Pravastatin has not been evaluated in patients with rare homozygous familial hypercholesterolemia. In this group of patients, it has been reported that statins are less effective because the patients lack functional LDL receptors.
To date, there has been limited experience with overdosage of pravastatin. If an overdose occurs, it should be treated symptomatically with laboratory monitoring and supportive measures should be instituted as required.
Pravastatin sodium is one of a class of lipid-lowering compounds, the statins, which reduce cholesterol biosynthesis. These agents are competitive inhibitors of HMG-CoA reductase, the enzyme catalyzing the early rate-limiting step in cholesterol biosynthesis, conversion of HMG-CoA to mevalonate.
Pravastatin sodium is designated chemically as 1-Naphthalene-heptanoic acid, 1,2,6,7,8,8a- hexahydro-2-methyl-8-(2-methyl-1-oxobutoxy)-β,δ,6-trihydroxy-,monosodium salt, [1S- [1α(βS*,δS*),2α,6α,8β(R*),8aα]]-.
Pravastatin sodium is white to off-white powder. It is a relatively polar hydrophilic compound with a partition coefficient (n-octanol/water) of 0.59. It is soluble in water (676 mg/mL).
Pravastatin sodium is available for oral administration as 10 mg, 20 mg, 40 mg, and 80 mg tablets. Inactive ingredients include: Croscarmellose sodium, lactose Monohydrate, magnesium oxide, magnesium stearate, microcrystalline cellulose, and povidone.
Pravastatin is a reversible inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes the conversion of HMG-CoA to mevalonate, an early and rate limiting step in the biosynthetic pathway for cholesterol. In addition, pravastatin reduces VLDL and TG and increases HDL-C.
Absorption: Pravastatin Sodium is administered orally in the active form. In studies in man, peak plasma pravastatin concentrations occurred 1 to 1.5 hours upon oral administration. Based on urinary recovery of total radiolabeled drug, the average oral absorption of pravastatin is 34% and absolute bioavailability is 17%. While the presence of food in the gastrointestinal tract reduces systemic bioavailability, the lipid-lowering effects of the drug are similar whether taken with or 1 hour prior to meals.
Pravastatin plasma concentrations, including area under the concentration-time curve (AUC), Cmax , and steady-state minimum (Cmin ), are directly proportional to administered dose. Systemic bioavailability of pravastatin administered following a bedtime dose was decreased 60% compared to that following an AM dose. Despite this decrease in systemic bioavailability, the efficacy of pravastatin administered once daily in the evening, although not statistically significant, was marginally more effective than that after a morning dose.
The coefficient of variation (CV), based on between-subject variability, was 50% to 60% for AUC. The geometric means of pravastatin Cmax and AUC following a 20 mg dose in the fasted state were 26.5 ng/mL and 59.8 ng*hr/mL, respectively.
Steady-state AUCs, Cmax , and Cmin plasma concentrations showed no evidence of pravastatin accumulation following once or twice daily administration of Pravastatin Sodium tablets.
Distribution: Approximately 50% of the circulating drug is bound to plasma proteins.
Metabolism: The major biotransformation pathways for pravastatin are: (a) isomerization to 6-epi pravastatin and the 3α-hydroxyisomer of pravastatin (SQ 31,906) and (b) enzymatic ring hydroxylation to SQ 31,945. The 3α-hydroxyisomeric metabolite (SQ 31,906) has 1/10 to 1/40 the HMG-CoA reductase inhibitory activity of the parent compound. Pravastatin undergoes extensive first-pass extraction in the liver (extraction ratio 0.66).
Excretion: Approximately 20% of a radiolabeled oral dose is excreted in urine and 70% in the feces. After intravenous administration of radiolabeled pravastatin to normal volunteers, approximately 47% of total body clearance was via renal excretion and 53% by non-renal routes (i.e., biliary excretion and biotransformation).
Following single dose oral administration of 14 C-pravastatin, the radioactive elimination t½ for pravastatin is 1.8 hours in humans.
Renal Impairment: A single 20 mg oral dose of pravastatin was administered to 24 patients with varying degrees of renal impairment (as determined by creatinine clearance). No effect was observed on the pharmacokinetics of pravastatin or its 3α-hydroxyl isomeric metabolite (SQ 31,906). Compared to healthy subjects with normal renal function, patients with severe renal impairment had 69% and 37% higher mean AUC and Cmax values, respectively, and a 0.61 hour shorter t1/2 for the inactive enzymatic ring hydroxylation metabolite (SQ 31,945).
