cholesterol
8 interactions related to cholesterol
pravastatin + grapefruit
Unlike simvastatin, lovastatin, and atorvastatin, pravastatin is not significantly metabolized by CYP3A4, so grapefruit juice does not meaningfully change its plasma exposure. Clinical pharmacokinetic studies show no significant effect of grapefruit juice on pravastatin disposition.
rosuvastatin + berberine
Rosuvastatin is taken into liver cells by the OATP1B1 transporter, and berberine has been shown to upregulate OATP1B1 in hepatocyte studies, increasing hepatic uptake of rosuvastatin. The clinical net effect (more LDL lowering vs. higher muscle/liver risk) is not well established in humans.
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.
simvastatin + st. john's wort
St. John's wort induces intestinal and hepatic CYP3A4 and P-glycoprotein, sharply increasing simvastatin's first-pass metabolism. In a crossover study of healthy adults, the AUC of active simvastatin hydroxy acid was cut roughly in half (to about 48% of placebo).
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.
cbd + simvastatin
Simvastatin is heavily dependent on CYP3A4 for first-pass and systemic clearance, and CBD inhibits CYP3A4. Co-administration is expected to raise simvastatin and active-metabolite exposure, increasing the risk of muscle pain, transaminase elevation, and rare rhabdomyolysis.
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.