14 Atorvastatin Interactions to Watch For

Atorvastatin (Lipitor, Atorvaliq) is one of the most prescribed medications in the U.S. Millions of people take this statin medication for high cholesterol. Atorvastatin can help lower the risk of heart disease by lowering cholesterol and triglyceride (a type of fat) levels. It works by blocking the production of cholesterol in the liver.

It works well, but atorvastatin interacts with other medications. So which atorvastatin interactions should you be most aware of?

Atorvastatin interactions at a glance

Atorvastatin has many possible interactions. This is something to keep in mind, especially if you’re taking other prescription and over-the-counter (OTC) medications.

It’s a good idea to maintain a complete medication list. Be sure to include OTC medications, vitamins, and supplements. A medication list can help your prescriber and pharmacist check for atorvastatin interactions.

Medications and supplements to avoid combining with atorvastatin include:

• Gemfibrozil (Lopid), a fibrate medication

• Paxlovid (nirmatrelvir / ritonavir)

• Other antiviral medications, such as Harvoni (ledipasvir / sofosbuvir)

• Cyclosporine (Sandimmune, Neoral, Gengraf)

• Red yeast rice

Medications, supplements, and foods that may require additional monitoring or dosage changes when combined with atorvastatin include:

• Grapefruit juice

• Other fibrate medications, such as fenofibrate (Lipofen, Antara)

• Oral azole antifungals, such as ketoconazole

• Certain macrolide antibiotics, such as clarithromycin

• Niacin (Niacor, vitamin B3)

• Colchicine (Colcrys, Gloperba, Lodoco, Mitigare)

• Digoxin (Lanoxin)

• Birth control pills that contain norethindrone or ethinyl estradiol

• Alcohol

• Cannabis and CBD

Below are details about 14 atorvastatin interactions you should be aware of. Keep in mind that this list doesn’t include all possible interactions.

1. Grapefruit and grapefruit juice

Grapefruit and grapefruit juice can increase the amount of atorvastatin in your body. This can raise your risk of side effects, such as muscle pain or weakness. In rare cases, this can lead to rhabdomyolysis (a breakdown of muscle that can cause harm to your kidneys).

But usually, this interaction is a problem only when you drink a lot of grapefruit juice (5 cups or 1 liter per day or more). Having a small glass now and then shouldn’t be a problem.

2. Paxlovid

Paxlovid is an antiviral that can treat COVID-19 in certain people. But the ritonavir in Paxlovid slows the breakdown of atorvastatin in your body. This can cause atorvastatin to build up, raising your risk of side effects. Your prescriber will likely have you stop taking atorvastatin until you finish Paxlovid.

3. Other antiviral medications

Like Paxlovid, other antiviral medications can slow the breakdown of atorvastatin. Many of these antivirals are prescribed for people living with HIV or hepatitis C. With some antivirals, you should avoid atorvastatin. For others, lowering the dosage of atorvastatin is enough to manage this interaction.

Examples of antivirals that may interact with atorvastatin include:

• Harvoni

• Kaletra (lopinavir / ritonavir)

• Fosamprenavir

• Prezcobix (darunavir / cobicistat)

• Mavyret (glecaprevir / pibrentasvir)

4. Cyclosporine

Cyclosporine is used to help prevent organ rejection after a transplant. But it can interact with atorvastatin and slow its breakdown. Like the medications already discussed, this can raise your risk of atorvastatin side effects. It’s not recommended to take these two medications together. So if you take cyclosporine, you’d likely need to take a different cholesterol medication.

5. Fibrates

Fibrates, such as gemfibrozil and fenofibrate, are another group of cholesterol medications. But like atorvastatin, fibrates have a risk of causing muscle pain and rhabdomyolysis. So taking fibrates and atorvastatin together increases this risk even more.

Gemfibrozil seems to have the highest chance of causing an interaction with atorvastatin. So it’s recommended to avoid combining these two medications. Other fibrates may be used with caution. If you’re taking both a fibrate and atorvastatin, contact your prescriber right away if you start to experience muscle pain.

6. Azole antifungals

Many azole antifungals can also slow the breakdown of atorvastatin. This can cause a buildup of atorvastatin in your body and raise your risk of side effects. This atorvastatin interaction would be a concern only if you’re taking these antifungals by mouth. Antifungal creams applied to the skin shouldn’t be a problem.

