Statins like Lipitor (atorvastatin) can interact with many different medications such as Paxlovid (which includes the antivirals nirmatrelvir and ritonavir).These drug interactions can change the medication’s effectiveness or makeside effectsmore likely.
For these reasons, it’s important that you discuss your medical history and everything you are taking with your healthcare provider before you start taking a statin.
This article discusses what medications may interact with statins like Lipitor (atorvastatin). It also covers medical conditions to report to your doctor before taking a statin.
Peter Dazeley / Getty Images
Side Effects of Statin Drugs
Possible Statin Drug Interactions
Rhabdomyolysis is one of the most serious side effects of atorvastatin and other statins. It occurs when damaged muscle tissue releases harmful substances into the blood. These substances can permanently damage the heart and kidneys.
Tell your healthcare professional if you are already taking any of the medications below. If you are taking one of them, it doesn’t mean that you can’t take a statin. However, your healthcare professional may want to monitor you more closely since it may increase your risk of side effects.
What Are Statins?Statinsare prescribed to improve cholesterol levels. They lowerLDL cholesterol(the “bad” cholesterol) andtriglycerideswhile raising HDL (“good”) cholesterol. Examples of statin medications include:Lipitor (atorvastatin)Zocor (simvastatin)Lescol (fluvastatin)Crestor (rosuvastatin)Mevacor (lovastatin)Pravachol (pravastatin)In the United States, Lipitor is one of the most commonly prescribed statin medications.
What Are Statins?
Statinsare prescribed to improve cholesterol levels. They lowerLDL cholesterol(the “bad” cholesterol) andtriglycerideswhile raising HDL (“good”) cholesterol. Examples of statin medications include:Lipitor (atorvastatin)Zocor (simvastatin)Lescol (fluvastatin)Crestor (rosuvastatin)Mevacor (lovastatin)Pravachol (pravastatin)In the United States, Lipitor is one of the most commonly prescribed statin medications.
Statinsare prescribed to improve cholesterol levels. They lowerLDL cholesterol(the “bad” cholesterol) andtriglycerideswhile raising HDL (“good”) cholesterol. Examples of statin medications include:
In the United States, Lipitor is one of the most commonly prescribed statin medications.
Always read the package insert to identify the drug interactions specific to the statin you are taking. Drug interactions can differ with various statins, including Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), or Zocor (simvastatin).
Muscle Pain in Statin Users
This is a general list of drugs that you should not take with atorvastatin and/or other statin medications. Not all of these drugs interact with all statins, so it is important to discuss the medications you’re taking with your healthcare provider so you can find the right statin. Keep in mind that this is not a complete list.
Antidepressants
Certain antidepressants may increase statin levels in the blood, though others have not been shown to have the same effect. Antidepressants that can interact with statins include:
If you take an antidepressant, be sure to talk to your healthcare provider about possible statin drug interactions.
Antibiotics
Antibiotics ending in-mycinsuch as erythromycin or Biaxin (clarithromycin) may increase the statin levels present in the blood and may also increase side effects.
Antifungal Drugs
Antifungal drugs ending in-azole, such as Nizoral (ketoconazole), Diflucan (fluconazole), Oravig (miconazole), or Sporanox (itraconazole), may increase the amount of some statins in the blood. They may also increase statin side effects.
Bile Acid Sequestrants
These medications also help manage high cholesterol, but they may decrease the effectiveness of certain statins.To avoid this, your healthcare provider may recommend that you take your statin dose and bile acid sequestrant dose at least four hours apart.
Bile Acid Sequestrants: Everything You Need to Know
Cardiovascular Medication
Certain drugs used to treat heart conditions likearrhythmia(irregular heartbeat),angina(chest pain), andhigh blood pressuremay interact with statins.These drugs can increase the amount of statins present in the blood and increase the risk for side effects like rhabdomyolysis.
Cardiovascular medications that may interact with statins include:
Warfarin
Warfarin is a medication that helps prevent blood clots. Taking a statin along with warfarin may slightly increase the anticoagulant effect, which can lead to an increased risk of bleeding.
Fibrates
Fibrates are another class of medications prescribed to lower high cholesterol. When taken with statins, they may increase the risk of experiencing statin side effects.
