atorvastatin
11 interactions related to atorvastatin
atorvastatin + niacin
Adding cholesterol-dose niacin to atorvastatin raises the risk of muscle injury (myopathy, rarely rhabdomyolysis) without improving cardiovascular outcomes in patients already well treated with a statin.
atorvastatin + coq10
Atorvastatin inhibits HMG-CoA reductase, the upstream enzyme also needed to make coenzyme Q10 (ubiquinone), so statin therapy lowers blood CoQ10 levels. Mitochondrial CoQ10 depletion is one proposed mechanism for statin-associated muscle symptoms, but evidence that taking CoQ10 reverses those symptoms is modest and mixed. This is a supplement-may-help question, not a harmful interaction.
atorvastatin + vitamin d
Vitamin D's active metabolite (calcitriol) can mildly induce CYP3A4, the liver enzyme that breaks down atorvastatin, which can lower atorvastatin blood levels. Despite this, the cholesterol-lowering effect appears largely preserved, so the combination is generally fine. Strip precise dose targets and review high-dose vitamin D regimens with your doctor or pharmacist.
atorvastatin + st. john's wort
St. John's wort induces CYP3A4, the enzyme that metabolizes atorvastatin, lowering statin exposure and weakening cholesterol-lowering efficacy over time.
atorvastatin + red yeast rice
Red yeast rice naturally contains monacolin K, the same compound as the prescription statin lovastatin. Taking it alongside atorvastatin effectively stacks two statins working through the same liver pathway, raising the risk of statin-associated muscle symptoms, rhabdomyolysis, and liver injury.
seville orange + atorvastatin
Seville (bitter) orange contains the same furanocoumarins as grapefruit, including bergamottin and 6',7'-dihydroxybergamottin, which inactivate intestinal CYP3A4. A randomized crossover study showed Seville orange juice raised levels of the CYP3A4 drug felodipine to a degree comparable with grapefruit juice, while ordinary sweet orange juice had no effect. Because atorvastatin is metabolised by the same CYP3A4 pathway, Seville orange can raise atorvastatin levels and increase the risk of statin-related muscle injury.
pomegranate + statins
Pomegranate inhibits the drug-metabolizing enzyme CYP3A4 in laboratory and animal studies, raising a theoretical concern that it could increase blood levels of CYP3A4-dependent statins such as simvastatin, atorvastatin, and lovastatin. However, controlled human studies - including ones using simvastatin and a sensitive CYP3A4 probe drug - did not find a meaningful effect, so pomegranate should not be treated like grapefruit. Concentrated pomegranate extract supplements warrant more caution than the whole fruit.
oat fiber + statins
Oat fiber is rich in beta-glucan, a soluble fiber that forms a viscous gel in the gut. Taken at the same time as a statin, this gel can bind the statin tablet and slow its absorption, potentially blunting some of the cholesterol-lowering effect. The evidence is mechanistic and based largely on animal data; separating the two in time appears to resolve the conflict.
alcohol + statins
Statins and alcohol are both processed by the liver, and heavy or chronic combined use can add to the strain on liver cells, modestly raising the risk of liver enzyme elevation and, less commonly, muscle problems. In people with established alcohol-related liver disease, statin levels in the blood can run higher than normal. For most people who drink lightly to moderately, a statin is still safe with routine monitoring.
bergamot + statins
Bergamot orange (Citrus bergamia) is the source of bergamottin, the prototype furanocoumarin that inactivates CYP3A4. Bergamot juice and concentrated bergamot polyphenol supplements (often marketed for cholesterol) could in theory raise levels of CYP3A4-metabolized statins (simvastatin, atorvastatin, lovastatin). The mechanism is well established in the lab and in animals, but no direct human pharmacokinetic studies of bergamot with statins exist, so the real-world magnitude is uncertain.
atorvastatin + berberine
In human trials, adding berberine to a statin did not raise muscle or liver side effects, and the two are sometimes studied together for cholesterol. The earlier claim that berberine meaningfully raises atorvastatin levels and risk is not supported by human evidence.