Written by Brian Leonard, PharmD, BCACP, BCGP | Reviewed by Stacia Woodcock, PharmD
Key takeaways:
Statins are a group of medications used to treat high cholesterol and lower the risk of heart attack and stroke. Examples include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor, FloLipid).
Statins can cause muscle pain. In rare cases, muscle damage that leads to rhabdomyolysis is possible. This risk can go up if they’re taken with other medications that have similar effects or that interfere with how statins are broken down in the body.
Not all statins interact with other medications in the same way. Talk to your provider about your current medications and which statin may be best for you.
Statins are among the most prescribed medications in the U.S. They’re used to lower cholesterol levels and decrease your risk of heart attack and stroke. Popular examples include atorvastatin, (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor, FloLipid). Since statins are so common, it’s a good idea to know if they interact with other medications you take.
When you compare statins, there are some differences when it comes to dosage and how you take them. And while each statin also has unique interactions, there are a few that apply to many (or all) of them. Below, we cover seven statin interactions and what they might mean for you.
Fibrates
Fibrates are a class of medications used to treat high cholesterol and high triglycerides. Examples include fenofibrate (Tricor), which is available in several different formulations, and gemfibrozil (Lopid).
Statins and fibrates each have a risk of muscle pain and serious muscle damage that leads to rhabdomyolysis. Rhabdomyolysis is when muscle tissue leaks into your bloodstream, which can lead to kidney failure. So taking these medications together can further increase this risk.
If you must take a statin and fibrate together, fenofibrate is generally preferred. This is because the risk of muscle pain and rhabdomyolysis is much higher with gemfibrozil. Gemfibrozil is typically avoided with statins. But in some cases, a lower statin dose may be recommended with this combination.
If you’re taking a fibrate and statin together, let your healthcare provider know if you experience muscle pain. Severe muscle pain, weakness, and cola-colored urine are common rhabdomyolysis symptoms. Go to the nearest emergency room if these develop.
Transplant medications
Organ transplant medications are used after a transplant so that your body doesn’t reject the new organ. Examples include cyclosporine (Sandimmune), tacrolimus (Prograf), and sirolimus (Rapamune).
Cyclosporine and tacrolimus can decrease the breakdown of statins in the body. This raises statin levels, which can increase the risk of side effects, such as muscle pain and rhabdomyolysis. Sirolimus and everolimus (Afinitor) may also have this effect on statins.
While all statins can potentially interact with these medications, certain combinations may be more concerning than others. For example, you may be able to take statins like rosuvastatin and pravastatin with cyclosporine, but at a lower dosage. Other combinations may need to be avoided altogether.
Make sure that your healthcare provider has your current medication list to check for potential interactions. You should also check in with them before starting a new medication. In some cases, your statin dosage may need to be adjusted. Or they may switch you to a statin with a lower risk of interactions.
Colchicine
Colchicine (Colcrys) is an anti-inflammatory medication most commonly used to treat gout flares. It’s also sold under the brand name Lodoco to lower the risk of heart attack and stroke in certain people.
Possible colchicine side effects include muscle pain. In severe cases, rhabdomyolysis is also possible. Colchicine and statins can potentially interact in a few different ways, which may increase the risk of these side effects if you take them together.
In general, you may not need to avoid a statin if you’re taking colchicine (and vice versa). But your healthcare provider may monitor you more closely for muscle-related side effects. In some cases, they may have you take a lower statin dose. Let them know right away if you develop muscle pain with this combination.
HIV medications
HIV medications have many potential drug interactions. This is because they can affect how other medications are broken down in the body, including statins. Examples of HIV medications that can interact with statins include atazanavir (Reyataz), darunavir (Prezista), and ritonavir (Norvir).
Lovastatin and simvastatin are most likely to interact with HIV medications, so certain combinations may need to be avoided. Pravastatin and rosuvastatin may be least likely to cause a significant problem, but you may need to take a lower dose.
Good to know: HIV medications are often taken as combination medications. It’s critical that your HIV specialist has a full, up-to-date list of all medications you take. They can evaluate which combination and dosage is safest for you.
Warfarin
Warfarin (Coumadin, Jantoven) is a blood thinner used to prevent or treat blood clots. It’s also well known for interacting with other medications, including statins. When taken with warfarin, certain statins may increase the risk of bleeding.
If you take a statin with warfarin, your healthcare provider may monitor your blood work more closely. This is to ensure that your warfarin dosage is safe and effective, especially when you start, stop, or change the dose of a statin. Let your provider know if you experience any signs of unusual bleeding or bruising with this combination.
Paxlovid
Paxlovid (nirmatrelvir / ritonavir) is used to treat certain people with COVID-19. Like some HIV medications, it contains ritonavir. Ritonavir’s purpose in Paxlovid is to help nirmatrelvir last longer in the body. One treatment course of Paxlovid lasts for 5 days.
Paxlovid can interfere with how your body breaks down statins. This can lead to increased statin side effects, such as muscle pain and rhabdomyolysis. But not all statins interact with Paxlovid to the same degree.
It’s OK to take pitavastatin and pravastatin with Paxlovid. But you may be told to stop taking other statins, such as atorvastatin or rosuvastatin, while you’re taking Paxlovid.
Lovastatin and simvastatin have more specific instructions. They should be stopped at least 12 hours before starting Paxlovid, during treatment, and for at least 5 days afterwards.
If you’re prescribed Paxlovid, don’t stop taking your statin before speaking with your healthcare provider. They can determine if there are any necessary changes to your medications. This may include continuing, stopping, or lowering the dose of your statin.
Alcohol
In general, it’s best to avoid or minimize alcohol if you’re taking a statin.
Alcohol, especially heavy or long-term use, can damage the liver. While rare, statins can also cause liver damage. In theory, combining the two may increase the risk of this side effect. What’s more, alcohol can raise cholesterol levels and increase the risk of heart disease, counteracting the benefits of taking a statin in the first place.
Small amounts of alcohol may be OK if you’re taking a statin. But you should check with your healthcare provider for guidance on what’s a safe amount for you. Let them know if you regularly consume alcohol, since you may need to be extra cautious.
When should you contact your healthcare provider about statin interactions?
First, make sure that your healthcare provider and pharmacist have an up-to-date list of your medications. This makes it easier to prevent and manage potential statin interactions before they occur.
Many statin interactions can increase the risk of muscle-related symptoms, such as muscle pain. Let your healthcare provider know if these symptoms develop. They can determine if it’s from an interaction and what steps need to be taken.
Severe muscle pain, weakness, and cola-colored urine are common symptoms of rhabdomyolysis. Go to the nearest emergency room if these symptoms develop. It’s important to address rhabdomyolysis early to prevent serious kidney damage.
The bottom line
Common statin interactions include fibrates, colchicine, and HIV medications. Paxlovid and warfarin can also potentially interact. In general, it’s best to avoid or minimize alcohol with statins due to its effects on the liver and cholesterol levels.
Speak with your healthcare provider and pharmacist before starting a statin. They can check to see if it interacts with anything else you take. In some cases, you may need to take a lower dose or a different statin due to an interaction.
References
Clinical Info. (2022). Guidelines for the use of antiretroviral agents in adults and adolescents with HIV – Table 24a. Drug interactions between protease inhibitors and other drugs.
Clinical Info. (2023). Guidelines for the use of antiretroviral agents in adults and adolescents with HIV.
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