Pitavastatin vs Pravastatin
- According to a clinical study pitavastatin is better at lowering choesterol than pravastatin.
- Both statins have a reduced risk of interacting with other drugs.
- Both statins are safe with grapefruit and grapefruit products.
For several decades, statins have been used to treat high cholesterol since the approval of lovastatin in 1987, the first statin in the U.S. Since then, newer statins have entered the market, and currently, there are 7 statins available. With so many options to choose from, it can be challenging to find the right one.
Read about Compare statins
This article aims to compare the dosage, efficacy, side effects, and interactions of pitavastatin and pravastatin to help you understand the similarities and differences between the two medications.
Pravastatin is an older statin that came into the U.S. market in 1991 under the brand name Pravachol. It’s a moderate- to low-intensity statin and approved for use in adults and children as young as 8 years old. Pitavastatin, on the other hand, is a newer statin with moderate intensity and available in two brands Livalo and Zypitamag. There are no generic options at the time of writing. Pitavastatin (Livalo) is also approved for use in children as young as 8 years old.
Pitavastatin is available in two brand names Livalo and Zypitamag. There are no generic options at the time of writing. Livalo and Zypitamag became available in the U.S. in 2009 and 2017 respectively.
Livalo vs Zypitamag
Both Livalo and Zypitamag are pitavastatin that work the same with one minor difference in their composition: the type of salt they use. Salt is used in medication to improve drug’s solubility and stability. Livalo includes calcium while Zypitamag includes magnesium. The salt does not affect the drug’s efficacy and both brands are considered bioequivalent by the FDA (Food and Drug Administration) which means they have the same active component and function in the same way.
However, cost might be a deciding factor for many people when choosing a pitavastatin. The cash-price for Zypitamag is $34.50/month compared to over $300/month with a coupon for Livalo.
Doses
Pravastatin
Pravastatin can be taken with or without food and is available in tablet form in dosages ranging between 10–80 mg taken by mouth daily, including:
- Moderate-intensity: 40–80 mg daily
Can reduce LDL by approximately 30%–49% - Low-intensity: 10–20 mg daily
Can reduce LDL nomore than 30%
Because the full impact of this medication is seen within 4 weeks, frequent lipid assessments should be done at this time, and the dosage should be changed based off of your response to pravastatin.
Pitavastatin
If you have not previously responded well to other statins and you’re looking for a statin that causes less muscular discomfort, then this medication may be most appropriate for you.
This medication is available in tablet form and can be taken with or without food. Pitavastatin is available in the following dosages:
- Moderate-intensity: 2–4 mg daily
Can reduce LDL by approximately 30%–49%
The dosage prescribed to you is determined by your age, medical history, treatment response, and any additional drugs you may be taking.
Metabolism and interactions
Drug interactions have a lot to do with their metabolism—how they are processed in your body.
After the medications you ingest are absorbed in the bloodstream they get excreted from your body. Your liver prepares (metabolizes) medications for elimination by using enzymes. The group of enzymes called CYP450 is responsible for metabolizing 70–80 % of all drugs on the market, including most statins. Since so many drugs are processed by this enzyme group, CYP450 may cause extensive drug-drug interactions with popular medications
Pitavastatin isn’t processed by CYP450. It’s primarily metabolized by a different liver enzyme called UGT (uridine 5'-diphosphate glucuronosyltransferase). Because pitavastatin bypasses CYP450 it has a reduced potential of drug interations.
Pravastatin is processed by CYP3A4 (part of CYP450), but unlike other statins it’s not extensively metabolized by this enzyme. Instead, it’s mostly excreted unchanged in the bile. Because CYP450 isn’t significantly involved in pravastatin’s metabolism, pravastatin also has a decreased risk of drug interactions.
Your physician must be aware of any additional medications you are taking because some of them might significantly raise your chance of developing serious muscle issues.
Tell your doctor or pharmacist of all prescription and over-the-counter (OTC) medications you may be taking, including:
| Drugs that can interact with | |
| Pravastatin | Pitavastatin |
| Erythromycin Cyclosporine Niacin Colchicine Gemfibrozil Clarithromycin Azithromycin |
Erythromycin
Cyclosporine Niacin Colchicine Gemfibrozil Atazanavir Retrovir Red yeast rice |
Additionally, it's recommended to take pravastatin dosage either 1 hour before or 4 hours after taking cholestyramine or colestipol if you take either of those medications.
It’s also recommended to avoid taking pitavastatin if you are also taking cyclosporine or have liver problems, especially if you have abnormal liver enzyme testing.
How about grapefruit?
Grapefruit contains a chemical that can interfere with your body's ability to break down or metabolize certain statin medications. Grapefruit and grapefruit products should be avoided while you're taking a statin, including atorvastatin, to avoid undesirable adverse effects.
Unlike most statins, pravastatin and pitavastatin do not interact with grapefruit juice or grapefruit products.
Which statin is better at lowering cholesterol?
According to a clinical study that compared the efficacy and safety of pitavastatin and pravastatin on people with high cholesterol, dosage levels of pitavastatin, including 2 mg, and 4 mg, showed considerably higher reductions in LDL (bad) cholesterol when compared to pravastatin 20, and 40 mg.
In short, pitavastatin is better at lowering cholesterol than pravastatin. However, the statin that is best for you will depend on a variety of things, including your cholesterol levels, any drugs you are taking, and any other health issues you may have.
