OralHyperlipidaemias, Cardiovascular risk reductionAdult: As sodium: 10-40 mg once daily in the evening, adjust according to response at 4-wk intervals. Max: 80 mg once daily. Child: Heterozygous familial hypercholestrolaemia: 8-13 yr 10-20 mg once daily; 14-18 yr 10-40 mg once daily.
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Moderate to severe: Initial dose: 10 mg/day.
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Moderate to severe: Initial dose: 10 mg/day.
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May be taken with or without food.
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Active liver disease or unexplained persistent increases in serum aminotransferases. Pregnancy and lactation. Concomitant use w/ gemfibrozil, fusidic acid.
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History of liver disease; alcoholism; untreated hypothyroidism; patients at risk of myopathy. Renal impairment.
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Nausea, vomiting, heartburn, diarrhoea, headache, cough, insomnia, chest pain, rash, fatigue, dizziness, influenza, blurred vision, myalgia, elevated serum transaminase, alopoecia, paraesthesia, impotence, gynaecomastia.
Potentially Fatal: Severe rhabdomyolysis w/ acute renal failure. Hepatitis, pancreatitis. Rare: Stevens-Johnson syndrome, anaphylaxis, toxic epidermal necrolysis.
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Monitor creatine kinase (CK) periodically and LFT. Discontinue if there is significant or persistent increase in CK levels, serum aminotransferase levels or evidence of myopathy.
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Management: Symptomatic and supportive treatment.
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May increase risk of myopathy w/ colchicine, fenofibrate, nicotinic acid. Ciclosporin, clarithromycin, and erythromycin may increase serum pravastatin levels. May increase bleeding risk w/ warfarin. Decreased serum levels w/ concomitant colestyramine.
Potentially Fatal: Increased risk of rhabdomyolysis w/ gemfibrozil, fenofibrate, fusidic acid.
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May decrease serum levels w/ St John's wort.
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Description: Mechanism of Action: Pravastatin inhibits HMG-CoA reductase, the enzyme which catalyses the rate-limiting step in cholesterol biosynthesis. It reduces concentration of total cholesterol and LDL cholesterol and triglyceride. It produces an increase in HDL cholesterol and it increases hepatic cholesterol uptake from blood. Pharmacokinetics: Absorption: Rapidly but incompletely absorbed from the GI tract. Absolute bioavailability: Approx 17%. Time to peak plasma concentration: 1-1.5 hr. Distribution: Plasma protein binding: Approx 50%. Metabolism: Undergoes extensive first-pass hepatic metabolism. Excretion: Via faeces (approx 70% as unchanged drug); urine (approx 20%). Elimination half-life: 1.5-2 hr.
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Anon. Pravastatin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 24/10/2013. Buckingham R (ed). Pravastatin sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/10/2013. Joint Formulary Committee. Pravastatin sodium. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/10/2013. McEvoy GK, Snow EK, Miller J et al (eds). Pravastatin sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 24/10/2013. Statins and HIV or Hepatitis C Drugs: Drug Safety Communication - Interaction Increases Risk of Muscle Injury. U.S. FDA. https://www.fda.gov/. Accessed 12/10/2013.
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