Shop products for 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 hypercholesterolaemia (high cholesterol).
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 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) |
 Avoid: Adverse interaction—Avoid these supplements
when taking this medication because taking them together may cause undesirable or dangerous
results. |
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. |
Grapefruit juice Niacin Vitamin A |
| Reduced drug absorption/bioavailability |
None known |
An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
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 was 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 Individuals taking pravastatin should consult a
doctor before taking niacin.
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.
