Drug Overview
Pravastatin is a member of the statin class of drugs (HMG-CoA reductase inhibitors) and is marketed under the brand name Pravachol.
It is primarily used to treat hypercholesterolemia—elevated cholesterol levels in the blood—and to reduce the risk of cardiovascular events such as heart attacks and strokes.
Pravastatin works by inhibiting the HMG-CoA reductase enzyme in the liver, which decreases cholesterol synthesis and leads to increased clearance of low-density lipoprotein (LDL) cholesterol from the bloodstream.
Relevant Genes and Their Roles
The primary gene affecting pravastatin pharmacokinetics is SLCO1B1. This gene encodes the OATP1B1 transporter, a protein that moves pravastatin from the blood into liver cells for metabolism.
Variants in SLCO1B1 can alter transporter activity. Reduced-function variants can slow hepatic uptake of pravastatin, leading to higher circulating drug levels, while increased-function variants maintain normal uptake. A transporter is simply a protein that helps carry drugs into cells.
Impact of Genetics on Drug Response
Individuals with SLCO1B1 variants that reduce or eliminate transporter function tend to have higher systemic exposure to pravastatin, which increases their risk of statin-associated muscle symptoms (myopathy). Those with normal or increased transporter function usually experience standard pravastatin levels and typical risk profiles. Patients with indeterminate or unknown SLCO1B1 genotypes should be managed with conventional dosing and clinical monitoring.
Want to know what your genetics say about how you'll respond to Pravastatin?
A Gene2Rx report reads your own DNA to show how it may affect your response to Pravastatin and your other medications.
{# data-track routes these through the sitewide cta_click listener in
base.html, which attaches page_type / drug_name / guide_slug from the
server-resolved page context. This one file instruments the mid-article
CTA on ~114 content pages. #}
Find out today
Or see an example report first
Expected Clinical Effects of Genetic Variation
Increased Function
- Effect on drug levels: Drug levels typically remain within expected range
- Clinical consequence: Standard risk of myopathy
- Side effects: Muscle pain or weakness is uncommon and similar to the general population
Normal Function
- Effect on drug levels: Drug levels typically remain within expected range
- Clinical consequence: Standard risk of myopathy
- Side effects: Muscle pain or weakness is uncommon and similar to the general population
Decreased Function
- Effect on drug levels: Slightly increased drug levels compared with normal
- Clinical consequence: Typical myopathy risk at standard doses, especially above 40 mg
- Side effects: Mild muscle symptoms may occur; uncommon
Possible Decreased Function
- Effect on drug levels: Slightly increased drug levels compared with normal
- Clinical consequence: Typical myopathy risk at standard doses, especially above 40 mg
- Side effects: Mild muscle symptoms may occur; uncommon
Poor Function
- Effect on drug levels: Significantly increased drug exposure
- Clinical consequence: Elevated risk of myopathy even at lower doses
- Side effects: Higher likelihood of muscle pain; moderate severity, may require dose reduction
Possible Poor Function
- Effect on drug levels: Significantly increased drug exposure
- Clinical consequence: Elevated risk of myopathy even at lower doses
- Side effects: Higher likelihood of muscle pain; moderate severity, may require dose reduction
Indeterminate
- Effect on drug levels: Unknown
- Clinical consequence: No specific guidance; follow standard dosing with clinical monitoring
- Side effects: Standard monitoring recommended
Not available
- Effect on drug levels: Unknown
- Clinical consequence: No specific guidance; follow standard dosing with clinical monitoring
- Side effects: Standard monitoring recommended
Dosing Guidelines
The following dosing guidelines are based on the available guidelines for SLCO1B1 and pravastatin from CPIC.
SLCO1B1 Dosing Guideline
| Phenotype |
Clinical Consequence |
Guideline Recommendation |
| Increased Function |
Typical myopathy risk and pravastatin exposure |
Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. |
| Normal Function |
Typical myopathy risk and pravastatin exposure |
Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. |
| Decreased Function |
Increased pravastatin exposure compared with normal function; typical myopathy risk with doses ≤40 mg |
Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially with doses >40 mg per day. |
| Possible Decreased Function |
Increased pravastatin exposure compared with normal function; typical myopathy risk with doses ≤40 mg |
Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially with doses >40 mg per day. |
| Poor Function |
Increased pravastatin exposure compared with normal and decreased function; typical myopathy risk with doses ≤40 mg |
Prescribe ≤40 mg as a starting dose and adjust doses of pravastatin based on disease-specific guidelines. If patient is tolerating 40-mg dose but higher potency is needed, a higher dose (>40 mg) or an alternative statin or combination therapy could be considered. Prescriber should be aware of possible increased risk for myopathy especially with pravastatin doses >40 mg. |
| Possible Poor Function |
Increased pravastatin exposure compared with normal and decreased function; typical myopathy risk with doses ≤40 mg |
Prescribe ≤40 mg as a starting dose and adjust doses of pravastatin based on disease-specific guidelines. If patient is tolerating 40-mg dose but higher potency is needed, a higher dose (>40 mg) or an alternative statin or combination therapy could be considered. Prescriber should be aware of possible increased risk for myopathy especially with pravastatin doses >40 mg. |
| Indeterminate |
No CPIC guidance for this phenotype |
Initiate therapy with recommended starting dose. |
| Not available |
No CPIC guidance for this phenotype |
Initiate therapy with recommended starting dose. |
Alternative Treatment Options
Examples of alternative statins or approaches mentioned in the CPIC guidelines include using a different statin such as atorvastatin or simvastatin, or combining pravastatin with non-statin lipid-lowering therapies when higher potency is needed. These are examples from CPIC guidelines, not medical advice.
Genes that affect Pravastatin
See the full list of drugs affected by each gene:
Brand names containing Pravastatin
See how your genetics affect each product Pravastatin shows up in:
Related Guides
Learn more about how genetics may affect your response to Pravastatin and related medications:
Disclaimer: This document is for informational purposes only and is not a substitute for medical advice. Clinical decisions should be made by a qualified healthcare professional.
Interested in learning more about how your genetics may affect your response to medication? Get started with Gene2Rx today.
I'm Interested