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Statin Side Effects and Drug Interactions

What You Should Know About Statin Side Effects and Drug Interactions

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Updated May 20, 2014

Statin drugs have the potential to induce statin side effects, they also have the potential for drug interactions.

Statins are a class of cholesterol-lowering drugs that target all aspects of your lipid profile: They lower LDL cholesterol and triglycerides, while raising HDL cholesterol. Although they are very effective in lowering cholesterol levels, statins may not be for everyone. There are some things you should let your healthcare provider know before you begin statin therapy, such as medical conditions you may have or any medications that have been prescribed to you by another physician. Additionally, if you receive medical treatment from someone other than your healthcare provider, you should let him or her know that you are taking a statin.

This is a general list of medical conditions and medications that you should be aware of. For a more complete list, remember to consult the information for the specific statin if you are taking (Crestor (rosuvastatin), Zocor (simvastatin), Mevacor (lovastatin), Lescol (fluvastatin), Lipitor (atorvastatin), or Pravachol (pravastatin)).

Medical Conditions

You should let your healthcare provider know if you have one or more of the following conditions before you begin taking a statin:
  • Active or chronic liver disease
  • Pregnancy – Statins may cause birth defects.
  • Breastfeeding – Statin drugs could cross the breast milk and be ingested by your baby.
  • Alcohol abuse – Statins could further increase liver enzymes.

Possible Drug Interactions

Some medications may interact with statins, by either decreasing the effectiveness of your statin or increasing the statin level in the blood to the point where it may become harmful to the body. Be sure to notify your healthcare provider if you are already taking any of these medications below. Just because you are on any of these medications, it does not mean that you are not able to take a statin. However, your healthcare provider may want to monitor you more closely while on these drugs, since taking these medications with a statin may increase your risk of side effects. This list is not inclusive, so if you need a complete list of drug interactions, please read the individual information about your statin (Crestor (rosuvastatin), Zocor (simvastatin), Mevacor (lovastatin), Lescol (fluvastatin), Lipitor (atorvastatin), or Pravachol (pravastatin )) or consult your healthcare provider for further information:
  • Nicotinic acid, or niacin, in high doses (greater than 1 gram a day) could increase risk of experiencing statin side effects.
  • Bile acid sequestrants may decrease the effectiveness of some statins. In order to avoid this, your statin dose and bile acid sequestrant dose can be separated by at least four hours.
  • Fibrates may increase the risk of experiencing statin side effects.
  • Samdimmune or Neoral (cyclosporine) may increase the amount of statins present in the blood and may also increase side effects.
  • Fluvoxamine may increase the concentration of some statins present in the blood and may also increase statin 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 present in the blood and may also increase statin side effects.
  • Antibiotics ending in "-mycin" such as erythromycin or Biaxin (clarithromycin) may increase the amount of statins present in the blood and may also increase side effects.
  • High blood pressure medications, such as diltiazem and verapramil, may increase the amount of statins present in the blood and may also increase side effects.
  • Cordarone (Amiodarone) may increase the amount of some statins present in the blood and may also increase the side effects of statins.
  • 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 and may also increase side effects.
  • Coumadin (warfarin) – Taking a statin with this drug could cause the blood to not clot as well.
  • Prilosec (omeprazole) may increase the amount of some statins present in the blood and may also increase the side effects of statins.
  • Tagamet (cimetidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins.
  • Zantac (rantidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins.
  • Oral contraceptives – Statins may increase the concentration of these hormones in the body.
  • Lanoxin (digoxin) – Statins may increase the concentration of some statins in the body.
  • Antacids containing magnesium or aluminum hydroxide may decrease the concentration of some statins in the body. This can be prevented by separating your statin dose and antacid dose by at least two hours.
  • St. John's Wort may decrease the effectiveness of some statins.

Sources:

Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 6th ed 2005.

Lacy CF, Armstrong LL, Goldman MP, et al. Lexicomp's Drug Information Handbook, 15th ed 2007.

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