Pravachol vs. Zetia
See how Pravachol and Zetia compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Pravachol is a statin that blocks cholesterol production in the liver and has decades of data showing it lowers heart attack and stroke risk.
Zetia works differently, blocking cholesterol absorption in the gut, and is most often added to a statin like Pravachol for extra LDL lowering.
Both are once-daily oral tablets, but Pravachol offers two dose strengths for flexibility while Zetia comes in a single 10 mg dose.
Pravachol vs. Zetia Drug Summary
Pravachol
Pravachol (pravastatin) is a statin, or HMG-CoA reductase inhibitor, used to lower LDL cholesterol and reduce the risk of heart attack, stroke, and cardiovascular death. It is taken as one tablet by mouth once a day, usually in the evening, at a dose of 40 mg or 80 mg.
Zetia
Zetia (ezetimibe) is a cholesterol absorption inhibitor that lowers LDL cholesterol by blocking its uptake in the small intestine. It is taken as a single 10 mg tablet once a day, either on its own or combined with a statin for greater LDL reduction.
Pravachol vs. Zetia Side Effects
Pravachol
Zetia
Pravachol vs. Zetia Dosage
Pravachol
Zetia
| 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 once daily | At the start |
| Maximum dose | 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 |
Zetia
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 10 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Pravachol vs. Zetia Indications
Pravachol
Pravachol is approved to lower LDL cholesterol and triglycerides in adults with high cholesterol. It also reduces the risk of heart attack, the need for artery-opening procedures, and cardiovascular death in people with or without existing heart disease.
Lowers LDL cholesterol and triglycerides in adults
Reduces risk of heart attack and cardiovascular death
Slows progression of coronary artery disease
Approved for children age 8 and older with familial high cholesterol
Zetia
Zetia is approved to lower LDL cholesterol in adults with high cholesterol, either alone or added to a statin. It is also used with fenofibrate for mixed high cholesterol and with a statin for certain inherited forms of very high cholesterol.
Lowers LDL cholesterol alone or added to a statin
Used with fenofibrate for mixed hyperlipidemia
Combined with a statin for homozygous familial hypercholesterolemia
Approved for children age 10 and older with heterozygous familial hypercholesterolemia
Pravachol vs. Zetia Pros and Cons
Pravachol
Pravachol has one of the longest safety track records of any statin, with large trials showing it cuts heart attacks and cardiovascular deaths. It is broadly available as a low-cost generic and covered by most insurance plans.
Pros
Decades of outcome data showing reduced heart attack and death risk
Fewer drug interactions than statins metabolized through CYP3A4
Two dose strengths allow adjustment based on LDL response
Widely covered generic with low copays
Cons
Muscle aches are a common reason patients stop taking it
Maximum LDL reduction is more modest than higher-intensity statins
Requires periodic liver enzyme monitoring
GI side effects like nausea and diarrhea are common
Zetia
Zetia works through a different pathway than statins, making it a useful add-on when a statin alone does not reach LDL goals. It is generally well tolerated on its own but carries added liver and muscle risks when combined with a statin.
Pros
Different mechanism adds LDL lowering on top of a statin
Option for patients who cannot tolerate statin side effects
Single 10 mg dose with no titration needed
Fewer muscle-related side effects when used alone
Cons
Modest LDL lowering when used by itself compared to statins
Not approved alone for homozygous familial hypercholesterolemia
Higher risk of liver enzyme elevation when paired with a statin
Less independent long-term heart attack outcome data than statins
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