Cautions and interactions with statins

Statins shouldn't be taken if you have severe liver disease or blood tests suggest that your liver may not be working properly.

This is because statins can affect your liver, and this is more likely to cause serious problems if you already have a severely damaged liver.

Before you start taking statins, your doctor should carry out a Blood tests to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver three months after treatment begins, and undergo another after 12 months.

Pregnancy and breastfeeding

Statins shouldn't be taken by women who are pregnant or breastfeeding, as there's no firm evidence on whether it's safe to do so.

If you do become pregnant while taking statins, contact your GP for advice.

People at an increased risk of side effects

Statins should be taken with caution if you're at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. Thiscan lead to kidney damage (rhabdomyolysis).

Things that can increase this risk include:

• being over 70 years old
• having a history of liver disease
• regularly drinking large quantities of alcohol
• having a history of muscle-related side effects when taking a statin or fibrate (another type of medicine for high cholesterol)
• having a family history of myopathy or rhabdomyolysis

Ifone or more of these apply to you, there's a chance that frequent monitoring may be needed to check for complications. A lower dose of statin may also be recommended.

If you have an underactive thyroid (hypothyroidism) , treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to anincreased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Medicationsthat can interact with some types of statin include:

• certain antibiotics and antifungals
• certain HIV medications
• warfarin a medication commonly use to prevent blood clots
• ciclosporin a medicationthat suppresses the immune system, which is used to treat a wide range of conditions, including psoriasis and rheumatoid arthritis
• danazol a synthetic hormone medication used to treat conditions such as endometriosis
• verapamil anddiltiazem types ofmedication called calcium channel blockers, which areused to treat various conditions affecting the heart and blood vessels
• amiodarone a medication sometimes used to treat irregular heartbeats
• fibrates medications that, like statins, help to reduce cholesterol levels inthe blood

If you are taking statins and need to take one of these medications, your doctor may prescribe an alternative statin or prescribe your current statin at a lower dosage. In some cases, they may recommend that you temporarily stop taking your statin.

Food and alcohol

Grapefruit juice can affect some statins and increase your risk of side effects. Your doctor may advise you to avoid it or to only consume it in small quantities.

There are no known interactions between statins and alcohol.