Pravastatin Aspirin

Berry SM, Berry DA, Natarajan K, Hennekens CH, and Beider R. 2004. Bayesian survival analysis with nonproportional hazards Meta-analysis of combination pravastatin-aspirin. JASA 99 36-44. 

Absorption of certain drugs, including those with neutral or cationic charge as well as anions, may be impaired by the resins. These include digitalis glycosides, thiazides, warfarin, tetracycline, thyroxine, iron salts, pravastatin, fluvastatin, folic acid, phenylbutazone, aspirin, and ascorbic acid. Any additional medication (except niacin) should be given 1 hour before or at least 2 hours after the resin to ensure adequate absorption. Colesevelam does not bind digoxin, warfarin, or reductase inhibitors. 

A 76-year-old man took troghtazone 400 mg in addition to ghmepiride 4 mg/day, metformin 1 g/day, aspirin, and pravastatin (126). After 18 months his hver function deteriorated and improved after withdrawal of troghtazone. 

A 62-year-old Chinese man is to be started on rifampin for treatment of his latent TB infection. His PMH is significant for HTN, CAD, and hypercholesterolemia. His current medications include metoprolol, diltiazem, aspirin, pravastatin, and nitroglycerin patches. Which of his current medications will most likely interact with rifampin ... 

D Rifampin significantly reduces the plasma concentrations of the calcium channel blockers verapamil, diltiazem, and nifedipine. Diltiazem is a substrate of Gi P3A4 and rifampin is an inducer of CYP3A4. Rifampin does not interact with metoprolol, aspirin, pravastatin, or nitroglycerin. However, if the patient had been on another HMG-CoA reductase inhibitor such as atorvastatin, lova-statin, or simvastatin instead of pravastatin, rifampin would have reduced the plasma concentrations of these agents since they are also metabolized via CYP3A4. 

Pravastatin (pravachol) therapy is started with a 20- or 40-mg dose that may be increased to 80 mg it should be taken at bedtime. Since pravastatin is a hydroxy acid, it is bound by bile-acid sequestrants, which reduce its absorption. This is rarely a problem since the resins should be taken before meals and pravastatin should be taken at bedtime. Pravastatin is also marketed in combination with buffered aspirin (PRAVIGARD). The small advantage of combining these two drugs should be weighed against disadvantages inherent in fixed-dose combinations. 

Since her admission to the hospital for an acute myocardial infarction, Ann ] Jeina has been taking the bile salt sequestrant cholestyramine and the HMG-CoA rednctase inhibitor pravastatin to lower her blood cholesterol levels (see Chapter 34). She also takes 160 mg acetylsalicylic acid (ASA aspirin) each day. At her most recent visit to her cardiologist, she asked whether she shonld... 

Aspirin 324 mg did not significantly affect the pharmacokinetics of a single 20-mg dose of pravastatin. ... 

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