Pravachol vs. Praluent
See how Pravachol and Praluent compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Pravachol is a low-cost daily tablet, while Praluent is an injection given every 2 to 4 weeks, so the two fit very different routines.
Praluent usually lowers LDL cholesterol more than Pravachol and is often added on top of a statin when diet and statin therapy alone are not enough.
Pravachol is an inexpensive generic with decades of use, while Praluent has no generic option and costs far more per month.
Pravachol vs. Praluent Drug Summary
Pravachol
Pravachol (pravastatin) is a statin that blocks an enzyme the liver uses to make cholesterol. It treats high LDL cholesterol, mixed dyslipidemia, and certain triglyceride disorders, and is taken as one tablet by mouth each day.
Praluent
Praluent (alirocumab) is a PCSK9 inhibitor that helps the liver clear more LDL cholesterol from the blood. It is used as an add-on to statin therapy for high cholesterol and to lower the risk of heart attack and stroke, given as a self-injection every 2 or 4 weeks.
Pravachol vs. Praluent Side Effects
Pravachol
Praluent
Pravachol vs. Praluent Dosage
Pravachol
Praluent
| 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 | 75 mg every 2 weeks | At the start |
| Maximum dose | 300 mg every 4 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
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 |
Praluent
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg every 2 weeks | At the start |
| Maximum dose | 300 mg every 4 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
Pravachol vs. Praluent Indications
Pravachol
Pravachol is FDA-approved to lower LDL cholesterol and triglycerides and raise HDL in adults with high cholesterol or mixed dyslipidemia. It also reduces the risk of heart attack and stroke in people with or without existing heart disease, and treats familial hypercholesterolemia in children 8 and older.
Primary hyperlipidemia and mixed dyslipidemia
Heterozygous familial hypercholesterolemia (ages 8+)
Reduces risk of heart attack, stroke, and revascularization
High triglyceride levels (Type IV hyperlipidemia)
Praluent
Praluent is FDA-approved as an add-on to diet and maximally tolerated statin therapy to further lower LDL cholesterol in adults with primary hyperlipidemia. It also treats heterozygous familial hypercholesterolemia in adults and children 8 and older, and lowers the risk of heart attack, stroke, and hospitalization for unstable angina in people with existing cardiovascular disease.
Add-on LDL lowering with diet and a statin
Heterozygous familial hypercholesterolemia (ages 8+)
Reduces risk of heart attack and stroke after cardiovascular disease
Reduces hospitalization for unstable angina
Pravachol vs. Praluent Pros and Cons
Pravachol
Pravachol is a generic statin with decades of real-world safety data and broad insurance coverage. It works well for people who need moderate LDL lowering and prefer a daily pill over an injection.
Pros
Roughly $5 to $30 a month without insurance, depending on pharmacy
Taken by mouth, no injections or needles
Long track record dating back to 1991 approval
Widely covered by insurance and Medicare Part D
Cons
Lowers LDL less than PCSK9 inhibitors like Praluent
Must be taken every day without missing doses
Dose must be limited when combined with cyclosporine or clarithromycin
Muscle and joint pain are common side effects
Praluent
Praluent offers a stronger LDL-lowering option for people who still have high cholesterol despite statin therapy, or who cannot tolerate statins well. Its infrequent dosing schedule appeals to people who prefer fewer doses over daily pills, but it comes at a much higher cost.
Pros
Greater LDL reduction than statins alone
Only 26 injections a year at most, versus 365 daily pills
Proven to cut cardiovascular events after acute coronary syndrome
Option for patients who cannot tolerate statin side effects
Cons
Roughly $500 to $640 per month without insurance, before savings programs
Requires self-injection with a prefilled pen
No generic or biosimilar version currently available
Can cause injection site reactions and rare serious hypersensitivity reactions
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