Pravastatin vs. Simvastatin: How Do They Compare for High Cholesterol?

Pravastatin and simvastatin (Zocor, FloLipid) are both statins, a class of medications widely considered to be first-choice medications for treating high cholesterol. Pravastatin and simvastatin both work similarly to help lower cholesterol.

But if they work in the same way, when would a healthcare provider pick one over the other? Below, we’ll discuss key similarities and differences between pravastatin and simvastatin to help you better understand these two treatment options.

How do pravastatin and simvastatin work?

Pravastatin and simvastatin work by lowering the amount of a certain type of cholesterol your liver makes.

Cholesterol can come from the foods you eat. But your liver also makes its own cholesterol. This ensures some cholesterol is always present in your body, even if it isn’t consumed through your diet. While cholesterol is commonly portrayed as bad, you actually need it in your system to function.

Statins, including pravastatin and simvastatin, work by lowering the amount of low-density lipoprotein (LDL, or “bad cholesterol”) your liver produces. They can also slightly raise levels of high-density lipoprotein (HDL, or “good cholesterol”). Additionally, they can help lower triglyceride levels (fatty substances in the blood).

Over time, too much LDL can cause plaques (fatty deposits) to form in your blood vessels. This can cause your arteries to harden (atherosclerosis). And this can raise your risk for heart complications, such as a stroke or heart attack. By lowering LDL levels, statins can help lower your risk of developing these issues.

Which is better at lowering cholesterol?

Pravastatin and simvastatin are similarly effective for lowering cholesterol. But the dose you’re taking can make a difference in how much they might lower your cholesterol.

One way to differentiate statins is sorting them based on their intensity level. A statin’s intensity describes how much it can lower LDL levels. There are three different levels of statin intensity:

• Low intensity: Statins that lower LDL levels by less 30%

• Moderate intensity: Statins that can lower LDL levels by 30% to 49%

• High intensity: Statins that can lower LDL levels by 50% or more

Depending on the dose, both pravastatin and simvastatin may provide low- or moderate-intensity statin treatment. Neither would be considered a high-intensity statin at any dose. The table below breaks down which doses fall into which intensity level.

How do you take pravastatin and simvastatin?

Most people take pravastatin or simvastatin once a day. You can take most versions with or without food. But the oral liquid version of simvastatin (FloLipid) should be taken on an empty stomach. Taking your medication with a meal (when it’s an option) may help you better remember your doses.

It’s best to take pravastatin or simvastatin in the evening. This is because your liver makes most of its cholesterol while you’re sleeping. Neither statin stays in the body very long. So taking doses at night helps more medication be available while more cholesterol is being produced.

What are some common side effects of pravastatin and simvastatin?

Statin side effects get quite a bit of negative attention. But many people are able to take statins without experiencing any side effects. Still, it’s good to be aware of them, in case they happen to you.

Some side effects commonly reported with both pravastatin and simvastatin include:

• Cold-like symptoms, such as a runny or stuffy nose

• Nausea

• Headache

• Muscle pain or weakness (more on this below)

There is one interesting difference with common side effects. People taking pravastatin in clinical trials reported diarrhea. People taking simvastatin in studies experienced constipation.

Keep in mind that the benefits of taking a statin often outweigh the risk of side effects for many people. Be sure to discuss your concerns with your healthcare provider.

More about statins and muscle pain

Muscle pain is one of the most well-known statin side effects. But it doesn’t happen as often as many people think. Pravastatin and most doses of simvastatin have similar risks when it comes to muscle pain.

This being said, the highest simvastatin dose (80 mg) carries a greater risk for muscle pain and damage compared to lower doses and compared to other statins. Due to this risk, the FDA recommends that healthcare providers avoid prescribing this dose of simvastatin for most people.

If you have muscle pain while taking pravastatin or simvastatin, contact your provider. This side effect frequently goes away on its own. But your provider may want to review your symptoms and other medications to determine what’s causing it. They may also suggest lowering your statin dose or switching to another statin to help relieve this side effect.

Do pravastatin and simvastatin interact with other medications?

Both pravastatin and simvastatin interact with other medications. They share some interactions, but have some different ones as well. These differences may determine which statin is a better choice for you. Many statin interactions can raise your risk of experiencing side effects, including muscle pain.

Some interactions that pravastatin and simvastatin share include:

• Macrolide antibiotics, such as azithromycin (Zithromax)

• Colchicine

• Cyclosporine (Sandimmune)

• Fibrates, especially gemfibrozil (Lopid)

• Niacin

Pravastatin also interacts with bile acid sequestrants, such as cholestyramine (Prevalite). These medications can make pravastatin less effective. Simvastatin doesn’t interact with bile acid sequestrants.

Overall, simvastatin has more interactions than pravastatin. The following interact with simvastatin, but not pravastatin:

• Certain heart medications, including diltiazem (Cardizem), and verapamil (Calan SR, Verelan)

• Oral azole antifungals, such as ketoconazole and itraconazole (Sporanox)

• Medications containing ritonavir, such as Paxlovid (nirmatrelvir / ritonavir)

• Grapefruit (the juice and the fruit itself)

This isn’t a complete list of interactions for either pravastatin or simvastatin. It’s important to ensure your healthcare provider and pharmacist always have an updated medication list. This can help them better check for pravastatin or simvastatin interactions.

Are there other risks with pravastatin or simvastatin you should be aware of?

There are a few other risks to consider when taking pravastatin or simvastatin. This is not a comprehensive list. It’s important to talk with your healthcare provider to learn more about your specific risks.

Two notable risks that pravastatin and simvastatin share are:

• Pregnancy. With a few rare exceptions, pravastatin or simvastatin shouldn’t be taken during pregnancy. Contact your provider immediately if you become pregnant while taking a statin. They can help decide whether you should stop taking it.

• Alcohol. It’s recommended to avoid or limit drinking alcohol while taking pravastatin or simvastatin. Very rarely, statins cause liver damage. Drinking alcohol can raise your risk of this serious side effect. Additionally, heavy alcohol use can raise your cholesterol. This can affect how well statins might work for you.

How to save on pravastatin and simvastatin

There are ways to save on pravastatin and simvastatin. Both are available as lower-cost generics. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 80% off the average retail price of the generic versions. Generic pravastatin’s price at certain pharmacies is as low as $14.40 with a free GoodRx discount. Generic simvastatin’s price may be as low as $12.60 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for patient assistance programs through the PAN Foundation. If eligible, your prescription for pravastatin or simvastatin may be free of charge.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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