Examples of azole antifungal that interact with atorvastatin include:

• Itraconazole (Sporanox, Tolsura)

• Ketoconazole

• Posaconazole (Noxafil)

• Voriconazole (Vfend)

Your prescriber may have you stop atorvastatin while taking your antifungal medication. But they may also recommend you take both and watch for atorvastatin side effects.

7. Macrolide antibiotics

Macrolides are a commonly prescribed group of antibiotics. But some, such as erythromycin (Ery-Tab) and clarithromycin, can lead to higher atorvastatin levels in your body. This raises the risk of side effects, including muscle pain or rhabdomyolysis.

Atorvastatin’s manufacturer recommends watching for new side effects if you start taking a macrolide. But your prescriber may suggest stopping atorvastatin until you finish your antibiotic.

8. Niacin

Niacin is a type of B vitamin (vitamin B3) that can be used to help lower cholesterol. But large doses (typically more than 1,000 mg per day) interact with atorvastatin. Niacin can raise your risk of developing muscle pain or rhabdomyolysis from atorvastatin.

If your prescriber suggests taking both medications, they’ll likely recommend a lower dose of niacin. If you start to experience muscle pain or weakness, tell your prescriber.

9. Colchicine

Colchicine is a medication used to help treat and prevent gout. There are some reports of colchicine causing muscle pain and rhabdomyolysis when combined with atorvastatin. If you take both medications, tell your prescriber if you notice new atorvastatin side effects.

10. Digoxin

Digoxin is a medication you may take if you have heart failure or an abnormal heart rhythm called atrial fibrillation. Atorvastatin can raise the amount of digoxin in your body. This can raise your risk of digoxin side effects, such as blurred vision or dizziness. You may need more frequent blood tests to check your digoxin levels if you take both medications.

11. Certain birth control pills

Atorvastatin interacts with birth control pills that include the hormones norethindrone or ethinyl estradiol. Atorvastatin elevates the amount of these hormones in your body. This may make side effects from birth control pills more likely. This interaction is known to apply only to oral forms of contraception. Options like the patch and vaginal ring don’t seem to be affected by atorvastatin.

Examples of birth control pills that contain one or both of these hormones include:

• Ethinyl estradiol / levonorgestrel (Aviane, Sronyx, Vienva, Jolessa)

• Ethinyl estradiol / norethindrone (Junel 1/20, Junel 1.5/30)

• Ethinyl estradiol / norgestimate (Tri-Sprintec, Sprintec)

• Norethindrone (Camila, Heather, Errin)

Many people can safely combine these birth control pills with atorvastatin. But if you experience new side effects after starting the combination, tell your prescriber. They may suggest switching birth control methods.

12. Alcohol

Drinking an occasional beer or glass of wine is unlikely to cause serious problems with atorvastatin. But chronic or heavy drinking can raise your risk of liver damage from atorvastatin (a rare but serious statin side effect). Drinking can also make it more likely that you’ll experience muscle pain from atorvastatin.

Beyond a higher risk of side effects, alcohol can also raise your cholesterol. This can make it harder for atorvastatin to do its job. And over time, this could put you at a higher risk for heart disease or a heart attack.

It’s a good idea to discuss alcohol use with your prescriber when taking atorvastatin. If needed, they can help you cut back on or stop drinking safely.

13. Cannabis and CBD

Cannabis and CBD may raise the amount of atorvastatin in your body. This potential interaction happens because atorvastatin and CBD are broken down by the same enzyme (protein) in your liver. This may raise your risk of atorvastatin side effects. Cannabis is also associated with a higher risk of heart attacks. So it may counteract some of atorvastatin’s benefits.

There are limited studies that focus on this interaction. It’s important to talk with your prescriber if you’re using cannabis or CBD products. They can help determine if it’s OK for you to use these products while taking atorvastatin.  

14. Red yeast rice

You shouldn’t combine red yeast rice and atorvastatin. Red yeast rice is an OTC supplement that works similarly to statins. Combining them can raise your risk of certain side effects, notably muscle pain and rhabdomyolysis.

It’s best to avoid this combination unless a healthcare professional tells you otherwise.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for a decade. He has served as an associate professor of pharmacy practice, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Christina Aungst, PharmD, MWC

Christina Aungst, PharmD, MWC is a senior pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019.

Reviewed by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

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