Statins are often used to improve cholesterol levels. They lower LDL cholesterol (“bad” cholesterol) and triglycerides, while raising HDL (“good”) cholesterol.
However, they also have the potential to interact with common over-the-counter and prescription medicines, as well as some supplements. These interactions can interfere with the way the drug works, change its effectiveness, or cause side effects. Also, if you have certain medical conditions, you should avoid statins or use them with caution.
For these reasons, it is important to discuss your medical history and all the items you are taking with your healthcare provider.
This article discusses which drugs may interact with statins. It also covers medical conditions that need to be reported to a doctor before taking a statin.
Does it matter if you have high cholesterol?
Medical Conditions to Report
It is important to let your healthcare professional know about any medical conditions you have before you start taking a statin. Chief among them is liver disease. Statins can further impair liver function, causing elevated liver enzymes, which indicate inflammation or damage to liver cells.
Having liver disease doesn’t mean you can’t take statins. However, it determines whether statins are the best or the only option available. Cases of alcohol use disorder also require caution because liver damage can occur when statins are added to the mix.
Due to early reports that statins may cause birth defects, statins are contraindicated (not recommended) during pregnancy. While many studies have questioned this association, it’s wise to avoid them just in case.
The same applies to the use of statins during breastfeeding, as these drugs can be passed to the baby through breast milk.
statin side effects
possible drug interactions
Before taking a statin, it is important to let your doctor know about any medications you are taking. This includes prescription, over-the-counter (OTC) medicines, and dietary or herbal supplements prescribed to you by other healthcare providers.
Some drugs may interact with statins by reducing their effectiveness. Others may have elevated blood statin levels to levels that may be harmful to the body.
Be sure to tell your healthcare professional if you are already taking any of the following medicines. If you’re taking one of these, it doesn’t mean you can’t take a statin. However, your healthcare professional may want to monitor you more closely, as this may increase your risk of side effects.
Your body metabolizes or processes various statins in different ways. This means that the potential for drug interactions may vary with each statin. Depending on the medication you’re taking, it’s usually possible to choose a statin that minimizes potential drug interactions.
Keep in mind that this is not a complete list and you should consult your healthcare professional for more information.
Be sure to read the package insert to identify drug interactions that are specific to the statin you are taking. Drug interactions may vary with various statins, including Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin) statin) or Zocor (simvastatin).
Here is a general list of medications you should be aware of:
- Antacids that contain magnesium hydroxide or aluminum hydroxide might decrease the concentration of some statins in your body. This can be prevented by taking statins and antacids at least two hours apart.
- Antibiotics end in -mycin Statins such as erythromycin or Biaxin (clarithromycin) may increase statins in the blood and may also increase side effects.
- antifungal drugs to -azole, such as Nizoral (ketoconazole), Diflucan (fluconazole), Mycelex (miconazole), or Sporanox (itraconazole), may increase the amount of certain statins in the blood. It may also increase the side effects of statins.
- Bile acid sequestrants might decrease the effectiveness of some statins. To avoid this, it is recommended that you take a statin and a bile acid sequestrant at least four hours apart.
- Cordarone (amiodarone) might increase the amount of some statins in the blood. It may also increase the side effects of statins.
- Coumarin (warfarin) and statins might decrease the blood’s ability to clot.
- Fibrates may increase the risk of statin side effects.
- Fluvoxamine might increase the concentration of certain statins in the blood. It may also increase the side effects of statins.
- Hypertension drugs that are calcium channel blockers, such as diltiazem and verapamil, lower blood pressure, but may also increase the presence of statins in the blood. They may also increase side effects.
- HIV protease inhibitors, such as Norvir (ritonavir), Agenerase (ampenavir), Crixivan (indinavir), or Viracept (nelfinavir), may increase the amount of certain statins in the blood . They may also increase side effects.
- Lanoxin (digoxin) might increase the concentration of some statins in the body.
- High doses (more than 1 gram per day) of niacin (niacin) may increase the risk of statin side effects.
- Taking oral contraceptives and statins at the same time may increase the concentration of these hormones in the body.
- Prilosec (omeprazole) might increase the levels of some statins in the blood. It may also increase the side effects of statins.
- Sandimmune (cyclosporine) might increase the amount of statins in the blood, and it might also increase side effects.
- St. John’s wort might decrease the effectiveness of some statins.
- Tagamet (cimetidine) might increase the amount of some statins in the blood, and it might also increase the side effects of statins.
- Zantac (ranitidine) might increase the amount of certain statins in the blood, and it might also increase the side effects of statins.
Update April 1, 2020: The U.S. Food and Drug Administration (FDA) has announced a recall of all medications containing ranitidine, which goes by the name Zantac.
The FDA also recommends against taking ranitidine in over-the-counter form. For patients taking prescription ranitidine, patients should discuss other treatment options with their healthcare provider before discontinuing the drug.
For more information, visit the FDA website.
Statins lower bad cholesterol and increase good cholesterol. However, they can cause problems if you have certain medical conditions or are taking another drug or supplemental statin.
Before taking a statin, let your healthcare provider know if you have liver disease, or if you are pregnant or breastfeeding. Also, be sure to tell them if you are taking any medications or supplements. They may want to monitor your condition or switch you to a different type of medication.
Statins help lower cholesterol and reduce the risk of heart disease. However, there are many precautions to consider.
These are just a few of the possible drug interactions. This is why it is important to discuss your medical history and all medications (prescription or otherwise) with your healthcare team before taking a statin.
It’s important to remember that statins aren’t the only way to treat high cholesterol. If statins are not an option, niacin, fibrate acid, PCSK9 inhibitors, bile acid sequestrants, and Zeta (ezetimibe) can also be used.
Frequently Asked Questions
What drugs interact 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 norethisterone or ethinyl estradiol, digoxin, rifampicin, and autumn Narcissine.
What foods should I avoid while taking Crestor?
Grapefruit and grapefruit juice can affect some statins, but it is believed to have little interaction with Crestor (rosuvastatin). However, it is best avoided until you discuss it with your healthcare provider.
What are the side effects of Tagamet?
Side effects of Tagamet (cimetidine) may include headache, dizziness, drowsiness, and diarrhea. Serious side effects are rare, but include depression, nervousness, and hallucinations. Tagamet can increase the side effects of statins. If you take a statin, talk to your doctor before taking Tagamet.
Is lisinopril a statin?
No, lisinopril is not a statin. It is used alone or with other medicines to treat high blood pressure (hypertension) and heart failure. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor.
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