Key takeaways:
Pravastatin is a statin medication that’s FDA-approved to lower cholesterol. It interacts with several other medications.
Pravastatin interacts with gemfibrozil (Lopid), fenofibrate, and clarithromycin (Biaxin XL). It also interacts with cyclosporine (Gengraf, Neoral, Sandimmune), niacin (Niacor), and colchicine (Colcrys, Lodoco, Mitigare). These medications raise the risk of pravastatin side effects, such as muscle pain.
Bile acid sequestrants, such as cholestyramine (Prevalite), can make pravastatin less effective. You should take pravastatin at least 1 hour before or 4 hours after bile acid sequestrants.
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Pravastatin is a statin cholesterol medication. It can help lower cholesterol. And it can also help lower your risk of cardiovascular events, such as heart attack or stroke.
When taking any medication, you want it to work well with the least amount of side effects possible. But drug interactions can change how a medication works in your body. For instance, certain medications raise your risk of muscle pain from pravastatin. So how can you limit or avoid pravastatin interactions?
Good to know: Unlike many statins, pravastatin does not interact with grapefruit juice. So feel free to enjoy it as part of your cholesterol-friendly diet.
Pravastatin interactions at a glance
The following medications interact with pravastatin:
Fibrates, such as gemfibrozil (Lopid) and fenofibrate
Macrolide antibiotics, such as clarithromycin (Biaxin XL) and erythromycin (Ery-Tab)
Cyclosporine (Gengraf, Neoral, Sandimmune)
Niacin (Niacor)
Colchicine (Colcrys, Lodoco, Mitigare)
Bile acid sequestrants, such as cholestyramine (Prevalite)
Keep in mind that this isn’t a complete list of all possible pravastatin interactions. Tell your healthcare team about all the medications you take. This includes over the counter (OTC) medications and dietary supplements.
1. Fibrates, such as gemfibrozil
Pravastatin interacts with gemfibrozil, a fibrate medication. Gemfibrozil is a cholesterol medication that works differently than statins. Pravastatin’s manufacturer recommends avoiding the combination. Taking gemfibrozil with pravastatin raises your risk for muscle pain and rhabdomyolysis. This is muscle breakdown that can cause kidney damage.
Fenofibrate, another fibrate medication, also interacts with pravastatin. But it has a lower risk of problems than gemfibrozil does. So some people may take both pravastatin and fenofibrate. If you’re taking this combination, tell your prescriber if you experience muscle pain. They may adjust your doses or try a different combination of cholesterol medications.
2. Clarithromycin and erythromycin
Pravastatin also interacts with macrolide antibiotics. Examples of macrolides include:
Clarithromycin
Azithromycin (Zithromax)
Clarithromycin and erythromycin raise the risk of pravastatin side effects, including rhabdomyolysis. But people don't always need to avoid this combination. It’s recommended to take no more than 40 mg of pravastatin per day while taking clarithromycin or erythromycin.
Azithromycin can also make pravastatin side effects more likely. But the risk is lower compared with the risk of clarithromycin or erythromycin. So there are no recommended pravastatin dosage adjustments if you’re taking azithromycin.
Tell your prescriber if you experience muscle pain after starting a macrolide. They may have you stop taking pravastatin until you finish taking your antibiotic. They may also switch your antibiotic, depending on your situation. But don’t stop taking pravastatin or your macrolide without your prescriber’s OK.
Good to know: Clindamycin (Cleocin) is an antibiotic whose name sounds like the names of macrolide antibiotics. But clindamycin is not a macrolide. And it interacts with different medications. Clindamycin doesn’t interact with pravastatin.
3. Cyclosporine
Pravastatin also interacts with the immunosuppressant cyclosporine. Cyclosporine is used to help prevent rejection after an organ transplant. It can also treat severe rheumatoid arthritis and plaque psoriasis.
Managing side effects: Many pravastatin interactions raise the risk of side effects, such as muscle pain.
