Why aren't many people using pravastatin, a drug with high safety? Are there any restrictions?

An elderly friend asked Huazi, I heard that among statins, pravastatin is the safest, but why not many people use it, are there any restrictions?

Huazi told him that there are currently seven commonly used statins, including lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, rosuvastatin, and pitavastatin. From the perspective of safety, pravastatin has obvious advantages, but because of its weak lipid-lowering effect, it is not widely used.

1. Safe pravastatin

Statins are commonly used drugs for the treatment of atherosclerosis and can effectively prevent the occurrence of cardiovascular and cerebrovascular diseases such as myocardial infarction and cerebral infarction. However, when using statins, they may cause adverse reactions such as abnormal liver function and muscle damage , as well as interactions with other drugs and increased blood sugar .

Pravastatin is metabolized by the liver but not by the hepatic drug enzyme system , so it has less impact on the liver and is not likely to interact with other drugs. Pravastatin is also mild in terms of myotoxicity and is not likely to cause blood sugar to rise.

Pravastatin is mainly excreted through feces, with a small amount excreted through urine. It has a dual clearance pathway through the liver and kidneys . When liver or kidney function declines, it will compensatory change the metabolic pathway and clear it. It is not easy to accumulate and cause poisoning , and its overall safety is very good.

2. However, the lipid-lowering intensity is relatively low

The efficacy of statins is now measured mainly by the reduction in low-density lipoprotein cholesterol (LDL-C) levels. When pravastatin is used at the maximum dose (40 mg per day), LDL-C levels drop by about 38%, which is lower than other statins.

Current studies have shown that the lower the LDL-C level, the easier it is to reverse atherosclerotic plaques . Therefore, when choosing statins, doctors always tend to use strong statins (atorvastatin, rosuvastatin) to achieve the best therapeutic effect. Only when strong statins cannot be tolerated, will other statins be considered as substitutes .

Therefore, pravastatin is often used as a second-line alternative drug and is not widely used in clinical practice.

3. Who can choose

When using high-potency statins or other medium-acting statins, if the transaminase (AST, ALT) level increases by more than 3 times the upper limit of normal; or there is severe muscle pain, fatigue, and creatine kinase (CK) increases by more than 4 times the upper limit of normal, the drug should be stopped first, and after the relevant indicators return to normal, pravastatin can be considered to continue treatment.

People who have many concurrent diseases and are already using multiple medications may also consider using pravastatin when starting statin treatment to reduce the possibility of drug interactions.

If pravastatin alone cannot bring LDL-C levels to the ideal range, it can be used in combination with cholesterol absorption inhibitors (ezetimibe, hebomib), PCSK9 inhibitors (evolocumab, alirocumab, etc.), inkesilan and other drugs to enhance control of LDL-C.

Pravastatin has a relatively good safety profile, and the incidence of adverse reactions is only relatively low, not that they will not occur. Therefore, it is still necessary to pay attention to liver function and myotoxicity when taking the medication. If abnormal levels exceed the standard, stop taking the medication and seek medical attention in time.

In summary, pravastatin has good safety, fewer adverse reactions, and fewer interactions with other drugs, but its lipid-lowering strength is not high, so it is not widely used. When you cannot tolerate the use of strong statins, or when you use more drugs and are prone to drug interactions, you can consider using pravastatin.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.