to be aware of.

What are the main differences between pravastatin and Lipitor?

Pravastatin is the generic name for Pravachol. Unlike other statin drugs, pravastatin is not extensively metabolized, or processed, by CYP3A4 enzymes in the liver. Instead, pravastatin is broken down in the stomach.

Pravastatin generic tablets are available in strengths of 10 mg, 20 mg, 40 mg, and 80 mg. Pravastatin is usually prescribed to be taken once daily in the evening. It has been shown that pravastatin is more effective when taken in the evening rather than in the morning.

Lipitor is a brand-name medication and is available in a generic version called atorvastatin. Unlike pravastatin, atorvastatin is heavily processed by the CYP3A4 enzyme in the liver. Therefore, atorvastatin may potentially interact with more medications than pravastatin.

Lipitor is available in oral tablets with strengths of 10 mg, 20 mg, 40 mg, and 80 mg. Lipitor can be taken in the morning or evening, and it is usually taken once daily.

Main differences between pravastatin and Lipitor
	Pravastatin	Lipitor
Drug class	HMG-CoA reductase inhibitor	HMG-CoA reductase inhibitor
Brand/generic status	Brand and generic version available	Brand and generic version available
What is the generic name? What is the brand name?	Brand name: Pravachol Generic name: Pravastatin	Brand name: Lipitor Generic name: Atorvastatin
What form(s) does the drug come in?	Oral tablet	Oral tablet
What is the standard dosage?	10 to 80 mg once daily	10 to 80 mg once daily
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Adults; children and adolescents aged 8 to 18 years old	Adults; children and adolescents aged 10 to 17 years

Conditions treated by pravastatin and Lipitor

Pravastatin and atorvastatin can help reduce the risk of heart attacks and strokes in people with coronary heart disease. Both medications can also help reduce the risk of death from heart disease. Risk factors for heart disease include high blood pressure, smoking, and high cholesterol levels.

Both pravastatin and atorvastatin are FDA approved to reduce elevated total-cholesterol and LDL levels (also known as hyperlipidemia or hypercholesterolemia). Statin medications can also help treat elevated levels of triglycerides, which are another type of fats or lipids in the body. Someone with elevated levels of triglycerides has hypertriglyceridemia.

Pravastatin and Lipitor can also increase HDL levels in the blood. HDL cholesterol is what is known as the “good” cholesterol in the blood.

Condition	Pravastatin	Lipitor
Hyperlipidemia	Yes	Yes
Hypercholesterolemia	Yes	Yes
Hypertriglyceridemia	Yes	Yes

Is pravastatin or Lipitor more effective?

Both pravastatin and atorvastatin are effective medications for treating high blood cholesterol. The more effective drug depends on your overall condition, the severity of your condition, other drugs you might be taking, and other factors.

One comparative study found that there is no significant difference between pravastatin, simvastatin, and atorvastatin for preventing cardiovascular events. In other words, these statin drugs were similarly effective for reducing heart attacks and coronary heart disease.

A systematic review that pooled over 90 clinical trials compared statin drugs such as fluvastatin, atorvastatin, pravastatin, simvastatin, and rosuvastatin. The review concluded that atorvastatin, fluvastatin, and simvastatin had the highest probability of being the best treatment for preventing cardiovascular events.

Consult a healthcare provider to determine the best statin drug for you. After conducting a blood test and evaluating your overall condition, a provider will be able to determine whether pravastatin or atorvastatin is a more effective drug for you. They might also prescribe a different statin drug such as Zocor (simvastatin) or Crestor (rosuvastatin).

Coverage and cost comparison of pravastatin vs. Lipitor

Pravastatin is a generic medication that is usually covered by Medicare and insurance plans. The average cash price of pravastatin is around $129.99 for a 30-day supply. A SingleCare savings card may be able to lower the cost of a pravastatin prescription to less than $15.

Lipitor is a brand-name medication that is also available in a cheaper, generic version. The generic version of Lipitor, atorvastatin, is typically covered by most Medicare and insurance plans. Brand-name Lipitor may be covered by insurance plans with a high copay. The cash price of Lipitor is around $249.99. SingleCare coupons can lower the cost to $15 at participating pharmacies.

	Pravastatin	Lipitor
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	30 tablets (40 mg)	30 tablets (40 mg)
Typical Medicare copay	$0–$20	$0–$16
SingleCare cost	$12+	$15+

Common side effects of pravastatin vs. Lipitor

The most common side effects of pravastatin are musculoskeletal or muscle pain, nausea, vomiting, diarrhea, and headache. The most common side effects of atorvastatin are musculoskeletal or muscle pain, diarrhea, and joint pain (arthralgia). Both pravastatin and atorvastatin can also cause other side effects such as indigestion, dizziness, fatigue, rash, and urinary tract infections.

Serious side effects of statin drugs include muscle disease (myopathy) and the rapid breakdown of muscle tissue (rhabdomyolysis). Contact a healthcare provider immediately if you experience persistent or unexplained muscle pain, weakness, or tenderness.

Pravastatin and atorvastatin can also cause elevated liver enzymes. Liver enzyme levels may need to be checked before and monitored throughout treatment.

