Pravastatin Colestipol

Pravastatin is the statin of choice in this patient as it is least likely to accumulate, is hydrophilic, and is not highly protein bound. The starting dose should be low and should be increased cautiously. Monitoring of LFTs is required. Colestyramine and colestipol may be considered and may help the patient s pruritus. Niacin and acipimox could be used if the pruritus does not worsen. The fibrates should be avoided because of the risk of gallstone formation. Ezetimibe could be considered alone. 

Statins should be avoided. If absolutely necessary, pravastatin could be used, starting at a low dose and with cautious adjustment according to clinical response. The patient s synthetic liver function should be monitored closely. In the event of the slightest deterioration of function, pravastatin should be stopped immediately. Colestyramine/colestipol should be safe to use but may cause a reduction in vitamin K absorption and increase the risk of a bleed. Constipation might induce encephalopathy. The fibrates should be avoided due to their potential effect on coagulopathy. Ezetimibe should be safe to use alone. Acipimox and niacin are gastric irritants and would be best avoided. 

Although colesityramine and colestipol reduce plasma fluvastatin and pravastatin levels, the overall total lipid-lowering effect is increased by concurrent use. Separating their administration minimises this interaction. Colestipol appears to interact with atorvastatin similarly. Colesevelam appears not to interact with iovastatin. 

Colestipol reduced the bioavailability of pravastatin in 18 subjects by about 50%, but no reduction in bioavailability was seen when pravastatin was given 1 hour before colestipol and a meal. ... 

Established interactions but of only relatively minor importance. Despite the reduction in the bioavailability of pravastatin caused by coiestyramine or colestipol, the overall lipid-lowering effect is increased by concurrent use. The effects of the interaction can be minimised by separating their administration as described above. This can be easily achieved by taking the coiestyramine or colestipol with meals, and the pravastatin at bedtime. Similarly, any interaction between fluvastatin and coiestyramine can be minimised by taking fluvastatin at least4 hours after coiestyramine. There would appear to be no reason for avoiding concurrent use of atorvastatin and colestipol, nor lovastatin and colesevelam. 

---