Hepatic Impairment: In a study comparing the kinetics of pravastatin in patients with biopsy confirmed cirrhosis (N=7) and normal subjects (N=7), the mean AUC varied 18-fold in cirrhotic patients and 5-fold in healthy subjects. Similarly, the peak pravastatin values varied 47-fold for cirrhotic patients compared to 6-fold for healthy subjects. [See Warnings and Precautions (5.3). ]
Geriatric: In a single oral dose study using pravastatin 20 mg, the mean AUC for pravastatin was approximately 27% greater and the mean cumulative urinary excretion (CUE) approximately 19% lower in elderly men (65-75 years old) compared with younger men (19-31 years old). In a similar study conducted in women, the mean AUC for pravastatin was approximately 46% higher and the mean CUE approximately 18% lower in elderly women (65-78 years old) compared with younger women (18-38 years old). In both studies, Cmax , Tmax , and t1/2 values were similar in older and younger subjects. [See Use in Specific Populations (8.5). ]
Pediatric: After 2 weeks of once-daily 20 mg oral pravastatin administration, the geometric means of AUC were 80.7 (CV 44%) and 44.8 (CV 89%) ng*hr/mL for children (8-11 years, N=14) and adolescents (12-16 years, N=10), respectively. The corresponding values for Cmax were 42.4 (CV 54%) and 18.6 ng/mL (CV 100%) for children and adolescents, respectively. No conclusion can be made based on these findings due to the small number of samples and large variability. [See Use in Specific Populations (8.4). ]
|Cyclosporine 5 mg/kg single dose||40 mg single dose||↑282%||↑327%|
|Clarithromycin 500 mg BID for 9 days||40 mg OD for 8 days||↑110%||↑128%|
|Boceprevir 800 mg TID for 6 days||40 mg single dose||↑63%||↑49%|
|Darunavir 600 mg BID/Ritonavir 100 mg BID for 7 days||40 mg single dose||↑81%||↑63%|
|Colestipol 10 g single dose||20 mg single dose||↓47%||↓53%|
|Cholestyramine 4 g single doseAdministered simultaneouslyAdministered 1 hour prior tocholestyramineAdministered 4 hours aftercholestyramine||20 mg single dose||↓40%↑12%↓12%||↓39%↑30%↓6.8%|
|Cholestyramine 24 g OD for 4 weeks||20 mg BID for 8 weeks5 mg BID for 8 weeks10 mg BID for 8 weeks||↓51%↓38%↓18%||↑4.9%↑23%↓33%|
|Fluconazole200 mg IV for 6 days200 mg PO for 6 days||20 mg PO+10 mg IV20 mg PO+10 mg IV||↓34%↓16%||↓33%↓16%|
|Kaletra 400 mg/100 mg BID for 14 days||20 mg OD for 4 days||↑33%||↑26%|
|Verapamil IR 120 mg for 1 day and Verapamil ER 480 mg for 3 days||40 mg single dose||↑31%||↑42%|
|Cimetidine 300 mg QID for 3 days||20 mg single dose||↑30%||↑9.8%|
|Antacids 15 mL QID for 3 days||20 mg single dose||↓28%||↓24%|
|Digoxin 0.2 mg OD for 9 days||20 mg OD for 9 days||↑23%||↑26%|
|Probucol 500 mg single dose||20 mg single dose||↑14%||↑24%|
|Warfarin 5 mg OD for 6 days||20 mg BID for 6 days||↓13%||↑6.7%|
|Itraconazole 200 mg OD for 30 days||40 mg OD for 30 days||↑11%(compared to Day 1)||↑17%(compared to Day 1)|
|Gemfibrozil 600 mg single dose||20 mg single dose||↓7.0%||↓20%|
|Aspirin 324 mg single dose||20 mg single dose||↑4.7%||↑8.9%|
|Niacin 1 g single dose||20 mg single dose||↓3.6%||↓8.2%|
|Diltiazem||20 mg single dose||↑2.7%||↑30%|
|Grapefruit juice||40 mg single dose||↓1.8%||↑3.7%|
BID = twice daily; OD = once daily; QID = four times daily
|Pravastatin Dosing Regimen||Name and Dose||Change in AUC||Change in Cmax|
|20 mg BID for 6 days||Warfarin 5 mg OD for 6 days Change in mean prothrombin time||↑17%↑0.4 sec||↑15%|
|20 mg OD for 9 days||Digoxin 0.2 mg OD for 9 days||↑4.6%||↑5.3%|
|20 mg BID for 4 weeks10 mg BID for 4 weeks5 mg BID for 4 weeks||Antipyrine 1.2 g single dose||↑3.0%↑1.6%↑Less than 1%||Not Reported|
|20 mg OD for 4 days||Kaletra 400 mg/100 mg BID for 14 days||No change||No change|
BID = twice daily; OD = once daily
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