Drug interactions
Atorvastatin + St john's wort
Severity: Moderate
Atorvastatin and St john's wort: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
St John's wort can lower atorvastatin concentrations and blunt its cholesterol-lowering effect. Stopping the herb later can lead to a rise in statin levels.
What this interaction means in plain words
Atorvastatin and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Induction of CYP3A4 and P-glycoprotein by hyperforin increases atorvastatin first-pass and systemic clearance.
What to do
Advise patients to avoid the herbal product, or monitor the lipid profile and adjust the atorvastatin dose if it is continued. Recheck lipids after starting or stopping the herb.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Atorvastatin
- Atorvastatin + Tipranavir Contraindicated
- Atazanavir + Atorvastatin Major
- Atorvastatin + Clarithromycin Major
- Atorvastatin + Cobicistat Major
- Atorvastatin + Cyclosporin Major
- Atorvastatin + Danazol Major
Frequently asked questions
Can I take Atorvastatin with St john's wort?
MediHelp rates the interaction as moderate. Atorvastatin and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. St John's wort can lower atorvastatin concentrations and blunt its cholesterol-lowering effect. Stopping the herb later can lead to a rise in statin levels.
How serious is the interaction between Atorvastatin and St john's wort?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Advise patients to avoid the herbal product, or monitor the lipid profile and adjust the atorvastatin dose if it is continued. Recheck lipids after starting or stopping the herb.
What other medicines interact with Atorvastatin?
MediHelp also lists interactions of Atorvastatin with, for example, Tipranavir, Atazanavir, Clarithromycin. The full list is on the Atorvastatin page.
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