Pravachol vs. Vytorin
See how Pravachol and Vytorin compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Pravachol is a single-ingredient statin, while Vytorin combines a statin with a cholesterol-absorption blocker for extra LDL reduction.
Generic pravastatin typically costs far less per month than brand-name Vytorin, which has no generic combination version in the US.
Vytorin is the only one of the two approved for homozygous familial hypercholesterolemia and homozygous sitosterolemia.
Pravachol vs. Vytorin Drug Summary
Pravachol
Pravachol (pravastatin) is a statin that lowers LDL cholesterol and triglycerides while raising HDL cholesterol. It is taken as one tablet by mouth once a day, with or without food. The brand name has been discontinued in the US, so it is now available only as generic pravastatin.
Vytorin
Vytorin combines ezetimibe, which blocks cholesterol absorption in the intestine, with simvastatin, a statin that blocks cholesterol production in the liver. It treats high cholesterol and certain inherited cholesterol disorders, taken as one tablet by mouth once a day. It comes in four strengths pairing a fixed 10 mg of ezetimibe with 10 mg to 80 mg of simvastatin.
Pravachol vs. Vytorin Side Effects
Pravachol
Vytorin
Pravachol vs. Vytorin Dosage
Pravachol
Vytorin
| 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 | 10 mg/10 mg once daily | At the start |
| Maximum dose | 10 mg/10 mg once daily | 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 |
Vytorin
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg/10 mg once daily | At the start |
| Maximum dose | 10 mg/10 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Pravachol vs. Vytorin Indications
Pravachol
Pravachol is FDA-approved to lower LDL cholesterol, total cholesterol, and triglycerides, and to raise HDL cholesterol in adults with high cholesterol. It also reduces the risk of heart attack, stroke, and cardiovascular death in adults with risk factors for heart disease, and lowers the risk of death in adults with existing coronary heart disease. It is approved for children 8 and older with heterozygous familial hypercholesterolemia.
Lower LDL cholesterol, total cholesterol, and triglycerides
Raise HDL cholesterol
Reduce risk of heart attack and stroke in adults with risk factors
Reduce risk of death in adults with existing coronary heart disease
Treat children 8 and older with heterozygous familial hypercholesterolemia
Vytorin
Vytorin is FDA-approved to lower LDL cholesterol, total cholesterol, triglycerides, and Apo B, and to raise HDL cholesterol in adults with high cholesterol. It also treats homozygous familial hypercholesterolemia and homozygous sitosterolemia, two rare inherited cholesterol disorders. In patients with a recent heart attack or unstable angina, it has been shown to reduce cardiovascular events beyond a statin alone.
Lower LDL cholesterol, total cholesterol, triglycerides, and Apo B
Raise HDL cholesterol
Treat homozygous familial hypercholesterolemia
Treat homozygous sitosterolemia
Reduce cardiovascular events after a recent heart attack or unstable angina
Pravachol vs. Vytorin Pros and Cons
Pravachol
Pravachol has decades of real-world safety data and is now available only as an inexpensive generic. It is considered a lower-to-moderate intensity statin, so it may lower LDL less than higher-intensity options or combination therapies.
Pros
Only available as generic pravastatin, typically $10 to $30 a month without insurance
Fewer drug interactions than many statins since it isn't broken down by CYP3A4
More than 30 years of real-world safety data as one of the earliest statins approved
Simple dosing with just one dose increase if the starting dose isn't enough
Cons
Considered a lower-to-moderate intensity statin, so it lowers LDL less than high-intensity options
Only one cholesterol-lowering mechanism, unlike combination therapies
Not approved for homozygous familial hypercholesterolemia or sitosterolemia
Muscle aches and elevated liver enzymes can still occur, especially at the 80 mg dose
Vytorin
Vytorin pairs a statin with a second cholesterol-absorption-blocking drug, giving it a different mechanism than pravastatin alone. It carries a much higher list price and more drug interaction concerns tied to the simvastatin component.
Pros
Combines two cholesterol-lowering mechanisms in one tablet for deeper LDL reduction
Only option here approved for homozygous familial hypercholesterolemia and sitosterolemia
IMPROVE-IT trial showed fewer cardiovascular events than a statin alone after a heart attack or unstable angina
Four dose strengths allow fine-tuning of the simvastatin component
Cons
List price runs roughly $600 to $650 a month without insurance, well above generic pravastatin
Simvastatin component is broken down by CYP3A4, adding more drug interaction risks
80 mg dose carries a higher muscle-injury risk and is generally avoided for new starts
Not recommended for patients with active liver disease
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