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Statins: what to be careful with

Statins lower LDL cholesterol by slowing the liver's own cholesterol production, and are prescribed to reduce the long-term risk of heart attack and stroke.

General information only, and not exhaustive. This is not medical advice, not a full list of interactions, and not a reason to start, stop or change a medicine. Interactions depend on the exact drug, the dose, your other medicines and your own health — a pharmacist or doctor is the one who decides. Always read the leaflet that came with your medicine, and ask your pharmacist before adding anything, including supplements.

Group, not a brandATC C10AA

Examples in this group: atorvastatin, simvastatin, rosuvastatin, pravastatin, fluvastatin. Interactions usually belong to the whole group, but your own leaflet is brand-specific — always the final word.

Food and drink to be careful with

• Grapefruit and grapefruit juice. Grapefruit blocks the CYP3A4 enzyme in the gut wall, so more of certain statins reaches the bloodstream than the dose intends. This matters for simvastatin and, to a smaller degree, atorvastatin; pravastatin and rosuvastatin are handled by different routes and are not affected in the same way. Seville oranges and pomelo behave like grapefruit. Which statin you are on decides whether this applies to you at all.
• Red yeast rice supplements. Red yeast rice contains monacolin K, which is chemically the same substance as the statin lovastatin. Taking it alongside a prescribed statin stacks two doses of the same kind of drug without anyone counting it.
• Plant sterol and stanol spreads. These are sold to lower cholesterol and are often used alongside a statin. That combination is common and generally uncontroversial, but it is still worth telling whoever monitors your cholesterol, so the numbers are read correctly.
• Large amounts of grapefruit-flavoured drinks. Flavouring is not the same as juice. What matters is actual grapefruit juice content, which the ingredients list will say.

Timing around meals

Simvastatin is traditionally taken in the evening because the body makes most of its cholesterol overnight and simvastatin does not stay in the blood long. Atorvastatin and rosuvastatin last much longer and are usually taken at whatever time of day makes them easy to remember. Food is not generally required.

Alcohol

There is no direct interaction between alcohol and statins. The reason alcohol comes up is the liver: both heavy drinking and statins are watched for effects on liver enzymes, so a heavy intake makes an abnormal liver test harder to interpret.

Other things to watch

• New, unexplained muscle pain, tenderness or weakness is the symptom that statin leaflets ask people to report, especially if it comes with dark urine.
• Some antibiotics and antifungals — clarithromycin, erythromycin, itraconazole — use the same enzyme as grapefruit and are a bigger interaction than any food.
• Statins are not taken in pregnancy; that is a discussion to have before trying to conceive, not afterwards.

If anything here does not match what you were told, or you notice a new symptom after starting a medicine, contact your pharmacist or doctor — do not just stop taking it. Stopping some medicines suddenly is more dangerous than any food interaction.

Source: The product's own Summary of Product Characteristics and patient information leaflet, published per medicine by the licensing authority. Which statins interact with grapefruit is stated in the individual product leaflet, because it differs between them. · checked 2026-09-02

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Other medicine groups

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