How to take it: Sometimes, prescribers manage interactions by lowering your pravastatin dosage.
More than medication: Learn how you can naturally lower your cholesterol.
Combining cyclosporine with pravastatin raises your risk of muscle pain and rhabdomyolysis. To manage this risk, you’ll likely take a lower pravastatin dose. It’s recommended not to exceed 20 mg of pravastatin with cyclosporine.
4. Niacin
Pravastatin also interacts with niacin (vitamin B3). This B vitamin can help lower cholesterol. It’s available both OTC and with a prescription.
Taking niacin with pravastatin raises your risk of muscle pain and breakdown. And this combination doesn’t appear to offer significant benefits for many people, either.
Even so, some healthcare professionals may still recommend that people take pravastatin and niacin together. If your prescriber OKs this combination for you, watch for new or worse side effects. Tell your care team right away if you notice muscle pain while taking both medications.
5. Colchicine
Pravastatin interacts with the gout medication colchicine, too. As with the other examples cited, colchicine makes muscle pain or breakdown with pravastatin more likely. But you may not need to avoid the combination.
A healthcare professional may prescribe both pravastatin and colchicine for you. If they do, keep an eye out for new side effects. If you start experiencing new or worse muscle pain, tell your prescriber. They may suggest a dosage change to one or both medications.
6. Bile acid sequestrants, such as cholestyramine
Pravastatin also interacts with bile acid sequestrants, such as cholestyramine. But the issue is the opposite of that with most pravastatin interactions. Bile acid sequestrants can stop your body from fully absorbing some oral medications. This includes pravastatin. And this can make your statin less effective.
You can manage this pravastatin interaction by separating the medications. Take your pravastatin dose at least 1 hour before or 4 hours after your bile acid sequestrant.
Frequently asked questions
Ask a healthcare professional before taking pravastatin with vitamin B3 (niacin). Taking both can raise your risk of pravastatin side effects, including muscle pain. Your healthcare team may want you to avoid or take a lower dose of vitamin B3 if you’re also taking pravastatin.
Yes, you can take Zetia (ezetimibe) and pravastatin at the same time. These two cholesterol medications don’t interact with each other. And it’s common to combine Zetia and a statin if the statin isn't working well enough on its own.
Yes, it’s OK to drink grapefruit juice with pravastatin. Unlike many statins, pravastatin doesn’t interfere with this tart citrus fruit. And grapefruit is one of many foods that can help support your cholesterol goals.
Ask a healthcare professional before taking pravastatin with vitamin B3 (niacin). Taking both can raise your risk of pravastatin side effects, including muscle pain. Your healthcare team may want you to avoid or take a lower dose of vitamin B3 if you’re also taking pravastatin.
Yes, you can take Zetia (ezetimibe) and pravastatin at the same time. These two cholesterol medications don’t interact with each other. And it’s common to combine Zetia and a statin if the statin isn't working well enough on its own.
Yes, it’s OK to drink grapefruit juice with pravastatin. Unlike many statins, pravastatin doesn’t interfere with this tart citrus fruit. And grapefruit is one of many foods that can help support your cholesterol goals.
The bottom line
Pravastatin is a statin medication that can help lower cholesterol. Many pravastatin interactions raise your risk of side effects, such as muscle pain. These include gemfibrozil (Lopid), fenofibrate, and clarithromycin (Biaxin XL). Cyclosporine (Gengraf, Neoral, Sandimmune), niacin (Niacor), and colchicine (Colcrys, Lodoco, Mitigare) also have this effect.
Bile acid sequestrants, such as cholestyramine (Prevalite), can make pravastatin less effective. Tell your healthcare team about all the medications you take before they start you on pravastatin.
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References
Bryant Ranch Prepack. (2025). Pravastatin Sodium- pravastatin sodium tablet [package insert].
Office of Dietary Supplements. (2021). Niacin: Fact sheet for consumers. National Institutes of Health.
Wilson, P. W. F., et al. (2018). Systematic review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation.
