Pravastatin and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Injection
Pravastatin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased pravastatin exposure and an increased risk of myopathy or rhabdomyolysis
Interaction Deep Dive
Studies comparing concurrent use of pravastatin and cycloSPORINE with pravastatin alone indicates that concurrent use results in significantly higher levels of pravastatin81; however, 4 other studies found no association with rhabdomyolysis 4367. Due to the potential increased risk of myopathy and rhabdomyolysis with pravastatin and cycloSPORINE combination therapy, initiate pravastatin at 10 mg once daily at bedtime and titrate cautiously to a maximum of 20 mg/day 1. Monitoring is recommended if concomitant use is required 8.
Why it happens (mechanism)
Inhibition of pravastatin metabolism
Literature reports
7 reports — tap to read
a) In drug interaction studies, the concomitant administration of cycloSPORINE and pravastatin resulted in an increase in pravastatin AUC and Cmax. Patients received single doses of cycloSPORINE 5 mg/kg and pravastatin 40 mg. Comparing cycloSPORINE plus pravastatin versus pravastatin administration alone, there was a 282% and 327% increase in pravastatin AUC and Cmax, respectively 1.
b) The concurrent use of single-dose pravastatin and cycloSPORINE was studied in 10 cardiac transplant patients and 10 non-transplant, hypercholesteremic patients. The 2 groups were not age or sex matched. The patients in the transplant group were receiving enough cycloSPORINE to maintain a plasma level of 80 to 360 nanograms/milliliter, prednisone, and azathioprine. Both groups were given pravastatin 20 mg orally after an overnight fast, which was continued for at least an hour after pravastatin administration. In the transplant group, the pravastatin Cmax value was 7 times greater, the AUC values were significantly higher, and the half-life was 4 times longer than for the nontransplant group. Because both pravastatin and cycloSPORINE are metabolized by the liver, it is likely that cycloSPORINE inhibits pravastatin metabolism 2.
c) A follow-up study after 4 years of a pravastatin 10-mg/day regimen in 24 renal transplant patients also treated with cycloSPORINE found no association with rhabdomyolysis. There was no increase in serum CPK levels throughout the treatment, and, although AST and ALT levels were increased in 2 patients, discontinuation of treatment was not required. The authors speculate that since pravastatin is water soluble, it may not enter muscle cells to interfere with cholesterol synthesis there 3.
d) In another study, 31 renal transplant patients taking pravastatin 20 mg daily for a minimum of 12 months along with cycloSPORINE and prednisone to maintain immunosuppression showed no adverse effects associated with rhabdomyolysis or myopathy. Only 2 patients experienced any adverse effects: 1 patient with nausea and vomiting who left the study after 3 doses of pravastatin and another patient with increased ALT, gamma-glutamyltranspeptidase (GGT), and alkaline phosphatase who was later diagnosed with gall bladder carcinoma. The pravastatin dose was increased to 30 mg daily in 4 patients after 3 months of treatment, due to continued high cholesterol. The authors conclude that pravastatin is safe to use in patients undergoing cycloSPORINE immunosuppression as long as the doses are moderate, and liver and renal function are monitored carefully 4.
e) Twenty-one renal transplant patients treated with cycloSPORINE received pravastatin 20 mg daily or lovastatin 20 mg daily for 28 days. Pharmacokinetic comparisons of single-dose (day 1) versus multiple-dose (day 28) pravastatin therapy indicated that since the AUC and Cmax were comparable on both occasions, pravastatin does not accumulate in the presence of cycloSPORINE. However, the authors point out that these AUC values are approximately 5 to 7 times higher than previously reported results in patients not receiving cycloSPORINE. Mean CPK, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and myoglobin were only minimally changed at day 28 compared with baseline values. The authors concluded that since cycloSPORINE had little impact on pravastatin pharmacokinetics, pravastatin may be useful in the long-term treatment of renal transplant patients taking cycloSPORINE 5.
f) Thirty-one renal transplant patients receiving cyclosporine therapy and having hypercholesterolemia and hypertriglyceridemia were entered into a study to determine the efficacy and safety of pravastatin and simvastatin. Fifteen patients were given simvastatin 10 mg once daily for 9 months while 16 patients received pravastatin 20 mg once daily for 9 months. Neither drug altered cycloSPORINE trough concentrations during the study, and significant changes in the cycloSPORINE dose were not needed. Additionally, clinical signs of myopathy and alterations in serum CPK were not observed 6.
g) One hundred and ten heart transplant recipients who had been treated with simvastatin 10 mg daily (n=26), simvastatin 20 mg daily (n=18), or pravastatin 20 mg daily (n=66) and immunosuppressive therapy consisting of cycloSPORINE, azathioprine, and prednisone were retrospectively studied. Four patients, all receiving simvastatin 20 mg daily, developed rhabdomyolysis, with a mean serum creatine kinase (CK) level of 2505 units/L. Two patients on pravastatin therapy showed mild, asymptomatic CK elevations (525 and 600 units/L) which returned to baseline after withdrawal of pravastatin 7.
Common questions
Can I take Pravastatin and Cyclosporine Injection together?
Increased pravastatin exposure and an increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Pravastatin and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Pravastatin or Cyclosporine Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (8)
- Product Information: PRAVACHOL(R) oral tablets, pravastatin sodium oral tablets. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2011. DailyMed
- Regazzi MB, Iacona I, Campana C, et al: Altered disposition of pravastatin following concomitant drug therapy with cyclosporine A in transplant recipients. Transplant Proc 1993; 24:2732-2734.
- Yoshimura N, Ohmori Y, Tsuji T, et al: Effect of pravastatin on renal transplant recipients treated with cyclosporine--4-year follow-up. Transplant Proc 1994; 26:2632-2633.
- Castelao AM, Grinyo JM, Castineiras MJ, et al: Effect of pravastatin in the treatment of hypercholesterolemia after renal transplantation under cyclosporine and prednisone. Transplant Proc 1995; 27:2217-2220.
- Kliem V, Wanner C, Eisenhauer T, et al: Comparison of pravastatin and lovastatin in renal transplant patients receiving cyclosporine. Transplant Proc 1996; 28:3126-3128.
- Capone D, Stanziale P, Gentile A, et al: Effects of simvastatin and pravastatin on hyperlipidemia and cyclosporin blood levels in renal transplant recipients. Am J Nephrol 1999; 19:411-415. PubMed
- Rodriguez JA, Crespo-Leiro MG, Paniagua MJ, et al: Rhabdomyolysis in heart transplant patients on HMG-CoA reductase inhibitors and cyclosporine. Transplant Proc 1999; 31:2522-2523. DOI
- Product Information: Pravafenix oral capsules, pravastatin sodium fenofibrate oral capsules. Laboratoires SMB s.a. (per EMA), Brussels, Belgium, 2011.
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