Statin (HMG-CoA reductase inhibitor)
ATC code: C10AA03 (Pravastatin)
A competitive HMG-CoA reductase inhibitor – the key enzyme in hepatic cholesterol synthesis. Unlike other statins, hydrophilic – not CYP-metabolized (renally excreted unchanged). This gives minimal drug interactions and is advantageous in patients on polytherapy. Intensity class: moderate ( reduction 30–40% at 40–80 mg).
Second line
Second-line for hypercholesterolemia per 2019 after high-intensity statins (atorvastatin, rosuvastatin). Dose 20–40 mg once daily at bedtime reduces by 30–40%. Preferred in patients on multiple CYP3A4-metabolized drugs (cyclosporine post-transplant, antiretrovirals, antifungals) – pravastatin has no significant interactions. Also in statin intolerance from muscle side effects.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Pravastatin is a weak-to-moderate hydrophilic statin with minimal CNS penetration. It is prescribed for hyperlipidemia and for primary/secondary CV prevention in high-risk patients ( 2019). In anti-aging practice, pravastatin is positioned as a mild statin for continuous vessel protection in people with normal lipids. In people with normal lipid profile, no clinical studies of prophylactic use exist. The drug causes myalgia, elevated liver enzymes, and new-onset diabetes risk. If pravastatin was prescribed at normal lipid levels, consider seeking a second opinion.
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FDA category X. Cholesterol is essential for fetal development. Stop statin 1–3 months before planned conception. FDA in 2021 revised its stance and allows individual decisions in very high cardiovascular risk patients, but Europe maintains an absolute contraindication.
Contraindicated during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Pravastatin is evaluated for the following indications with varying evidence strength: Primary hypercholesterolemia (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Pravastatin (≥ 1 in 100): Myalgia (1–5%), Headache, Nausea, Diarrhea or constipation, ALT elevation (modest, reversible). See the Safety section for uncommon and serious reactions.
FDA category X. FDA category X. Cholesterol is essential for fetal development. Stop statin 1–3 months before planned conception. FDA in 2021 revised its stance and allows individual decisions in very high cardiovascular risk patients, but Europe maintains an absolute contraindication.
Contraindicated during lactation.
Pravastatin is contraindicated in: Hypersensitivity to pravastatin or other statins; Active liver disease or transaminase elevation over 3× upper limit; Pregnancy and lactation; Age under 8. Full list in the Safety section.