Examples of fibrates include:
Medications to Lower Cholesterol and Triglyceride Levels
Heartburn Medication
Medications used to treat and prevent heartburn/acid reflux can also interact with statins. These include:
Heartburn Relief: Natural Antacids, Medication, Prevention
HIV Protease Inhibitors
HIV protease inhibitors such as Norvir (ritonavir) or Viracept (nelfinavir), may increase the amount of some statins present in the blood. They may also increase side effects.
Drug Interactions of Lipitor (Atorvastatin) and Other Statins
Nicotinic Acid (Niacin)
Niacinis a B vitamin that helps support your digestive system, nervous system, and skin. It is available over the counter as a supplement. Niacin is sometimes used to help lower cholesterol, but there is evidence that taking it with a statin could increase the risk of experiencing statin side effects.
In a 2013 study, participants taking 40 mg of simvastatin were given 2 g of niacin daily along with a medication to reduce niacin side effects such as flushing. The subjects taking the niacin experienced an increased incidence of muscle weakness compared to those taking a placebo.
Oral Contraceptives
Takingoral contraceptivesand statins at the same time may increase the concentration of hormones in the body. This doesn’t stop the contraception from working, but it may lead to an increased risk of related side effects.
You should avoid eatinggrapefruitorpomeloor drinking grapefruit juice when taking most statins. Although grapefruit is believed to have little or no interaction with Crestor (rosuvastatin), it may best be avoided until discussed with a healthcare provider.
Why Grapefruit and Statin Drugs Do Not Mix
Paxlovid (Nirmatrelvir/Ritonavir)
What Are the Side Effects of Paxlovid?
Sandimmune (Cyclosporine)
Cyclosporine is prescribed to prevent your body from rejecting a transplanted organ. When taken with statins, it may increase the the blood levels of statins and may also increase side effects.
St. John’s Wort
St. John’s Wort is a supplement commonly used to treat depression and other mental health conditions. It may decrease the effectiveness of some statins.
Medical Conditions to Report
It is important to let your healthcare professional know about anymedical conditionyou have before you start taking statins. Chief among these is liver disease. Statins can further impair liver function, causing an elevation in liver enzymes that indicates inflammation or damage to liver cells.
Having liver disease doesn’t automatically mean you can’t use statins. However, it factors into the decision as to whether statins are the best or only options available.Cases of alcohol use disorderalso require caution, since liver injury may occur when statins are added to the mix.
Your healthcare professional may recommend that you avoid statins if you are pregnant. This is due to earlier reports that they may cause birth defects. Although a number of studies have questioned the association, it is nevertheless wise to avoid them.
Summary
Statin drugs can decrease bad cholesterol and increase good cholesterol. However, they can cause problems if you have certain medical conditions or if you’re taking another medication or supplement with the statin.
Before taking statins, let your healthcare provider know if you have liver disease, or if you’re pregnant or nursing. Also, be sure to tell them if you’re taking any medications or supplements. They may want to monitor your condition or switch you to a different type of medicine.
A Word From Verywell
Statins can be beneficial in lowering cholesterol and decreasing your risk for heart disease. However, there are many precautions to be considered.
These are only a few of the possible drug interactions. That’s why it’s important to discuss your medical history and all medications—prescription or otherwise—with your healthcare team before taking a statin.
It is important to remember that statins are not the only treatment for high cholesterol.Nicotinic acid,fibric acid,PCSK9 inhibitors,bile acid sequestrants, and Zetia (ezetimibe) can also be used if statins are not an option.
What Is Hyperlipidemia?
