Be Aware of These Statin Drug Interactions

16 Medications That May Trigger Adverse Events

Statins are commonly prescribed to improve cholesterol levels. They lower LDL cholesterol (the "bad" cholesterol) and triglycerides while raising HDL ("good") cholesterol.

However, they also have the potential for drug interactions with common over-the-counter and prescription medications and some supplements. These interactions can interfere with the way the drug works, changing its effectiveness or causing side effects. In addition, if you have certain medical conditions, you should avoid statins or use them with caution.

For these reasons, it's important that you discuss your medical history and everything you are taking with your healthcare provider.

This article discusses what medications may interact with statins. It also covers what medical conditions to report to your doctor before taking a statin.

statins pill pack
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Medical Conditions to Report

It is important to let your healthcare professional know about any medical condition you have before you start taking statins. Chief among these is liver disease. Statins can further impair liver function, causing an elevation in liver enzymes that indicates inflammation or damage to liver cells.

Having liver disease doesn't automatically mean you can't use statins. However, it factors into the decision as to whether statins are the best or only options available. Cases of alcohol use disorder also require caution, since liver injury may occur when statins are added to the mix.

Statins are contraindicated (recommended not to be used) in pregnancy due to early reports that they may cause birth defects. Although a number of studies have questioned the association, it is nevertheless wise to avoid them just in case.

The same applies to the use of statins during breastfeeding, since the drugs can be passed in breast milk to your baby.

Possible Drug Interactions

Before taking statins, it's important to let your doctor know about any medications you're taking. That includes those prescribed to you by another healthcare provider, over-the-counter (OTC) drugs, and dietary or herbal supplements.

Some medications may interact with statins by decreasing the effectiveness of the statin. Others may increase the statin level in the blood to the point where it may become harmful to the body.

Be sure to tell your healthcare professional if you are already taking any of the medications below. If you are taking one of them, it doesn't mean that you can't take a statin. However, your healthcare professional may want to monitor you more closely since it may increase your risk of side effects.

Various statin drugs are metabolized or processed by your body differently. That means the potential for drug interactions can be different with various statins. It is usually possible to select a statin that minimizes potential drug interactions, depending on which medications you're taking.

Keep in mind that this is not a complete list and you should consult your healthcare professional for further information.

Always read the package insert to identify the drug interactions specific to the statin you are taking. Drug interactions can differ with various statins, including Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), or Zocor (simvastatin).

This is a general list of medications that you should be aware of:

  • Antacids containing magnesium or aluminum hydroxide may decrease the concentration of some statins in the body. This may be prevented by taking your statin dose and antacid dose at least two hours apart.
  • Antibiotics ending in -mycin such as erythromycin or Biaxin (clarithromycin) may increase the statins present in the blood and may also increase side effects.
  • Antifungal drugs ending in -azole, such as Nizoral (ketoconazole), Diflucan (fluconazole), Mycelex (miconazole), or Sporanox (itraconazole), may increase the amount of some statins in the blood. It may also increase statin side effects.
  • Bile acid sequestrants may decrease the effectiveness of some statins. To avoid this, it may be recommended to take your statin dose and bile acid sequestrant dose at least four hours apart.
  • Cordarone (amiodarone) may increase the amount of some statins present in the blood. It may also increase the side effects of statins.
  • Coumadin (warfarin) along with a statin may reduce the blood's ability to clot.
  • Fibrates may increase the risk of experiencing statin side effects.
  • Fluvoxamine may increase the concentration of some statins present in the blood. It may also increase statin side effects.
  • High blood pressure medications which are calcium channel blockers, such as diltiazem and verapamil, lower blood pressure but may also increase the statins present in the blood. They may also increase side effects.
  • HIV protease inhibitors, such as Norvir (ritonavir), Agenerase (amprenavir), Crixivan (indinavir), or Viracept (nelfinavir), may increase the amount of some statins present in the blood. They may also increase side effects.
  • Lanoxin (digoxin) may increase the concentration of some statins in the body.
  • Nicotinic acid (niacin) in high doses (greater than 1 gram a day) could increase the risk of experiencing statin side effects.
  • Oral contraceptives and statins that are taken simultaneously may increase the concentration of these hormones in the body.
  • Prilosec (omeprazole) may increase the amount of some statins present in the blood. It may also increase the side effects of statins.
  • Sandimmune (cyclosporine) may increase the number of statins present in the blood and may also increase side effects.
  • St. John's Wort may decrease the effectiveness of some statins.
  • Tagamet (cimetidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins.
  • Zantac (ranitidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac.

The FDA also advised against taking OTC forms of ranitidine. For patients taking prescription ranitidine, patients should speak with their healthcare provider about other treatment options before stopping the medication.

For more information, visit the FDA site.

Summary

Statin drugs can decrease bad cholesterol and increase good cholesterol. However, they can cause problems if you have certain medical conditions or if you're taking another medication or supplement with the statin.

Before taking statins, let your healthcare provider know if you have liver disease, or if you're pregnant or nursing. Also, be sure to tell them if you're taking any medications or supplements. They may want to monitor your condition or switch you to a different type of medicine.

A Word From Verywell

Statins can be beneficial in lowering cholesterol and decreasing your risk for heart disease. However, there are many precautions to be considered.

These are only a few of the possible drug interactions. That's why it's important to discuss your medical history and all medications—prescription or otherwise—with your healthcare team before taking a statin.

It is important to remember that statins are not the only treatment for high cholesterol. Nicotinic acid, fibric acid, PCSK9 inhibitors, bile acid sequestrants, and Zeta (ezetimibe) can also be used if statins are not an option.

Frequently Asked Questions

  • Which drugs have interactions with atorvastatin?

    Certain drugs can interact with atorvastatin (Lipitor) and increase its side effects. These include fibrates, niacin supplements, cyclosporine, clarithromycin, itraconazole, HIV protease inhibitors, oral contraceptives containing norethindrone or ethinyl estradiol, digoxin, rifampin, and colchicine.

  • What foods should be avoided when taking Crestor?

    Grapefruit and grapefruit juice can affect some statin drugs, but it is believed to have little or no interaction with Crestor (rosuvastatin). However, it may best be avoided until discussing it with a healthcare provider.

  • What are the side effects of Tagamet?

    Side effects of Tagamet (cimetidine) can include headache, dizziness, drowsiness, and diarrhea. Severe side effects are rare but include depression, nervousness, and hallucination. Tagamet can increase the side effects of statins. If you take statins, check in with your doctor before taking Tagamet.

  • Is lisinopril a statin?

    No, lisinopril is not a statin. It is used by itself or alongside other medications to treat hypertension (high blood pressure) as well as heart failure. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gillett RC Jr, Norrell A. Considerations for safe use of statins: liver enzyme abnormalities and muscle toxicity. Am Fam Physician. 2011 Mar 15;83(6):711-6.

  2. Harvard Health. Grapefruit juice and statins.

  3. MedlinePlus. Cimetidine.

  4. MedlinePlus. Lisinopril.

Additional Reading
  • Lacy CF, Armstrong LL, Goldman MP, et al. Lexicomp's Drug Information Handbook. 26th ed. Hudson, OH:Lexi-Comp Inc.; 2017.

  • Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education. 2017.