Pravachol


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Related to Pravachol: Lipitor, Ezetrol, Crestor

pravastatin

(pra-va-sta-tin) ,

Pravachol

(trade name)

Classification

Therapeutic: lipid lowering agents
Pharmacologic: hmg coa reductase inhibitors
Pregnancy Category: X

Indications

Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias.Primary prevention of coronary heart disease (myocardial infarction, coronary revascularization, cardiovascular mortality) in asymptomatic patients with increased total and low-density lipiprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol.Secondary prevention of myocardial infarction, coronary revascularization, stroke, and overall mortality in patients with clinically evident coronary heart disease.

Action

Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol.

Therapeutic effects

Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL cholesterol.
Slows the progression of coronary atherosclerosis with resultant decrease in coronary heart disease-related events.

Pharmacokinetics

Absorption: Poorly and variably absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Extensively metabolized by the liver, most during first pass; excreted in bile and feces. 20% excreted unchanged by the kidneys.
Half-life: 1.3–2.7 hr.

Time/action profile (cholesterol-lowering effect)

ROUTEONSETPEAKDURATION
POdays2–4 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Active liver disease or unexplained persistent ↑ in AST and ALT; Obstetric / Lactation: Pregnancy or lactation.
Use Cautiously in: History of liver disease; Alcoholism; Renal impairment; Pediatric: Children <8 yr (safety not established); Women of childbearing age.

Adverse Reactions/Side Effects

Central nervous system

  • amnesia
  • confusion
  • dizziness
  • headache
  • insomnia
  • memory loss
  • weakness

Ear, Eye, Nose, Throat

  • rhinitis

Respiratory

  • bronchitis

Cardiovascular

  • chest pain
  • peripheral edema

Gastrointestinal

  • abdominal cramps (most frequent)
  • constipation (most frequent)
  • diarrhea (most frequent)
  • flatus (most frequent)
  • heartburn (most frequent)
  • altered taste
  • drug-induced hepatitis
  • dyspepsia
  • ↑ liver enzymes
  • nausea
  • pancreatitis

Genitourinary

  • erectile dysfunction

Dermatologic

  • rash (most frequent)
  • pruritus

Endocrinologic

  • hyperglycemia

Musculoskeletal

  • rhabdomyolysis (life-threatening)
  • arthralgia
  • arthritis
  • immune-mediated necrotizing myopathy
  • myalgia
  • myositis

Miscellaneous

  • hypersensitivity reactions

Interactions

Drug-Drug interaction

Cholesterol-lowering effect may be ↑ with bile acid sequestrants (cholestyramine, colestipol ).Bioavailability may be ↓ by bile acid sequestrants ; administer pravastatin ≥1 hr before or 4 hr after bile acid sequestrants.Risk of myopathy is ↑ by concurrentcyclosporine, fibrates, colchicine, erythromycin, clarithromycin, or large doses of niacin ; concurrent use with gemfibrozil should be avoided; consider lower dose of pravastatin with niacin.May ↑ effects of warfarin.Levels may be significantly ↑ by azoleantifungals (temporarily discontinue HMG-CoA reductase inhibitor, effect is less than with other statins).Saquinavir and ritonavir may ↓ levels and effectiveness.

Route/Dosage

Oral (Adults) 10–20 mg once daily at bedtime, may be adjusted at 4-wk intervals as needed (usual range 10–40 mg/day); Concurrent cyclosporine therapy—Dose should not exceed 20 mg/day; Concurrent clarithromycin therapy—Dose should not exceed 40 mg/day.
Oral (Children 14-18 yrs) 40 mg once daily.
Oral (Children 8-13 yrs) 20 mg once daily.
Oral (Geriatric Patients) 10–20 mg once daily at bedtime, may be adjusted at 4-wk intervals as needed (usual range 10–20 mg/day).

Hepatic Impairment

Renal Impairment

Oral (Adults) 10–20 mg once daily at bedtime, may be adjusted at 4-wk intervals as needed (usual range 10–20 mg/day).

Availability (generic available)

Tablets: 10 mg, 20 mg, 40 mg, 80 mg

Nursing implications

Nursing assessment

  • Obtain a diet history, especially with regard to fat consumption.
  • Lab Test Considerations: Evaluate serum cholesterol and triglyceride levels before initiating, after 4–6 wk of therapy, and periodically thereafter.
    • Monitor liver function tests prior to initiation of therapy and as clinically indicated. If symptoms of serious liver injury, hyperbilirubinemia, or jaundice occurs should be discontinue pravastatin and do not restart. May also cause ↑ alkaline phosphatase and bilirubin levels.
    • If patient develops muscle tenderness during therapy, CPK levels should be monitored. If CPK levels are markedly ↑ or myopathy occurs, therapy should be discontinued.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

  • Oral: Administer once daily in the evening. May be administered without regard to food.
    • Avoid grapefruit and grapefruit juice during therapy; may increase risk of toxicity.
    • If administered in conjunction with bile acid sequestrants (cholestyramine, colestipol), administer 1 hr before or 4 hr after bile acid sequestrant.

Patient/Family Teaching

  • Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Advise patient to avoid drinking more that 200 mL/day of grapefruit juice during therapy. Medication helps control but does not cure elevated serum cholesterol levels.
  • Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
  • Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
  • Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare).
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Instruct female patients to notify health care professional promptly if pregnancy is planned or suspected.
  • Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.

Evaluation/Desired Outcomes

  • Decrease in LDL and total cholesterol levels.
    • Increase in HDL cholesterol levels.
    • Decrease in triglyceride levels.
  • Slowing of the progression of coronary artery disease.

Pravachol

(prăv′ə-kōl′)
A trademark for the drug pravastatin.
References in periodicals archive ?
The best known of these are Zocor, manufactured by Merck and Company, and Pravachol, produced by Bristol Myers-Squibb, both of which have reported soaring sales in recent months.
C-reactive protein (CRP), a sign of low-level inflammation in the body, fell 36 percent in patients taking Lipitor, but only five percent in patients taking Pravachol.
Just toss a box of Mevacor or Pravachol into the shopping cart and you're off.
In 2006 the patents protecting Zocor and Pravachol expired, which together with the anticipated patent expiry of Lipitor in 2010, will result in a flood of generic statins onto the market, heavily impacting sales of branded drugs.
Some brand-name statins such as Lescol and Pravachol saw their prescriptions decline, while generic lovastatin prescriptions increased 15.
If you take Lipitor, Pravachol, or other statin drugs plus large doses of the B-vitamin niacin to control your cholesterol, there's another reason to avoid high doses of antioxidants: they may interfere with the drugs.
He takes Zantac twice a day to control an upper-digestive tract problem, Pravachol and niacin once a day each to keep his cholesterol level down and, finally, Metamucil once a day for lower colon health.
Drugs include the company's best-seller, the blood thinner Plavix, its antipsychotic Abilify, the cholesterol treatment Pravachol and the cancer therapy Taxol.
The two new generics -- pravastatin and simvastatin -- are the generic versions of Pravachol and Zocor, respectively, both of which lost patent protection in 2006 (Pravachol in April and Zocor in June).
Statin drugs--like Pravachol, Zocor, and Lipitor--dramatically lower cholesterol and cut the risk of heart disease and stroke.
McAllister has worked on the development of such major pharmaceutical products as Lupron, Pravachol, Capoten, Kerlone, Cardene, Calan, Avandia, Actos, Teveten, and Atacand.
The prevalence of Alzheimer's disease was 60 to 73 percent lower in those taking Mevacor (lovastatin) or Pravachol (pravastatin) than in others.