cholesterol
8 interactions related to cholesterol
pravastatin + grapefruit
Unlike simvastatin, lovastatin, and atorvastatin, pravastatin is not significantly broken down by the gut enzyme CYP3A4 that grapefruit blocks. Controlled pharmacokinetic studies show grapefruit juice does not meaningfully change pravastatin levels, so grapefruit in normal dietary amounts is fine with this statin.
rosuvastatin + berberine
Rosuvastatin is carried into liver cells by the OATP1B1 transporter. In a laboratory study using human liver-cell cultures, berberine increased OATP1B1 activity and pushed more rosuvastatin into the cells. This is an early, test-tube signal only: there is no human or animal data showing it changes blood levels, cholesterol response, or side-effect risk in real life.
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.
simvastatin + st. john's wort
St. John's wort induces the CYP3A4 enzyme and the P-glycoprotein transporter that simvastatin depends on, sharply increasing the drug's first-pass breakdown. In a controlled crossover study of healthy volunteers, two weeks of St. John's wort substantially lowered the amount of active simvastatin reaching the bloodstream, weakening its cholesterol-lowering effect.
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.
cbd + simvastatin
Simvastatin is cleared mainly by the liver enzyme CYP3A4, and CBD inhibits that same enzyme. Combining them is expected to raise simvastatin exposure, which could increase the risk of muscle pain and, rarely, more serious muscle injury. This is a predicted, mechanism-based interaction rather than one confirmed by a direct human study.