11 Lovastatin Interactions to Consider
Key takeaways:
Lovastatin (Altoprev) is a statin medication with several drug interactions to consider. You should avoid taking it with cyclosporine, some antiviral medications, and gemfibrozil. These medications raise lovastatin levels and increase the risk of muscle damage.
Other lovastatin interactions include some antifungals, macrolide, antibiotics, and colchicine. Calcium channel blockers and amiodarone can also interact. In most cases, these interactions can be managed by pausing lovastatin or lowering your dosage.
You should avoid grapefruit and grapefruit juice, red yeast rice, and St. John’s wort supplements while taking lovastatin. Check with your healthcare team before taking any over-the-counter vitamins or supplements with lovastatin.
Table of contents
If your cholesterol levels are higher than recommended, chances are your prescriber will recommend a statin to help lower them. Lovastatin is a common choice. It comes as an immediate-release tablet. And it’s also available as an extended-release tablet under the brand name Altoprev.
As with any medication, lovastatin has interactions you should be aware of. Here, we’ll look at 11 key lovastatin interactions to know about. This isn’t a complete list of all possible interactions. So be sure to discuss any new medications or supplements with your healthcare team to help prevent interactions while taking lovastatin.
1. Some antifungals
Antifungal medications treat fungal infections such as oral thrush and vaginal yeast infections. Examples include ketoconazole, itraconazole (Sporanox), and voriconazole (Vfend).
These antifungals block the enzyme (protein) that breaks down lovastatin in the body. If they’re taken together, lovastatin levels can go up. This increases the risk of lovastatin side effects, such as muscle pain, upset stomach, and kidney problems.
Combining lovastatin with these antifungals isn’t recommended. If you need an antifungal medication, your prescriber will likely have you pause lovastatin until after you finish the treatment.
Other antifungal medications, such as fluconazole (Diflucan), don’t raise lovastatin levels as much. So you may be able to take them along with lovastatin. But you should still watch for lovastatin side effects and let your healthcare team know if they occur.
Tips for taking statins: Learn the best time to take a statin and more pharmacist-backed tips to get the most from your medication.
Statin side effects: Here’s what to expect when taking a statin, and when you should seek medical care for possible side effects.
Statin comparison: Not all statins are created equally. Your cholesterol levels help determine which statin will work best for you. Here’s what you should know about statin intensity.
2. Macrolide antibiotics
Some macrolide antibiotics also cause lovastatin interactions. Examples include clarithromycin (Biaxin XL) and erythromycin (Ery-tab). As with antifungals, these antibiotics can raise lovastatin levels in the body, making side effects more likely. So it’s best to avoid this combination.
Be sure to let your prescriber know you’re taking lovastatin if you need an antibiotic. They may have you pause lovastatin while you’re taking a macrolide. Or they may decide a different antibiotic is a better option for you. Many antibiotics are available that don’t interact with lovastatin.
3. Some antiviral medications, such as Paxlovid
Certain antiviral medications can also raise lovastatin levels in the body. The combination can lead to serious statin side effects, such as muscle breakdown. So you shouldn’t take them together. Examples include:
Protease inhibitors that treat HIV, such as ritonavir (Norvir) and atazanavir (Reyataz)
Combination HIV medications that contain a protease inhibitor, such as Kaletra (lopinavir / ritonavir)
Paxlovid (nirmatrelvir / ritonavir), a COVID-19 treatment
If you’re taking a daily antiviral medication, a different statin may be a safer option for you.
If you need to take Paxlovid, there are strict recommendations if you’re also taking lovastatin. You’ll need to wait at least 12 hours after your last dose of lovastatin before starting Paxlovid. And you shouldn't restart lovastatin until at least 5 days after your last dose of Paxlovid.
4. Grapefruit
Grapefruit and grapefruit juice can interact with many medications, including lovastatin. Taking lovastatin with grapefruit products, especially in large amounts, greatly increases the amount of lovastatin in your body. It’s best to avoid grapefruit while taking lovastatin.
If you enjoy grapefruit as part of your diet, talk to your prescriber. A different statin that doesn’t interact with grapefruit may be a better option for you. Rosuvastatin (Crestor), pravastatin, and pitavastatin (Livalo) are all safe to take with grapefruit.
5. Other medications that treat high cholesterol
Other medications that lower cholesterol can raise the risk of muscle damage and kidney problems if they’re taken with lovastatin. Examples include niacin and two fibrates: gemfibrozil (Lopid) and fenofibrate (Tricor).
It’s best to avoid combining lovastatin with fibrates or with niacin doses over 1 gram per day. But in some cases, your prescriber may decide the benefits of this combination outweigh the risks. In this case, fenofibrate is a safer choice than gemfibrozil. And a lower niacin dosage is best.
Your prescriber will determine if and when it’s safe to combine lovastatin with other medications to lower your cholesterol.
6. Nefazodone
Nefazodone is an antidepressant medication that can raise lovastatin levels in the body. This combination isn’t recommended.
If you’re taking nefazodone, a different statin may be a better option for you. If you’re starting an antidepressant while taking lovastatin, talk to your prescriber about an option that’s less likely to interact with lovastatin.
