Pravachol vs. Leqvio
See how Pravachol and Leqvio compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Pravachol is a daily oral statin pill, while Leqvio is an injection given by a provider only twice a year after two starter doses.
Both lower LDL cholesterol, but Leqvio is approved for adults with hypercholesterolemia and for people 12 and older with inherited high cholesterol, often used when statins alone aren't enough.
Cost differs sharply: generic pravastatin can run just a few dollars a month, while Leqvio's brand-only price runs into the thousands per dose.
Pravachol vs. Leqvio Drug Summary
Pravachol
Pravachol (pravastatin) is an HMG-CoA reductase inhibitor, or statin, that lowers LDL cholesterol and triglycerides. It's FDA-approved for adults and children with high cholesterol and can reduce the risk of heart attack, stroke, and cardiovascular death. It comes as a tablet taken once daily, usually starting at 40 mg.
Leqvio
Leqvio (inclisiran) is a PCSK9 synthesis inhibitor made from small interfering RNA that lowers LDL cholesterol by silencing a liver protein. It's FDA-approved as an add-on for adults with hypercholesterolemia and for people 12 and older with certain inherited high cholesterol conditions. It's given as an injection by a healthcare provider, with two starter doses and then one shot every six months.
Pravachol vs. Leqvio Side Effects
Pravachol
Leqvio
Pravachol vs. Leqvio Dosage
Pravachol
Leqvio
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg injection | Day 1 |
| Maximum dose | 284 mg injection | Same as starting |
| Dose changes | None | Fixed dose |
Pravachol
| 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 |
Leqvio
| STAGE | DOSE | WHEN |
| Starting dose | 284 mg injection | Day 1 |
| Maximum dose | 284 mg injection | Same as starting |
| Dose changes | None | Fixed dose |
Pravachol vs. Leqvio Indications
Pravachol
Pravachol is prescribed to lower LDL cholesterol and triglycerides alongside diet changes. It's also used to cut cardiovascular risk in people with or without existing heart disease, including lowering the chance of a first heart attack, stroke, or need for a bypass procedure.
Lowers LDL cholesterol and triglycerides in adults and children 8 and up
Reduces risk of heart attack, stroke, and cardiovascular death
Slows progression of coronary artery atherosclerosis
Treats very high triglycerides (hypertriglyceridemia)
Approved for pediatric heterozygous familial hypercholesterolemia
Leqvio
Leqvio is used alongside diet and exercise to lower LDL cholesterol in adults with hypercholesterolemia. It's also approved for people 12 and older with heterozygous or homozygous familial hypercholesterolemia, inherited conditions that cause very high LDL levels.
Lowers LDL cholesterol in adults with hypercholesterolemia
Approved for heterozygous familial hypercholesterolemia, ages 12 and up
Approved for homozygous familial hypercholesterolemia in ages 12 to 17 only
Given alongside diet and exercise for LDL-C reduction
Effect on heart attack and stroke risk has not yet been established
Pravachol vs. Leqvio Pros and Cons
Pravachol
Pravachol has decades of real-world safety data and is available almost everywhere as an inexpensive generic. It lowers LDL less aggressively than high-intensity statins or newer injectables, and daily dosing means missed doses more easily affect cholesterol control.
Pros
Generic tablet often costs $10 to $30 a month in cash price, far less with a discount card
Decades of long-term outcome data across large cardiovascular trials
Proven to reduce heart attack, stroke, and cardiovascular death
Take-at-home tablet with no office visit needed
Cons
Requires daily adherence; missed doses can affect LDL control
Considered a lower-to-moderate intensity statin, so LDL lowering is modest
Muscle aches and GI side effects are common enough to affect some patients
Interacts with cyclosporine, colchicine, and fibrates, needing monitoring
Leqvio
Leqvio offers the least frequent dosing of any LDL-lowering injectable, needing only two shots a year after the starter doses. It must be given by a healthcare provider, and its brand-only price is far higher than a generic statin, which matters for patients without strong drug coverage.
Pros
Only two injections a year after the starter doses, the least frequent LDL-lowering injectable available
Silences PCSK9 production in the liver, a different mechanism than statins
Adherence doesn't depend on remembering a daily pill
Approved for hard-to-treat inherited cholesterol conditions in adolescents
Cons
Must be given by a healthcare provider, so it can't be picked up at a pharmacy
Brand-only list price runs about $3,250 to $3,600 per dose, far above generic statins
Hasn't been shown to reduce heart attacks or strokes; outcome data is still pending
Hypersensitivity reactions, including rare anaphylaxis and angioedema, have been reported
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