Pravastatin and Pharmacogenomics

Personalising Cholesterol Treatment in the UK

Pravastatin is one of the longest-standing statins used in modern medicine, commonly prescribed to lower cholesterol and reduce the risk of heart disease and stroke. As a hydrophilic statin, it has a lower tendency to penetrate muscle and brain tissues, which often results in fewer side effects—particularly muscle-related ones.

But even with its good safety profile, not everyone responds to pravastatin in the same way. Thanks to the rise of pharmacogenetics and pharmacogenomics in the UK, it's now possible to personalise cholesterol treatment using a patient’s genetic information. This type of PGx testing for statins can improve outcomes, reduce unnecessary side effects, and help the NHS cut down on costly trial-and-error prescribing.

What Makes Pravastatin Different?

Patented in 1980 and approved for medical use in 1989, pravastatin has decades of clinical use behind it (15). Unlike many other statins, it’s hydrophilic—meaning it prefers to stay in watery environments like the bloodstream. This makes it less likely to accumulate in muscles or cross into the brain, potentially lowering the chance of side effects like muscle pain or cognitive symptoms.

Common Reasons to Prescribe Pravastatin for Patients

Clinicians may consider prescribing pravastatin in several common scenarios (5):

• To lower high cholesterol when lifestyle changes aren’t sufficient

• To prevent cardiovascular events in patients at high risk of heart disease or stroke (primary prevention)

• To reduce the risk of future events following a heart attack or stroke (secondary prevention) — though off-label in some regions, this use is clinically supported

Doctors may prescribe pravastatin for a range of reasons (5):

• To lower high cholesterol when lifestyle changes aren’t enough

• To prevent cardiovascular events in people at high risk of heart disease or stroke (primary prevention)

• To reduce the risk of further events after a heart attack or stroke (secondary prevention) — although this use may be unlicensed in some regions, it’s widely supported by evidence

When and How to Take Pravastatin

Pravastatin is typically taken once per day in the evening, because the body naturally produces more cholesterol at night (12).

Recommended dosages:

• High cholesterol: 10–40 mg at night, adjusted at 4-week intervals

• Heart disease prevention: 40 mg daily at night

Beyond Cholesterol: How Pravastatin Supports Heart Health

Like other statins, pravastatin does more than just reduce LDL cholesterol. It also offers pleiotropic benefits, meaning it supports heart health through multiple mechanisms (2, 3, 4, 7):

• Stabilises atherosclerotic plaques, reducing the risk of rupture and clotting

• Improves blood vessel function, helping vessels relax and improving circulation

• Reduces inflammation and oxidative stress, supporting vascular health

Pravastatin Side Effects and Genetics

While pravastatin is often better tolerated than some other statins, it can still cause side effects for certain individuals.

Common Side Effects Include:

• Muscle pain or tenderness (especially in thighs and calves)

• Joint aches

• Tiredness

• Sleep problems

• Dizziness

• Digestive discomfort

• Liver enzyme changes

Who Is at Higher Risk of Side Effects?

People are more likely to experience side effects from pravastatin if they (11):

• Are over 60

• Have hypothyroidism or diabetes

• Engage in strenuous physical activity

• Are taking higher doses

• Have vitamin D deficiency or recently had major surgery

Pravastatin’s hydrophilic nature may reduce side effect risks, but genetics also plays a crucial role. That’s where pharmacogenetic testing for statins becomes useful.

Pharmacogenetics: How A Patient's Genes Affect Pravastatin

The body processes pravastatin using proteins and transporters encoded by specific genes. Variations in these genes can affect how well the drug works—or whether it causes side effects (10, 11).

Key Pathways:

• Absorption: ~18% oral bioavailability, with liver uptake via OATP1B1 and OATP2B1

• Elimination: Pravastatin is primarily excreted unchanged through the bile and urine. Transporters such as MRP2, BSEP, and BCRP help move it out of the liver

• Half-life: Approximately 1.8 hours

Important Genes:

• SLCO1B1 – Encodes OATP1B1, a liver transporter critical for pravastatin’s effectiveness. People with reduced-function variants (like c.521T>C) may have higher drug levels in their blood, increasing the risk of muscle side effects

This is where a PGx test for statins comes in. A quick, non-invasive pharmacogenomics test in the UK can determine if a cardiac patient is at increased risk—and whether another statin or dose might be more appropriate.

Frequently Asked Questions About Pravastatin and Genetic Testing

Can pharmacogenetic testing help if I’ve had side effects from other statins?
Yes. If a patient has previously experienced statin intolerance or muscle symptoms, a PGx test can help identify a safer alternative. View all our PGx-covered medications here.

Is pravastatin safe for older adults?
It’s often chosen for older patients due to its favourable side effect profile, but PGx testing can provide additional assurance.

Can genetic testing really reduce NHS prescribing costs?
Yes. By avoiding failed treatments and side effects, PGx-guided statin prescribing has the potential to lower costs and improve patient adherence.

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