7. Cyclosporine
Cyclosporine (Sandimmune, Gengraf, Neoral) is a medication that helps prevent organ rejection after a transplant. It raises lovastatin levels in the body, so this combination isn’t recommended.
If you’re taking cyclosporine, a different statin, such as pravastatin or rosuvastatin, would be a safer option. Your healthcare team will likely keep a close eye on your medications after an organ transplant. But be sure to let them know you’re taking lovastatin, especially if cyclosporine is prescribed for you.
8. Calcium channel blockers
Calcium channel blockers (CCBs) are a group of medications that treat high blood pressure and other heart conditions. Certain CCBs, such as diltiazem (Cardizem) and verapamil (Verelan), can raise lovastatin levels in the body.
You can take lovastatin with diltiazem or verapamil. But the lovastatin dosage shouldn’t be more than 20 mg per day. In some cases, your prescriber may prefer a statin that doesn’t interact with CCBs, such as pravastatin or rosuvastatin.
9. Colchicine
Colchicine (Colcrys, Mitigare, Gloperba) is another medication that can raise lovastatin levels. Colchicine is commonly used to treat gout, but it’s also prescribed for some heart conditions under the brand name Lodoco. Taking lovastatin and colchicine together can raise the risk of statin side effects.
If you’re only taking colchicine as needed for gout flares, it’s likely your prescriber will just have you keep an eye out for any muscle-related side effects. But if you take daily colchicine, the lowest effective dose of lovastatin is recommended. Or a different statin may be a better option for you.
10. Amiodarone
Amiodarone (Pacerone) treats irregular heart rhythms. It can increase lovastatin levels if they’re combined. It’s recommended to take no more than 40 mg of lovastatin daily with amiodarone. This helps lower the risk of muscle-related side effects. Or your prescriber may prefer a different statin, such as pravastatin, to avoid this interaction.
11. Dietary supplements, such as red yeast rice
Red yeast rice is a dietary supplement that can help lower cholesterol levels. It works similarly to statins. In fact, red yeast rice contains an active ingredient that has the same chemical structure as lovastatin.
Since it mimics lovastatin in the body, taking red yeast rice and lovastatin together can raise your risk of side effects. This includes an increased chance of muscle damage and liver problems.
Red yeast rice products aren’t regulated by the FDA. And a 2021 study found that 36 of the 37 red yeast rice products tested contained citrinin — a known toxin that harms the kidneys.
St. John's wort is another supplement that interacts with lovastatin. It can lower lovastatin levels in the body, which can make it less effective.
Good to know: Even though they’re sold over-the-counter (OTC), vitamins and supplements can interact with your medications. Be sure to talk to your pharmacist or prescriber before taking any OTC products. They can make sure they’re safe for you.
Can you take lovastatin with another statin, such as atorvastatin?
No, you should only take one statin at a time. Taking more than one statin raises the risk of side effects.
If one statin isn’t working, your prescriber may switch you to a higher-intensity statin. Or they may add a different type of medication, such as ezetimibe (Zetia) or bempedoic acid (Nexletol), to help lower your cholesterol further.
Can you take lovastatin with lisinopril or losartan?
Yes. Lisinopril (Zestril) and losartan (Cozaar) are different types of blood pressure medications. The names of these medications may look similar, but neither one interacts with lovastatin.
The bottom line
Lovastatin (Altoprev) is a medication that treats high cholesterol levels. Many medications can raise lovastatin levels in the body, which increases the risk of muscle damage and other side effects. You should avoid taking lovastatin with some antiviral medications, cyclosporine, and gemfibrozil. It’s also best to avoid combining grapefruit juice or red yeast rice supplements with lovastatin.
If you’re taking a short course of some antifungals and antibiotics, colchicine, or Paxlovid (nirmatrelvir / ritonavir), your prescriber may have you pause lovastatin until you’ve finished treatment. You may need a lower dose of lovastatin if you’re taking it with amiodarone, calcium channel blockers, or daily colchicine.
Why trust our experts?
References
Bryant Ranch Prepack. (2024). Lovastatin- lovastatin tablet [package insert].
Cicero, A. F. G., et al. (2019). Red yeast rice for hypercholesterolemia. Methodist DeBakey Cardiovascular Journal.
Duong, H., et al. (2023). Lovastatin. StatPearls.
Eljaaly, K., et al. (2017). An updated review of interactions of statins with antibacterial and antifungal agents. Journal of Translational Science.
Farkouh, A., et al. (2019). Mini-review: Medication safety of red yeast rice products. International Journal of General Medicine.
Imazio, M., et al. (2021). Colchicine and the heart. European Heart Journal.
Jacobson, T. A., et al. (2006). Fibrates in combination with statins in the management of dyslipidemia. Journal of Clinical Hypertension.
National Center for Complementary and Integrative Health. (2022). Red yeast rice: What you need to know.
Righetti, L., et al. (2021). Risk assessment of RYR food supplements: Perception vs. reality. Frontiers in Nutrition.
Wiggins, B. S., et al. (2016). Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American Heart Association. Circulation.
Was this page helpful?
Related Articles
Browse medications
View AllResearch prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.