Pravastatin dosage, forms, and strengths

Pravastatin is a cholesterol-lowering medication that belongs to a family of drugs called HMG-CoA reductase inhibitors (“statins”). These drugs block liver enzymes that synthesize “bad” LDL cholesterol (LDL-C), reducing total cholesterol, bad cholesterol, and fats in the blood. Statins also increase the serum levels of “good” HDL cholesterol (HDL-C), the version of cholesterol that helps remove bad LDL cholesterol. Doses will vary, and tablets are taken once daily without regard to food.

Pravastatin forms and strengths

Pravastatin comes in only one dosage form: tablets. 

• Tablet: 10 mg, 20 mg, 40 mg, 80 mg

Pravastatin dosage for adults

Pravastatin lowers cholesterol and fats in people diagnosed with various cholesterol-related conditions: high cholesterol, high fats, hereditary high cholesterol, and similar conditions such as dysbetalipoproteinemia, a genetic disorder causing high cholesterol and triglycerides. It’s also FDA-approved to lower cholesterol and fats in people who have an increased risk of heart attack, stroke, and similar problems because of heart disease or other risk factors. 

Most people can take pravastatin safely, but not everyone. The medication is contraindicated in people with liver failure, serious and progressing liver cirrhosis, or known allergies or reactions to pravastatin. Pravastatin is not safe to take when pregnant and will probably be discontinued if a woman becomes pregnant.

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Pravastatin dosage for high cholesterol

High cholesterol affects about 71 million people in the U.S. and increases the risk of atherosclerosis, heart attack, stroke, hospitalization, and death. 

Statins are the first-line treatment to lower cholesterol. Statins reduce total cholesterol, “bad” cholesterol (LDL cholesterol and VLDL cholesterol), fats (triglycerides), and a precursor of “bad” cholesterol called apolipoprotein B (Apo B). They also raise “good” cholesterol (HDL cholesterol) levels in the blood. HDL cholesterol plays a crucial role in eliminating “bad” cholesterol in the body. 

Many conditions cause high cholesterol. Pravastatin is FDA-approved to treat the most common type of high cholesterol, primary hyperlipidemia—high fats and cholesterol in the blood due to diet and normal metabolic processes. It’s also approved to treat high-fat levels in the blood (hypertriglyceridemia), hereditary high cholesterol (heterozygous familial hypercholesterolemia), and high Apo B levels (primary dysbetalipoproteinemia), another hereditary condition.

When treating high cholesterol, healthcare providers typically start with atorvastatin or simvastatin. They may switch to pravastatin if those medications are not effective or cause side effects. Some people may be prescribed medications that react strongly with other statins, such as the COVID-19 medication Paxlovid, so a healthcare provider may switch to pravastatin or rosuvastatin, which don’t react to those medications.

• Standard dosage for high cholesterol: 5–40 mg once daily

• Maximum dosage for high cholesterol: 40 mg daily

Pravastatin dosage for the prevention of cardiovascular disease 

One common use of statins is to decrease the risk of heart attack, stroke, or other serious cardiovascular events in people with normal or near-normal cholesterol levels. In these cases, the goal is to bring cholesterol into the lower levels of “normal.” 

Statin therapy is not for everyone. The FDA has approved the use of statins as a preventive treatment only for people with coronary heart disease (CHD) or other risk factors such as high blood pressure, obesity, plaque buildup (atherosclerosis), chest pain, age, obesity, or lifestyle choices. Doses are the same as high cholesterol doses.

• Standard dosage for the prevention of cardiovascular events: 5–40 mg once daily

• Maximum dosage for the prevention of cardiovascular events: 40 mg daily

Pravastatin dosage for children

The FDA has approved pravastatin to lower cholesterol in children 8 years of age and older born with a hereditary high cholesterol condition called heterozygous familial hypercholesterolemia (HeFH). About 1 in 200 children are affected, but statin treatment is crucial to preventing early cardiovascular problems like heart attack. Pediatric doses are 20 mg daily for children. Adolescents take 40 mg daily. Maximum dosages have not been specified.

• Standard pravastatin dosage for children 8–13 years of age with heterozygous familial hypercholesterolemia: 20 mg tablet once daily

• Standard pravastatin dosage for children 14 years of age and older with heterozygous familial hypercholesterolemia: 40 mg tablet once daily

Pravastatin dosage restrictions

Dose restrictions are not needed for people with mild or moderate kidney disease. However, they will be started on the lowest dose possible (10 mg daily). The maximum daily dose for people with severe renal impairment is 40 mg daily.

People with mild or moderate liver disease can also take normal doses. However, Pravastatin is never used in people with active liver failure or decompensated liver cirrhosis.

