atorvastatin
11 interactions related to atorvastatin
atorvastatin + niacin
Combining high-dose niacin (1-2 g/day, typically extended-release) with atorvastatin or other statins increases the risk of myopathy and rhabdomyolysis. The HPS2-THRIVE trial documented a fourfold excess of myopathy when extended-release niacin was added to simvastatin-based therapy, and the AIM-HIGH trial showed no cardiovascular benefit from this combination.
atorvastatin + coq10
Atorvastatin inhibits HMG-CoA reductase, the same upstream enzyme required to synthesize coenzyme Q10 (ubiquinone). Plasma CoQ10 levels can drop by 30-40% with atorvastatin therapy, and the resulting mitochondrial dysfunction is one proposed mechanism for statin-associated muscle symptoms.
atorvastatin + vitamin d
Vitamin D's active metabolite (calcitriol) can induce CYP3A4, which metabolizes atorvastatin. Small studies show vitamin D supplementation may reduce atorvastatin and metabolite plasma levels by up to ~55%, although LDL-lowering efficacy appears largely preserved.
atorvastatin + red yeast rice
Red yeast rice naturally contains monacolin K, which is chemically identical to the prescription statin lovastatin. Combining it with atorvastatin effectively stacks two statins, sharply increasing the risk of myopathy, rhabdomyolysis, and liver injury.
seville orange + atorvastatin
Seville (bitter) orange contains the same furanocoumarins as grapefruit, including bergamottin and 6',7'-dihydroxybergamottin, which irreversibly inhibit intestinal CYP3A4. A landmark crossover study showed Seville orange juice raised felodipine AUC by 76%, comparable to grapefruit, and atorvastatin shares the same CYP3A4 metabolic pathway, raising the risk of statin-induced myopathy.
pomegranate + statins
Pomegranate juice inhibits intestinal CYP3A4, the main enzyme that metabolizes simvastatin, atorvastatin, and lovastatin. A published case report links pomegranate juice consumption to rhabdomyolysis in a patient stable on rosuvastatin, and the same enzyme inhibition can raise the systemic exposure and muscle toxicity risk of CYP3A4-metabolized statins.
oat fiber + statins
Oat bran is a soluble fiber rich in beta-glucan that can bind statins in the gut and slow their absorption, reducing the cholesterol-lowering effect when both are taken simultaneously. Animal data show oat bran taken with atorvastatin reduced the lipid-lowering effect by roughly 50 percent at low statin doses.
alcohol + statins
Statins and alcohol are both metabolized by the liver and can independently raise transaminases; combined heavy use increases the risk of hepatotoxicity and, in some cases, myopathy or rhabdomyolysis. Atorvastatin plasma levels rise sharply in patients with alcoholic liver disease.
bergamot + statins
Bergamot orange (Citrus bergamia) is the source of bergamottin, the prototype furanocoumarin that irreversibly inhibits CYP3A4. Bergamot juice and high-dose bergamot polyphenol supplements (BPF), often marketed for cholesterol, can theoretically raise levels of CYP3A4-metabolized statins (simvastatin, atorvastatin, lovastatin), though human pharmacokinetic data with statins are limited.
atorvastatin + st. john's wort
St. John's wort potently induces hepatic and intestinal CYP3A4, accelerating atorvastatin's first-pass metabolism. A controlled study showed roughly a 12% drop in atorvastatin AUC and meaningful increases in LDL and total cholesterol over 4 weeks of co-administration.
atorvastatin + berberine
Berberine inhibits CYP3A4 in vitro and can raise plasma levels of CYP3A4 substrates, including atorvastatin, which may increase the risk of muscle pain, liver enzyme elevation, and rhabdomyolysis. The interaction direction is complex — some animal data also show induction — but co-use is unpredictable.