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PRAVASTATIN
Pravastatin is a member of the HMG-CoA reductase inhibitor family of drugs, also called “statins,” such as lovastatin and simvastatin. Pravastatin blocks a key step in the body’s production of cholesterol and is used to lower cholesterol levels in people with hypercholesterolemia (high cholesterol).
Safetychecker Summary
for Pravastatin
(for details about the summarized interactions, read the full article)
 May be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Coenzyme Q10 |
| May be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Milk thistle* |
| May be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Fish oil (EPA) Niacin |
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
Niacin* Red yeast rice* |
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Vitamin A Grapefruit juice |
| Reduced drug absorption/bioavailability |
None known |
Interactions with Dietary Supplements
Coenzyme
Q10
In double-blind trials, treatment with pravastatin and other HMG-CoA reductase inhibitors has
resulted in depleted blood levels of coenzyme Q10 (CoQ10).1 2
Supplementation with 90–100 mg CoQ10 per day has been shown to prevent reductions in
blood levels of CoQ10 due to simvastatin,
another drug in the same category as pravastatin.3 4 However, some
investigators have questioned whether it is worthwhile or necessary for individuals taking
HMG-CoA reductase inhibitors to supplement with CoQ10.5 Until more is known, people
taking pravastatin should ask a doctor about supplementation with 30–100 mg CoQ10 per
day.
Fish
oil
The omega-3 fatty acid EPA present in fish oil may improve the cholesterol and triglyceride-lowering effect of pravastatin. In a
preliminary trial, people with high cholesterol who had been taking pravastatin for about
three years were able to significantly lower their triglyceride levels and raise their levels
of HDL (“good”) cholesterol by supplementing with either 900 mg or 1,800 mg of EPA
for three months in addition to pravastatin.6 The authors of the study concluded
that the combination of pravastatin and EPA may prevent coronary heart disease better than
pravastatin alone.
Niacin (Vitamin
B3, Nicotinic acid)
Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin
plus niacin to lower cholesterol.7 Niacin was added over a two week period, to a
maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin
continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in
significantly reduced cholesterol levels. Others have also shown that the combination of
pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin
alone.8 However, large amounts of niacin taken with pravastatin might cause serious
muscle disorders (myopathy or rhabdomyolysis).9
Red yeast rice
(Monascus purpureas)
A supplement containing red yeast rice (Monascus purpureas) (Cholestin®) has
been shown to effectively lower cholesterol
and triglycerides in people with moderately
elevated levels of these blood lipids.10 This extract contains small amounts of
naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used by people who are
currently taking lovastatin or pravastatin.
Vitamin
A
A study of 37 people with high cholesterol treated with diet and HMG-CoA reductase inhibitors
found serum vitamin A levels increased over two years of therapy.11 It remains
unclear whether this moderate increase suggests that people taking lovastatin have a
particular need to restrict vitamin A supplementation.
Interactions with Herbs
Milk
thistle (Silybum marianum)
One of the possible side effects of pravastatin is liver toxicity. Although no clinical
studies substantiate its use with pravastatin, a milk thistle extract standardized to
70–80% silymarin may reduce the potential liver toxicity of pravastatin. The suggested
use is 200 mg of the extract three times daily.
Interactions with Foods and Other Compounds
Food
Pravastatin may be taken with or without food.12
Grapefruit juice
A study of grapefruit juice and lovastatin (a
drug closely related to pravastatin) reported significantly increased lovastatin levels in
people who drank grapefruit juice compared with water.13 This interaction has not
yet been reported with pravastatin. Until more is known, it is prudent to avoid grapefruit
juice during pravastatin therapy or discuss grapefruit juice intake (before consuming any)
with the prescribing doctor. Although grapefruit could, in theory, be used to reduce the
effective dose of the drug, current knowledge is not sufficient to guarantee against
potentially harmful fluctuations in the levels of the drug in the body. Anyone taking
pravastatin and drinking grapefruit juice would require very careful monitoring. The same
effects might be seen from eating grapefruit as from drinking its juice.
References:
1. Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997;18(suppl):S137–44.
2. Ghirlanda G, Oradei A, Manto A, et al. Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. J Clin Pharmacol 1993;33:226–9.
3. Bargossi AM, Grossi G, Fiorella PL, et al. Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors. Molec Aspects Med 1994;15(suppl):s187–93.
4. Miyake Y, Shouzu A, Nishikawa M, et al. Effect of treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on serum coenzyme Q10 in diabetic patients. Arzneimittelforschung 1999;49:324–9.
5. Paloma’ki A, Malminiemi K, Solakivi T, Malminiemi O. Ubiquinone supplementation during lovastatin treatment: Effect of LDL oxidation ex vivo. J Lipid Res 1998;39:1430–7.
6. Nakamura N, Hamazaki T, Ohta M, et al. Joint effects of HMG-CoA reductase inhibitors and eicosapentaenoic acids on serum lipid profile and plasma fatty acid concentrations in patients with hyperlipidemia. Int J Clin Lab Res 1999;29:22–5.
7. Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother 1997;31:677–82.
8. O’Keefe JH Jr, Harris WS, Nelson J, Windsor SL. Effects of pravastatin with niacin or magnesium on lipid levels and postprandial lipemia. Am J Cardiol 1995;76:480–4.
9. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
10. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231–6.
11. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout two years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
12. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Sep 1998, 172.
13. Kantola T, Kivisto KT, Neuvonen PJ. Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther 1998;63:397–402.
Copyright © 2002 Healthnotes, Inc. All rights reserved. www.healthnotes.com
Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.
Learn more about Healthnotes, the company.
Learn more about the authors of Safetychecker.
The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.
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