How to take pravastatin

Pravastatin tablets don’t require special dosing or handling, so dosing instructions are relatively simple: 

• Take pravastatin doses as instructed. The dose may need to be changed during treatment.

• Do not change the dose or take doses more frequently than prescribed.

• Take one dose daily.

• Take pravastatin tablets at any time of day unless the prescriber instructs otherwise.

• Tablets can be taken without regard to food.

• Swallow the tablet whole. Do not break, crush, or chew it.

• Store pravastatin tablets in a tightly closed container at room temperature. Protect from moisture.

Pravastatin dosage FAQs

How long does it take pravastatin to work?

Pravastatin begins working after the first dose. However, it may take one or more weeks for cholesterol levels to drop significantly. 

How long does pravastatin stay in your system?

The half-life of pravastatin is around two to three hours, so it takes about half a day to be completely cleared from your system. 

What happens if I miss a dose of pravastatin?

Take a missed dose as soon as it’s remembered. If it’s almost time for the next dose, do not take the missed dose. Take the next dose at its regularly scheduled time. Never take two doses at once to make up for a missed dose.

How long can you take pravastatin?

 Pravastatin is used as a long-term treatment and is prescribed for months or years as long as it works and doesn’t cause serious side effects. 

How do I stop taking pravastatin?

Do not stop taking pravastatin until consulting with a healthcare provider. Discontinuing pravastatin will not cause side effects, but cholesterol levels could increase dramatically unless another lipid-lowering drug is substituted. To replace pravastatin, healthcare providers could prescribe another statin, the cholesterol absorption inhibitor ezetimibe, a bile acid sequestrant, a fibrate drug, or high-dose niacin. In some cases, people may be candidates for monoclonal antibodies (PCSK-9 inhibitors), a new treatment for high cholesterol.

What is the maximum dosage for pravastatin?

The maximum adult dosage of pravastatin is 80 mg daily. Maximum dosages have not been specified for children.

Can you overdose on pravastatin?

Never exceed the prescribed pravastatin dose. Too much pravastatin increases the risk of serious side effects such as muscle pain (myopathy) or severe muscle damage (rhabdomyolysis). If too much pravastatin is taken or you experience muscle pain or weakness, call a healthcare provider or get medical help.

What interacts with pravastatin?

Pravastatin has fewer drug interactions than other statins, but some drug combinations can still cause problems. Tell the doctor about all the prescription drugs, over-the-counter medications, and supplements being taken, especially:

• Macrolide antibiotics such as clarithromycin, erythromycin, or telithromycin

• Lipid-lowering drugs called fibrates, such as gemfibrozil or fenofibrate

• Cholesterol-lowering drugs called bile acid resins, such as cholestyramine or colestipol

• The gout treatment colchicine 

• The immunosuppressant cyclosporine

What happens when you mix pravastatin and alcohol?

Alcohol does not interact with pravastatin. However, both pravastatin and alcohol can damage the liver. The concomitant use of both increases the risk of liver injury. Tell the prescriber if you consume two or more alcoholic drinks daily.

Is it safe to take pravastatin during pregnancy?

Pregnant women should not use pravastatin. It can harm an unborn baby. If you get pregnant or think you’re pregnant, immediately inform your healthcare provider. The drug may need to be discontinued.

Is it safe to take pravastatin while breastfeeding?

Because of potential harm to the nursing infant, breastfeeding is not recommended during pravastatin therapy. Pravastatin is present in human breast milk. The effects on an infant are unknown but could be significant since cholesterol is important to a baby’s growth and health. 

What should I tell the doctor?

Tell the doctor about all the drugs you take and all your medical conditions, particularly:

• Unexplained muscle pain or similar problems

• Kidney problems

• Active liver disease

• Thyroid problems

• Myasthenia gravis

Tell the doctor if you are:

• Pregnant

• Breastfeeding

• Older than 65 years of age

Tell the doctor if you drink two or more alcoholic drinks daily.

What are the side effects of pravastatin?

The most common side effects of pravastatin are:

• Muscle pain

• Heartburn

• Chest pain

• Nausea and vomiting

• Upper respiratory tract infections

• Diarrhea

• Headache

What are the serious side effects of pravastatin?

The most serious side effects of statin therapy are muscle pain and severe muscle damage (rhabdomyolysis), particularly at higher doses. Other serious adverse reactions include increased blood sugar levels and liver problems. Immediately talk to your healthcare provider if you experience unexplained muscle pain, muscle weakness, muscle cramps, or jaundice.

Sources

• Pravachol drug summary, Prescriber’s Digital Reference (PDR)

• Pravastatin, Statpearls

• Pravastatin sodium tablet prescribing information, DailyMed (NIH National Library of Medicine)