Pravastatin vs Lovastatin

## Overview

Pravastatin and lovastatin are both moderate-intensity statins but with very different pharmacokinetic profiles. Pravastatin is hydrophilic with no CYP metabolism; lovastatin is lipophilic with complete CYP3A4 dependence. Their potency is similar, making drug interaction profile the key differentiator.

## Mechanism of Action

Both inhibit HMG-CoA reductase. Lovastatin is a prodrug; pravastatin is the active open-acid form. Pravastatin's OATP-mediated hepatic uptake enhances its hepatoselectivity.

## Pharmacokinetics

Pravastatin: bioavailability ~17%, no CYP metabolism, half-life ~2 h. Lovastatin: bioavailability ~5%, CYP3A4 (major), half-life 2–3 h, must be taken with meals.

## Pharmacodynamics

Both are classified as moderate-intensity statins. Lovastatin 40 mg reduces LDL by ~31%; pravastatin 40 mg reduces LDL by ~29%. At 80 mg, lovastatin achieves ~40% and pravastatin ~34%. The efficacy difference is modest.

## Clinical Evidence

Pravastatin has the stronger outcome trial record: WOSCOPS (primary prevention), CARE, LIPID, and PROSPER (elderly). Lovastatin's AFCAPS/TexCAPS provides primary prevention data. Neither has the extensive outcome data of atorvastatin.

## Safety

Lovastatin 80 mg carries the same FDA restriction as simvastatin 80 mg. Pravastatin lacks such restrictions. Pravastatin is the better-studied statin in elderly populations and has a well-established safety record in renal transplant patients.

## Key Takeaways

- Comparable moderate-intensity potency
- Pravastatin: no CYP interactions, hydrophilic, preferred in polypharmacy
- Lovastatin: CYP3A4-dependent, food-dependent absorption, 80 mg restricted
- Pravastatin has stronger outcome trial evidence overall