How statins work
Since both pravastatin and pitavastatin belong to the same drug class (HMG-CoA reductase inhibitors), they work in very similar ways.
What is cholesterol?
Cholesterol is a waxy substance your body, specifically your liver, makes. Cholesterol isn’t inherently bad. Your body needs it to make cells, vitamins and hormones. But too much of bad cholesterol (LDL-C) can cause cardiovascular disease. Cholesterol circulates in your blood. If you have too much LDL-C, it can stick to the artery walls and form plaque, a buildup of fats, cholesterol and other substances. If the plaque ruptures, it can lead to conditions like a heart attack or stroke.
Learn more about Cholesterol
The enzyme called HMG-GoA reductase converts mevalonate (a naturally occurring chemical) to cholesterol in your liver. Statins reduce cholesterol synthesis by blocking this enzyme. Additionally, statins increase your liver's ability to take in and break down cholesterol from your blood.
With proper diet and exercise, statins are used to reduce your “bad” cholesterol (LDL), decreasing triglycerides (a type of fat in your blood), and increasing your “good” cholesterol (HDL), overall lowering your risk of having a heart attack or stroke.
The conditions pitavastatin and atorvastatin are used for:
- Dyslipidemia—an abnormal balance between good and bad cholesterol levels
- Hypercholesterolemia—high cholesterol levels in your blood
- Heterozygous Familial Hypercholesterolemia (HeFH)
—an inherited medical condition that causes high levels of LDL
—pitavastatin is used in adolescents as young as 8 years to decrease total cholesterol and LDL cholesterol - Homozygous Familial Hypercholesterolemia (HoFH)
—HoFH is a medical condition that develops when your body has trouble eliminating LDL from your blood, resulting in an increased risk of developing a heart attack at a young age. - Primary and secondary Atherosclerotic Cardiovascular Disease (ASCVD)—a condition caused by the development of cholesterol plaque (build-up) in your arteries.
Side effects
Pravastatin and pitavastatin are part of the same drug class, which means they share similar adverse effects.
Although these statins are considered safe and effective for many individuals, they do cause an extensive amount of negative effects, including the following:
- Myopathy (skeletal muscle disorder causing muscle spasms, muscle stiffness and muscle weakness)
- Myalgias (muscle pain and/or soreness)
- Arthralgia (joint pain)
- Cognitive impairment
- Headache
- Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
- Insomnia
- Nausea
- Heartburn
- Abdominal pain
- Indigestion
- Constipation
- Weakness
Do not abruptly discontinue taking your statin if you believe you are encountering any negative side effects. Consult your doctor to determine whether a dose adjustment or switching to a different drug could be beneficial in your case.
Serious side effects
- Difficulty raising your arms and/or difficulty rising or standing
- Muscle aches in your hips, shoulders, neck, and back
- Hepatic (liver) issues, such as upper abdominal pain, weakness, fatigue, decreased appetite, dark urine, and jaundice (yellowing of the skin or eyes)
- Kidney issues, such as little to no urination, ankle or foot swelling, fatigue, or shortness of breath
- Confusion and/or memory problems
If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.
Warning
Individuals taking statins may experience blood in their urine, also called hematuria, or protein in their urine commonly referred to as proteinuria.
Learn more about Statin Intolerance
What should I avoid while taking pravastatin or pitavastatin?
Consume less food that's rich in cholesterol or fat. If you don’t adhere to a cholesterol-lowering food plan, these medications will not decrease your cholesterol as effectively.
Avoid excessive consumption of alcohol. It may increase your risk of liver damage and boost your lipid levels. Before taking this medication, inform your doctor if you generally drink more than 2 alcoholic beverages a day.
Can I take pravastatin or pitavastatin if I’m pregnant or breastfeeding?
When taking pravastatin or pitavastatin, you should inform your doctor if you get pregnant or think you could be pregnant.
If you do get pregnant while taking this medication, stop taking pravastatin and notify your doctor immediately. Your doctor will advise you on whether you should discontinue this medication during pregnancy and if you should temporarily stop using these medications while nursing or breastfeeding.
Following giving birth, women who need statins and are at high risk of heart attack or stroke should not breastfeed; instead, they should utilize alternatives such as baby formula.
Kidney failure may result from muscle tissue degradation brought on by pitavastatin. If you experience inexplicable muscular pain, soreness, or stiffness while taking pitavastatin, consult your physician immediately, particularly if you're also experiencing fever, unusual fatigue, or dark urine.
Missed dose
If you forget to take a dose of your statin, take it as soon as you remember. However, if your missed dose was more than 12 hours ago, it's best to skip it. You can take your next dose again on your regular schedule.
Consult your physician or pharmacist if you're unsure about taking a missed dose or skipping it.
To make up for a missed dosage, do not take another pill. This might increase your likelihood of experiencing negative adverse effects.
Consider utilizing a medicine reminder to ensure that you don't forget to take a dosage. This may entail using a timer or setting an alarm. On your phone, you might also download a reminder app.
Speak with your doctor
Both medications are considered safe and effective when taken appropriately (as prescribed by your doctor). Talk to your doctor today about using pitavastatin and atorvastatin and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.
Marley Drug provides free nationwide shipping, allowing you to receive your medication at no additional cost straight to your door.