Can You Drink Alcohol While Taking Lipitor and Other Statins?

Can you drink alcohol with Lipitor or other statin medications? If a package insert refers to "moderate" alcohol intake, what does that mean? What is the effect of statins on the liver? From the opposite angle, what do we know about the effect of statins on liver disease?

Statins have made a big difference with regard to heart disease. They stabilize the coronary artery plaques that can lead to heart attacks, the leading cause of death in the U.S. before cancer. They reduce the size of these plaques. They reduce inflammation. They appear to help with abnormal blood clotting. They reduce the risk of ​Alzheimer's disease. They decrease the chance that you will have cataracts. They may even improve survival with lung cancer, the most common cause of cancer-related deaths in men and women. So a question about whether you should combine these drugs with alcohol deserves a careful answer.

According to the official Lipitor (atorvastatin) package insert—approved by the U.S. Food and Drug Administration (FDA)—Lipitor “should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease.” Unfortunately, there is not an "official" definition of what substantial quantity of alcohol means.

To understand why any amount of alcohol could be a problem with Lipitor or any statins, let's take a look at how these medications may affect the liver, and how alcohol might increase that effect.

It's not uncommon to have abnormal liver tests when taking statins, but it is important to understand what lies behind this. There are several different ways to explain how statins affect the liver, so let's look at changes in liver tests alone (no symptoms,) clinical liver disease (symptoms) related to statin use, severe liver disease, as well as how statins may actually reduce mortality in some people who already have liver disease.

Current recommendations are that liver function tests be checked prior to beginning Lipitor, and then 12 weeks later. Monitoring should continue periodically for the duration of time a person is on the medication. That said, the longer that Lipitor has been on the market, the less stringent many physicians have become in following these tests over time.

Studies have found that some people who use Lipitor have an elevation of the liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT.)  An increase (up to three times normal) in these values occurs in roughly three percent of people. What we have learned over time, however, is that most of the time these elevations are only temporary and not usually dangerous.

Since moderate to high alcohol intake can also increase liver function tests, the combination of heavy drinking and statins will increase the chances of an abnormality.

Clinically apparent liver injury—injury enough to causes symptoms rather than simply abnormal liver function tests alone—is very uncommon with statins, unlike the elevations in liver enzymes alone we just noted.

Certainly, the severe liver injury is possible. There are at least 50 case reports of liver injury in people taking statins which have led to death or the need for liver transplantation. Looking at these numbers, however, it's important to note that during this time Lipitor has been the number one most prescribed drug worldwide. (In comparison, it's thought that at least 15,000 people die each year from gastrointestinal bleeding from Advil.) The serious liver injury is possible on statins, but this is quite rare.

When talking about the effect of alcohol on liver disease related to statins, it's important to note that severe liver injury is not usually due to the cumulative effect of the injury. Rather, the drug-induced liver disease is usually an autoimmune condition, in which the drug prompts some people's bodies to make antibodies which attack their own liver tissue. This is considered an "idiosyncratic" reaction, something that isn't well understood and can't be predicted.

It may be somewhat reassuring to hear that, despite the recommendation to monitor liver tests, and the uncommon risk of severe liver injury, statins may be helpful for some people with liver disease.

In one study looking at people with the severe alcoholic liver disease, the use of statins halved the risk of death from alcoholic cirrhosis. The conclusion of a 2017 study was that statins used for people with the chronic liver disease might actually reduce liver failure and complications of liver failure such as portal hypertension. Statins are currently being evaluated for their ability to reduce the worsening of liver disease in people with the non-alcoholic fatty liver disease.

In addition, those who have liver disease due to chronic hepatitis C infections may respond better to medications (interferon) when they are given statins. (Of note is that alcohol worsens hepatitis C.)

All of that said, excess alcohol could pose a problem for people when combined with Lipitor. Increased liver function tests are not the only possible side effect. Muscle problems with statins are not uncommon, and alcohol can lead to damage as well. Alcohol may also interfere with the metabolism of many drugs, such as those that may be used along with Lipitor for heart disease. The primary concern with alcohol in people using Lipitor, however, is likely the host of other problems which are found with alcohol alone. Lipitor and other statins may reduce your risk of heart disease, but alcohol, through causes such as alcoholic cardiomyopathy and much more, may worsen your risk. Of course, alcohol has plenty of calories, something that also increases the risk of heart disease.

What most people really want to know is, "Can I have a beer or two or a glass of wine while I'm taking statins? It's likely that adding alcohol to statins has little effect overall when consumed in moderation.

The real question come down to, "Do you have a problem with alcohol?" For those who consume large amounts of alcohol (more than two drinks per day for a man or more than one drink per day for women), there is likely much more to be concerned about than the effect on your liver of combining statins and alcohol.

The U.S. Centers for Disease Control and Prevention (CDC) defines drinking in moderation as one alcoholic drink each day for women and two drinks for men. Regarding wine, one drink is five ounces. However, researchers who are studying the beneficial effects of alcohol on preventing heart disease define moderate drinking as up to two drinks each day for women and up to four drinks each day for men.

If you have any family members or friends who have expressed concern over your drinking, it's important to take an honest look at your consumption. If you drink at all, take a moment and try this quiz to see if you may have an alcohol use problem.

If you drink alcohol you should let your physician know. Many people underestimate their intake, but being honest with your doctor will ultimately her take care of you as well as possible. Your physician knows your medical history and current health status and should be able to advise you about your alcohol use.

Take time to learn about the treatment options for alcoholism whether you are concerned about yourself or a friend or family member. Thankfully, you won't have to go very far to hear wonderful success stories from people who have been given a new lease on life after quitting.