Pravastatin
HMG-CoA reductase inhibitor · “The transplant patient's statin”
The Clinical Case
Male, 49 yo. Renal transplant 2 years ago, on ciclosporin + tacrolimus. Develops hypercholesterolaemia (LDL 4.1 mmol/L). Nephrologist wants to start a statin but is concerned about CYP3A4 and CYP2C9 interactions with immunosuppressants. Which statin undergoes virtually no CYP450 metabolism?
The Answer
Played on: 4 Jan 2026 · 18 Jan 2026 · 1 Feb 2026 · 15 Feb 2026 · 1 Mar 2026 · 15 Mar 2026 · 29 Mar 2026 · 12 Apr 2026 · 26 Apr 2026 · 10 May 2026 · 24 May 2026 · 7 Jun 2026 · 21 Jun 2026 · 5 Jul 2026 · 19 Jul 2026 · 2 Aug 2026 · 16 Aug 2026
Clinical Pearl
Metabolism: Only statin with no CYP450 metabolism — fewest drug interactions of all statins; hydrophilic; half-life 1.8 h → optimally dosed in the evening
All Hints
Metabolism: Only statin with no CYP450 metabolism — fewest drug interactions of all statins; hydrophilic; half-life 1.8 h → optimally dosed in the evening
Transplant: Drug of choice with ciclosporin; no pharmacokinetic interaction; preferred in liver disease
HIV / ART: Used in HIV patients on protease inhibitors (strong CYP3A4 inhibitors) where other statins are unsafe
Efficacy: Moderate LDL reduction (~28–35%); consider combining with ezetimibe if target not reached
Evidence: CARE & LIPID "trials": reduced recurrent MI and coronary death in post-MI secondary prevention
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