	Pravastatin		Lipitor
Side effect	Applicable?	Frequency	Applicable?	Frequency
Musculoskeletal pain	Yes	10%	Yes	4%
Nausea/vomiting	Yes	7%	Yes	4%
Diarrhea	Yes	7%	Yes	7%
Indigestion	Yes	3%	Yes	5%
Dizziness	Yes	4%	Yes	*
Headache	Yes	6%	No	–
Fatigue	Yes	3%	Yes	*
Rash	Yes	5%	Yes	*
Arthralgia	Yes	*	Yes	7%
Urinary tract infection	Yes	3%	Yes	6%

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Pravastatin), DailyMed (Lipitor)
*not reported

Drug interactions of pravastatin vs. Lipitor

Pravastatin and atorvastatin interact with similar medications. However, since atorvastatin is metabolized primarily by the CYP3A4 enzyme in the liver, it may interact with more drugs that affect the CYP3A4 enzymes in the liver.

Taking medications like cyclosporine, clarithromycin, or ritonavir with either pravastatin or atorvastatin can lead to increased statin levels in the blood, which can increase the risk of adverse effects.

Antacids can interfere with the absorption of statin medications and reduce their effectiveness. The administration of antacids and statins should be separated by at least two hours. Cholestyramine can also decrease the absorption and effectiveness of statins. The administration of cholestyramine and statins should be separated by four hours.

Niacin and fibrates can increase the risk of myopathy and rhabdomyolysis when taken with either pravastatin or atorvastatin.

The use of atorvastatin should be avoided or monitored while consuming grapefruit juice. Grapefruit juice acts as a CYP3A4 inhibitor that can lead to increased levels of atorvastatin in the blood and increase the risk of side effects.

Drug	Drug class	Pravastatin	Lipitor
Cyclosporine	Immunosuppressants	Yes	Yes
Clarithromycin Erythromycin	Antibiotics	Yes	Yes
Ketoconazole Itraconazole Voriconazole Posaconazole	Antifungals	No	Yes
Ritonavir Simeprevir Ledipasvir Boceprevir Darunavir	Antivirals	Yes	Yes
Niacin	Antilipemic agents	Yes	Yes
Fenofibrate Gemfibrozil	Fibrates	Yes	Yes
Digoxin	Cardiac glycosides	Yes	Yes
Cholestyramine	Bile acid sequestrants	Yes	Yes
Aluminum hydroxide Magnesium hydroxide	Antacids	Yes	Yes

Consult a healthcare professional for other possible drug interactions.

Warnings of pravastatin and Lipitor

Pravastatin and atorvastatin should be avoided in those with active liver disease or high liver enzyme levels. Statin medications can cause further liver damage in someone with liver disease.

Pravastatin and atorvastatin should not be used in those with a history of hypersensitivity reactions to statin medications. Signs and symptoms of a hypersensitivity reaction include rash, itching, swelling, and trouble breathing.

Statin medications carry a risk of severe muscle damage and muscle pain. There may be an increased risk of muscle pain in those who are over 65 years old or who have uncontrolled hypothyroidism or kidney problems.

Pravastatin and atorvastatin should not be used in those who are pregnant or lactating.

Talk to a healthcare provider to discuss other possible warnings or precautions associated with pravastatin or atorvastatin.

Frequently asked questions about pravastatin vs. Lipitor

What is pravastatin?

Pravastatin is a generic medication used to lower cholesterol and prevent complications caused by high cholesterol levels. The brand name of pravastatin is Pravachol. It is prescribed to be taken once daily in the evening. Pravastatin is available as an oral tablet.

What is Lipitor?

Lipitor is a brand-name medication manufactured by Pfizer. The generic name of Lipitor is atorvastatin. It is used to treat high cholesterol levels and reduce the risk of heart attack and stroke. Lipitor is prescribed to be taken once daily in the morning or evening. It is available as an oral tablet.

Are pravastatin and Lipitor the same?

Both pravastatin and atorvastatin are medications used to reduce high levels of cholesterol. However, they are not the same. Atorvastatin is primarily metabolized by the CYP P450 enzyme system in the liver while pravastatin is broken down in the stomach. Pravastatin is usually taken at night while Lipitor is taken in the morning or evening.

Is pravastatin or Lipitor better?

Both pravastatin and Lipitor are effective forms of statin therapy. Both medications can help prevent complications of high cholesterol levels, such as atherosclerosis, heart attack, and stroke. Some studies from cardiology journals have found that atorvastatin, the active ingredient in Lipitor, is more effective than other statin drugs for preventing cardiovascular events like heart attack and stroke. A healthcare provider can provide medical advice on the best statin medication for you.

Can I use pravastatin or Lipitor while pregnant?

Pravastatin and atorvastatin are not recommended to be taken while pregnant. Both medications carry a high risk of causing birth defects. Consult a healthcare provider for guidance on the best treatment for high cholesterol while pregnant.

Can I use pravastatin or Lipitor with alcohol?

There is no significant health risk involved with moderate alcohol consumption and statins. Statin drugs and excessive consumption of alcohol can damage the liver. Talk to a healthcare provider to assess whether it is safe for you to drink alcohol while taking a statin medication.