Lipitor vs. Pravachol

See how Lipitor and Pravachol compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Lipitor is a higher-intensity statin that lowers LDL cholesterol more per milligram than Pravachol, which is a lower-to-moderate-intensity option.

  • Pravachol is not broken down by the liver's CYP3A4 enzyme, so it interacts with fewer other medications than Lipitor, a plus for patients on multiple drugs.

  • Both are taken once daily as a tablet, but generic pravastatin typically costs far less out of pocket each month than brand-name Lipitor.

Lipitor vs. Pravachol Drug Summary

Lipitor

Lipitor (atorvastatin) is a statin that blocks a liver enzyme involved in making cholesterol, lowering LDL and triglycerides while modestly raising HDL. It comes as a once-daily oral tablet, dosed from 10 mg to 80 mg depending on how much LDL lowering a patient needs.

Pravachol

Pravachol (pravastatin) is also a statin that blocks the same liver enzyme to lower LDL and triglycerides, though it produces smaller reductions per milligram than Lipitor. It comes as a once-daily oral tablet, usually starting at 40 mg and increasing to 80 mg if needed.

Lipitor vs. Pravachol Side Effects

Lipitor

Most common
nasopharyngitis (up to 8.3%)
arthralgia (up to 6.9%)
diarrhea (up to 6.8%)
pain in extremity (up to 6.0%)

Pravachol

Most common
musculoskeletal pain (up to 24.9%)
upper respiratory infection (up to 21.2%)
nausea/vomiting (up to 10.5%)
diarrhea (up to 6%)

Lipitor vs. Pravachol Dosage

Lipitor

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose 80 mg once daily If needed
Dose changes 3 increases As tolerated

Pravachol

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 40 mg once daily At the start
Maximum dose 80 mg once daily If needed
Dose changes 1 increase As tolerated

Lipitor vs. Pravachol Indications

Lipitor

Lipitor is prescribed to lower LDL cholesterol and triglycerides in adults and children 10 and older, and to reduce the risk of heart attack, stroke, and certain heart procedures in people with cardiovascular risk factors. It's also approved for adults with type 2 diabetes who have added risk factors, and for both forms of familial hypercholesterolemia.

  • Lowering LDL cholesterol and triglycerides in adults and children 10+

  • Reducing heart attack, stroke, and heart surgery risk in adults with risk factors

  • Reducing heart attack and stroke risk in adults with type 2 diabetes

  • Treating heterozygous familial hypercholesterolemia in adolescents

Pravachol

Pravachol is prescribed to lower LDL cholesterol and triglycerides in adults with primary hyperlipidemia, and to reduce the risk of heart attack, stroke, and revascularization procedures in adults with or without existing heart disease. It's also approved to treat heterozygous familial hypercholesterolemia in children ages 8 to 18.

  • Lowering LDL cholesterol and triglycerides in adults with hyperlipidemia

  • Reducing heart attack, stroke, and revascularization risk in adults

  • Reducing elevated triglyceride levels in adults with hypertriglyceridemia

  • Treating heterozygous familial hypercholesterolemia in children 8 to 18

Lipitor vs. Pravachol Pros and Cons

Lipitor

Lipitor is a high-intensity statin, meaning it lowers LDL cholesterol more per milligram than Pravachol at comparable doses. It carries the same core statin risks as other drugs in its class, but its wider list of FDA-approved uses gives doctors more flexibility for higher-risk patients.

Pros

  • Higher-intensity LDL lowering, often reaching bigger reductions at equivalent doses

  • Broadest FDA-approved indication list among common statins, including homozygous FH

  • Long real-world track record as the most-prescribed statin in history

Cons

  • Metabolized through CYP3A4, so more prone to interactions with certain antibiotics and antifungals

  • Brand-name list price runs far higher than generic pravastatin, though Lipitor's own generic is cheap

  • Higher-intensity dosing can carry a somewhat greater relative risk of muscle-related side effects

Pravachol

Pravachol is a lower-to-moderate-intensity statin, so it lowers LDL cholesterol less per milligram than Lipitor. Because it isn't broken down by the liver's CYP3A4 enzyme, it interacts with fewer other medications, which can matter for patients taking multiple drugs.

Pros

  • Not metabolized by CYP3A4, so it interacts with fewer common medications

  • Backed by long-term outcome trials such as WOSCOPS, CARE, and LIPID

  • Generic pravastatin has a much lower cash list price than brand-name Lipitor

Cons

  • Lower-intensity LDL lowering per milligram, may not reach goal for patients needing large reductions

  • Narrower FDA-approved indication list, not approved for homozygous familial hypercholesterolemia

  • Maximum approved dose of 80 mg may be insufficient for some very high-risk patients

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