The presence of food reduces bioavailability further, but no difference in the lipid-lowering effect was detected between patients receiving pravastatin with meals compared with those receiving it 1 hour before meals. Pravastatin is relatively more hydrophilic than the other agents, although it is uncertain if this provides any clinical advantage. Bioavailability data can be misleading with drugs like pravastatin. Administration of pravastatin in the evening results in lower systemic bioavailability, but efficacy is slightly better than after AM dosing. Pravastatin undergoes extensive first-pass extraction and metabolism by the liver.
Serum concentrations are significantly higher in patients with hepatic disease than in controls.
Metabolites do not possess clinical activity. Administering pravastatin 1 hour before or 4 hours after a dose of the bile acid sequestrant is advised if both agents are used together. Pravastatin has been administered with niacin, gemfibrozil, and probucol. Severe myopathy was not observed, although muscle biopsies were not performed. Combination therapy of the related agent lovastatin with cyclosporine or other immunosuppressive agents, gemfibrozil, erythromycin, or lipid-lowering doses of niacin, vitamin BA has been associated with myopathy and rhabdomyolysis.