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Food and Drug Administration.PAXLOVID (nirmatrelvir tablets; ritonavir tablets).Centers for Disease Control and Prevention.Rhabdomyolysis and work.Salami JA, Warraich H, Valero-Elizondo J, et al.National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights from the Medical Expenditure Panel Survey.JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700Palleria C, Roberti R, Iannone LF, et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Hylton Gravatt LA, Flurie RW, Lajthia E, Dixon DL.Clinical guidance for managing statin and antimicrobial drug-drug interactions.Curr Atheroscler Rep. 2017;19(11):46. doi:10.1007/s11883-017-0682-xU.S. Food and Drug Administration.ORAVIG (miconazole) buccal tablets.Feingold KR.Cholesterol lowering drugs. In: Feingold KR, Anawalt B, Blackman MR, et al, eds.Endotext. MDText.com, Inc.; 2021.Wiggins BS, Saseen JJ, Page RL, et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American heart association.Circulation. 2016;134(21). doi:10.1161/CIR.0000000000000456Kellick KA, Bottorff M, Toth PP.A clinician’s guide to statin drug-drug interactions.Journal of Clinical Lipidology. 2014;8(3):S30-S46. doi:10.1016/j.jacl.2014.02.010Barkas F, Elisaf M, Rizos CV, Klouras E, Kostapanos MS, Liberopoulos E.Proton pump inhibitors and statins: A possible interaction that favors low-density lipoprotein cholesterol reduction?Hippokratia. 2015;19(4):332-337.Hughes CA, Tseng A, Cooper R.Managing drug interactions in HIV-infected adults with comorbid illness.CMAJ. 2015;187(1):36-43. doi:10.1503/cmaj.131626HPS2-THRIVE Collaborative Group.HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: Trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.Eur Heart J. 2013;34(17):1279-91. doi:10.1093/eurheartj/eht05510.1093/eurheartj/eht055NHS.Common questions about atorvastatin.Harvard Health.Grapefruit juice and statins.U.S. Food and Drug Administration.Statins: Drug Safety Communication - FDA requests removal ofstrongest warning against using cholesterol-lowering statins during pregnancy.Additional ReadingLacy CF, Armstrong LL, Goldman MP, et al. Lexicomp’s Drug Information Handbook. 26th ed. Hudson, OH:Lexi-Comp Inc.; 2017.Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education. 2017.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Food and Drug Administration.PAXLOVID (nirmatrelvir tablets; ritonavir tablets).Centers for Disease Control and Prevention.Rhabdomyolysis and work.Salami JA, Warraich H, Valero-Elizondo J, et al.National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights from the Medical Expenditure Panel Survey.JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700Palleria C, Roberti R, Iannone LF, et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Hylton Gravatt LA, Flurie RW, Lajthia E, Dixon DL.Clinical guidance for managing statin and antimicrobial drug-drug interactions.Curr Atheroscler Rep. 2017;19(11):46. doi:10.1007/s11883-017-0682-xU.S. Food and Drug Administration.ORAVIG (miconazole) buccal tablets.Feingold KR.Cholesterol lowering drugs. In: Feingold KR, Anawalt B, Blackman MR, et al, eds.Endotext. MDText.com, Inc.; 2021.Wiggins BS, Saseen JJ, Page RL, et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American heart association.Circulation. 2016;134(21). doi:10.1161/CIR.0000000000000456Kellick KA, Bottorff M, Toth PP.A clinician’s guide to statin drug-drug interactions.Journal of Clinical Lipidology. 2014;8(3):S30-S46. doi:10.1016/j.jacl.2014.02.010Barkas F, Elisaf M, Rizos CV, Klouras E, Kostapanos MS, Liberopoulos E.Proton pump inhibitors and statins: A possible interaction that favors low-density lipoprotein cholesterol reduction?Hippokratia. 2015;19(4):332-337.Hughes CA, Tseng A, Cooper R.Managing drug interactions in HIV-infected adults with comorbid illness.CMAJ. 2015;187(1):36-43. doi:10.1503/cmaj.131626HPS2-THRIVE Collaborative Group.HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: Trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.Eur Heart J. 2013;34(17):1279-91. doi:10.1093/eurheartj/eht05510.1093/eurheartj/eht055NHS.Common questions about atorvastatin.Harvard Health.Grapefruit juice and statins.U.S. Food and Drug Administration.Statins: Drug Safety Communication - FDA requests removal ofstrongest warning against using cholesterol-lowering statins during pregnancy.Additional ReadingLacy CF, Armstrong LL, Goldman MP, et al. Lexicomp’s Drug Information Handbook. 26th ed. Hudson, OH:Lexi-Comp Inc.; 2017.Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education. 2017.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Food and Drug Administration.PAXLOVID (nirmatrelvir tablets; ritonavir tablets).Centers for Disease Control and Prevention.Rhabdomyolysis and work.Salami JA, Warraich H, Valero-Elizondo J, et al.National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights from the Medical Expenditure Panel Survey.JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700Palleria C, Roberti R, Iannone LF, et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Hylton Gravatt LA, Flurie RW, Lajthia E, Dixon DL.Clinical guidance for managing statin and antimicrobial drug-drug interactions.Curr Atheroscler Rep. 2017;19(11):46. doi:10.1007/s11883-017-0682-xU.S. Food and Drug Administration.ORAVIG (miconazole) buccal tablets.Feingold KR.Cholesterol lowering drugs. In: Feingold KR, Anawalt B, Blackman MR, et al, eds.Endotext. MDText.com, Inc.; 2021.Wiggins BS, Saseen JJ, Page RL, et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American heart association.Circulation. 2016;134(21). doi:10.1161/CIR.0000000000000456Kellick KA, Bottorff M, Toth PP.A clinician’s guide to statin drug-drug interactions.Journal of Clinical Lipidology. 2014;8(3):S30-S46. doi:10.1016/j.jacl.2014.02.010Barkas F, Elisaf M, Rizos CV, Klouras E, Kostapanos MS, Liberopoulos E.Proton pump inhibitors and statins: A possible interaction that favors low-density lipoprotein cholesterol reduction?Hippokratia. 2015;19(4):332-337.Hughes CA, Tseng A, Cooper R.Managing drug interactions in HIV-infected adults with comorbid illness.CMAJ. 2015;187(1):36-43. doi:10.1503/cmaj.131626HPS2-THRIVE Collaborative Group.HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: Trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.Eur Heart J. 2013;34(17):1279-91. doi:10.1093/eurheartj/eht05510.1093/eurheartj/eht055NHS.Common questions about atorvastatin.Harvard Health.Grapefruit juice and statins.U.S. Food and Drug Administration.Statins: Drug Safety Communication - FDA requests removal ofstrongest warning against using cholesterol-lowering statins during pregnancy.
U.S. Food and Drug Administration.PAXLOVID (nirmatrelvir tablets; ritonavir tablets).
Centers for Disease Control and Prevention.Rhabdomyolysis and work.
Salami JA, Warraich H, Valero-Elizondo J, et al.National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights from the Medical Expenditure Panel Survey.JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700
Palleria C, Roberti R, Iannone LF, et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058
Hylton Gravatt LA, Flurie RW, Lajthia E, Dixon DL.Clinical guidance for managing statin and antimicrobial drug-drug interactions.Curr Atheroscler Rep. 2017;19(11):46. doi:10.1007/s11883-017-0682-x
U.S. Food and Drug Administration.ORAVIG (miconazole) buccal tablets.
Feingold KR.Cholesterol lowering drugs. In: Feingold KR, Anawalt B, Blackman MR, et al, eds.Endotext. MDText.com, Inc.; 2021.
Wiggins BS, Saseen JJ, Page RL, et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American heart association.Circulation. 2016;134(21). doi:10.1161/CIR.0000000000000456
Kellick KA, Bottorff M, Toth PP.A clinician’s guide to statin drug-drug interactions.Journal of Clinical Lipidology. 2014;8(3):S30-S46. doi:10.1016/j.jacl.2014.02.010
Barkas F, Elisaf M, Rizos CV, Klouras E, Kostapanos MS, Liberopoulos E.Proton pump inhibitors and statins: A possible interaction that favors low-density lipoprotein cholesterol reduction?Hippokratia. 2015;19(4):332-337.
Hughes CA, Tseng A, Cooper R.Managing drug interactions in HIV-infected adults with comorbid illness.CMAJ. 2015;187(1):36-43. doi:10.1503/cmaj.131626
HPS2-THRIVE Collaborative Group.HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: Trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.Eur Heart J. 2013;34(17):1279-91. doi:10.1093/eurheartj/eht05510.1093/eurheartj/eht055
NHS.Common questions about atorvastatin.
Harvard Health.Grapefruit juice and statins.
U.S. Food and Drug Administration.Statins: Drug Safety Communication - FDA requests removal ofstrongest warning against using cholesterol-lowering statins during pregnancy.
Lacy CF, Armstrong LL, Goldman MP, et al. Lexicomp’s Drug Information Handbook. 26th ed. Hudson, OH:Lexi-Comp Inc.; 2017.Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education. 2017.
Lacy CF, Armstrong LL, Goldman MP, et al. Lexicomp’s Drug Information Handbook. 26th ed. Hudson, OH:Lexi-Comp Inc.; 2017.
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