Can you take atorvastatin and Paxlovid together?

In this article:

• Can you take atorvastatin and Paxlovid together?
• What happens if you take Paxlovid with atorvastatin?
• How long should I be off a statin before taking Paxlovid?
• Bottom line

In this article

• Can you take atorvastatin and Paxlovid together?
• What happens if you take Paxlovid with atorvastatin?
• How long should I be off a statin before taking Paxlovid?
• Bottom line

Maybe you’ve had high cholesterol for a while, and now you also have COVID. Or maybe COVID contributed to your high cholesterol problems (yes, this is a thing, according to the Global Center for Health Security). Regardless, you find yourself needing atorvastatin and Paxlovid at the same time. Can you take them together?

First, we must understand what these medications are used for and what they do. Atorvastatin is a prescription medication in the statin drug class that treats high cholesterol by lowering “bad” cholesterol (aka low-density lipoprotein, or LDL) while raising levels of “good” cholesterol (aka high-density lipoprotein, or HDL). This can reduce the risk of complications from cardiovascular disease or diabetes mellitus. Risk factors for those conditions include age, hypertension (high blood pressure), smoking, low HDL levels, and a family history.

Paxlovid is an antiviral medication manufactured by Pfizer and approved by the Food and Drug Administration (FDA). It treats mild-to-moderate COVID-19, also known as coronavirus or SARS-CoV-2, in patients with a high risk for severe disease, hospitalization, or death. Its active ingredients are nirmatrelvir and ritonavir.

While the co-administration of these drugs may seem necessary to treat each disease process, doctors don’t recommend it. But why, and what do you do if you need both?

Can you take atorvastatin and Paxlovid together?

Taking these two medications together—especially without medical supervision— isn’t in your best interest, to say the least. “We would recommend temporarily stopping atorvastatin while taking Paxlovid,” says Dr. Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. 

Essentially, they can interact with each other. “Paxlovid contains ritonavir, which blocks an enzyme (CYP3A) that helps break down many medications, including atorvastatin,” explains Dr. Edmond Hakimi, DO, a dual-board-certified internal medicine physician and the medical director at Wellbridge. When that enzyme is inhibited, atorvastatin stays in the body much longer than usual, increasing the risk of serious side effects.”

What happens if you take Paxlovid with atorvastatin? 

When these two medications are taken together, several potential drug interactions can also occur, according to Dr. Hakimi and Dr. Chen.

For example, the statin level in the blood can increase significantly, leading to muscle damage, liver issues, and kidney strain.

Rhabdomyolysis, one of the most serious risks, can also occur. This is when muscle tissues break down and release harmful proteins into the bloodstream, which can overwhelm the kidneys and cause serious complications. Symptoms of rhabdomyolysis include muscle pain, weakness, dark urine, and severe fatigue.

Additionally, patients face an increased risk of liver toxicity, jaundice (yellowing of the skin or eyes), and abdominal pain. They may also experience nausea, headaches, or fatigue.

While a dose reduction or dose adjustment is the answer with some medications, that’s not the case here. “Because of these risks, pausing atorvastatin while taking Paxlovid is usually the safest way to avoid complications,” Dr. Hakimi restates. “Since statins work over the long-term to lower cholesterol, a brief break of a few days is unlikely to impact heart health majorly.”

Other Paxlovid drug interactions to note include (but aren’t limited to) the following: 

• Statins besides atorvastatin (such as rosuvastatin)
• Calcium channel blockers (such as amlodipine, diltiazem, and nifedipine)
• Anticoagulants and antiplatelet agents (such as apixaban, clopidogrel, rivaroxaban, ticagrelor, and warfarin)
• Psychiatric medications, like antipsychotics, benzodiazepines, and antidepressants (such as diazepam, lurasidone, clozapine, quetiapine, and trazodone)
• Erectile dysfunction medications (such as sildenafil, tadalafil, and vardenafil)
• Migraine medications (such as ergotamine)
• Hormonal contraception medications that contain ethinyl estradiol
• Immunosuppressants (such as cyclosporine, everolimus, sirolimus, and tacrolimus)
• Anticonvulsants (such as carbamazepine, phenobarbital, and phenytoin)
• St. John’s Wort

Additionally, colchicine and ranolazine are other drugs primarily metabolized by CYP3A, which, when elevated, are associated with serious and/or life-threatening reactions. Medications that are contraindicated with Paxlovid (meaning the two shouldn’t be combined) include voriconazole, protease inhibitors, salmeterol, and more.

According to healthcare providers, the medications with the most dangerous interactions affect heart rhythm, blood clotting, and neurological function, specifically blood thinners, antiarrhythmic drugs, and other medications. 

As always, talk to your healthcare provider before changing your medications or making other medical decisions. They can help you do what’s most effective and safe for your body.

How long should I be off a statin before taking Paxlovid? 

Medications stay in the body for hours after they’re consumed. So, if these two medications shouldn’t be in the body simultaneously, how much time should patients put between them? 

First, let’s look at their half-life, or how long it takes for the body to get rid of half of the medication. Atorvastatin’s half-life is about 14 hours, and Paxlovid’s half-life is a little more than six hours.

An important note is that the number of days people should wait before taking each medication depends on the specific statin. “For atorvastatin and other commonly used statins, doctors typically recommend stopping them on the day you start Paxlovid,” Dr. Hakimi says. “For more potent statins, like simvastatin and lovastatin, some doctors recommend stopping them a day or two before starting Paxlovid to allow more time for the statin to clear from the body.”

Dr. Chen has a similar answer. “It is best to stop atorvastatin at least 12 hours before starting Paxlovid,” he says.

But again, he says the best course of action may differ for each individual, so talking with a prescribing healthcare provider before making any change is paramount.

The same goes for restarting the statin: The number of days between that and taking Paxlovid depends on the statin. With atorvastatin (and rosuvastatin), patients can usually resume the statin immediately.

“You can start taking atorvastatin the next day after finishing Paxlovid treatment,” Dr. Chen says.

With more potent statins, a wait period of five days may be best to ensure the Paxlovid has fully cleared out, according to Dr. Hakimi.

“Before resuming any medication, it’s a good idea to check with a healthcare provider to confirm the best approach based on individual health needs,” he adds. 

Bottom line

Taking atorvastatin and Paxlovid at the same time isn’t safe and not recommended, but patients can take them at different times. For specifics and individualized care—and before making any changes— always consult your healthcare provider.