Pravachol - Indications & Dosage

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Lipid-altering agents should be used in addition to a diet restricted in saturated fat and cholesterol when the response to diet and other nonpharmacological measures alone has been inadequate (see NCEP Guidelines below). Prior to initiating therapy with pravastatin, secondary causes for hypercholesterolemia (e. g., poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, alcoholism) should be excluded, and a lipid profile performed to measure Total-C, HDL-C, and TG. For patients with triglycerides (TG) < 400 mg/ dL ( 4.5 mmol/ L), LDL-C can be estimated using the following equation:

LDL-C= Total-C -HDL-C -¹ TG

For TG levels > 400 mg/ dL ( 4.5 mmol/ L), this equation is less accurate and LDL-C con-centrations should be determined by ultracentrifugation. In many hypertriglyceridemic patients, LDL-C may be low or normal despite elevated Total-C. In such cases, HMG-CoA reductase inhibitors are not indicated.

Lipid determinations should be performed at intervals of no less than four weeks and dosage adjusted according to the patient's response to therapy.

The National Cholesterol Education Program's Treatment Guidelines are summarized below:

NCEP Treatment Guidelines: LDL-C Goals and Cutpoints for Therapeutic Lifestyle Changes and Drug Therapy in Different Risk Categories

LDL Levels at Which to Initiate Therapeutic LDL Level at Which to LDL Goal Lifestyle Changes Consider Drug Therapy Risk Category (mg/ dL) (mg/ dL) (mg/ dL)

CHD a or CHD Risk <100 100 130 equivalents (100-129: drug optional) b

(10-year risk >20%)

<130 130 10-year risk 10%-20%: 2+ Risk factors

130 (10-year risk 20%) 10-year risk <10%:

160 0-1 Risk factor c <160 160 190

(160-189: LDL-lowering drug optional)

a CHD, coronary heart disease.

b Some authorities recommend the use of LDL-lowering drugs in this category if an LDL-C level of <100 mg/ dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL-C, e. g., nicotinic acid or fibrate. Clinical judgement also may call for deferring drug therapy in this subcategory.