Atorvastatin with Black Cohosh Interaction Details
Brand Names Associated with Atorvastatin
- Atorvastatin
- Caduet® (as a combination product containing Amlodipine, Atorvastatin)
- Lipitor®
- Liptruzet® (as a combination product containing Atorvastatin, Ezetimibe)
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Elevated liver enzymes
Interaction Summary
A case report described elevated ALT levels in a 53-year-old woman taking atorvastatin and black cohosh concomitantly. In this case, discontinuing black cohosh restored liver enzyme levels to within the normal limits. While use of black cohosh has been associated with hepatotoxicity, inhibition of the CYP3A4-mediated atorvastatin metabolism by black cohosh may also be responsible for increasing atorvastatin levels, thereby resulting in elevated liver enzymes[1]. Patients receiving atorvastatin should be advised to avoid taking black cohosh concomitantly.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Patients should be advised to avoid concomitant administration of atorvastatin and black cohosh as this may lead to increased atorvastatin concentrations and consequently, elevated liver enzyme levels.
Mechanism Of Interaction
Inhibition of CYP3A4-mediated atorvastatin metabolism and/or additive hepatotoxicity
Literature Reports
A) In a case report of a 53-year-old female with hyperlipidemia, a past history of chest pain, and family history of heart disease, concomitant use of atorvastatin and black cohosh resulted in a significantly elevated ALT level. Her baseline AST and ALT values were 17 units/L each (normal 15 to 40 units/L), and both were within normal limits at 3-, and 6-months after starting atorvastatin. The patient was also taking aspirin 81 mg/day, and had been switched from conjugated estrogens to estradiol to treat menopausal symptoms. At the subsequent follow-up visit, the patient revealed that she had discontinued estradiol and was taking black cohosh 400 mg daily for five days per week. A lab workup one year later showed an elevated ALT value of 128 units/L compared with an ALT value of 33 units/L one month after starting black cohosh. Other liver enzyme values, including AST, total and direct bilirubin, and alkaline phosphatase, were within normal limits. The patient denied acute or chronic alcohol use and additional testing ruled out other causes for the elevated liver enzymes. Immediate discontinuation of black cohosh was recommended. Within one week of discontinuing black cohosh, the patient's liver enzymes decreased to normal limits and were completely normal within 1 month [1].
References
1 ) Patel NM & Derkits RM: Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007; 20(4):341-346.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
Atorvastatin Overview
-
Atorvastatin is used together with diet, weight loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Atorvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.
-
Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with atorvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.