Is It Safe to Mix Alcohol With Lipitor?

Nov 20, 2023

Jeffrey S. Lander, MD, is a board-certified cardiologist and the President and Governor of the American College of Cardiology, New Jersey chapter.

If you are taking Lipitor (atorvastatin) or other statins to control your cholesterol levels, it's best to avoid drinking more than a moderate amount of alcohol. Lipitor and alcohol both affect the liver, and people who drink excessively may need to be extra cautious while taking this medication.

That said, having the occasional drink while on Lipitor should not cause harm in people who do not have liver problems and are generally healthy.

This article will discuss how liver function is impacted by statins as well as by alcohol, and who should avoid combining the two.

Statins have made a big difference with regard to heart disease. They stabilize and reduce the size of the coronary artery plaques that can lead to heart attacks, the leading cause of death in the U.S. before cancer.

According to the official package insert approved by the Food and Drug Administration (FDA), Lipitor should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease.

The U.S. Centers for Disease Control and Prevention (CDC) defines drinking in moderation as one alcoholic drink each day for women and two drinks for men.

According to the CDC, one standard drink is equal to:

While combining Lipitor and alcohol is potentially harmful to the liver, there is no solid research to confirm a higher risk of problems in those who take this medication and drink alcohol.

It's not uncommon to have abnormal liver function tests when taking Lipitor, but there are other considerations when looking at the effects of statins on the liver.

There are changes in liver tests alone (no symptoms,) clinical liver disease (symptoms) related to statin use, and severe liver disease. Statins may actually reduce mortality in some people who already have liver disease.

Current recommendations are that liver function tests be completed before beginning statin therapy and only repeated if there is a clinical reason to do so. Studies have found that some people who use Lipitor have an elevation of the liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

An increase of in these values occurs in roughly 3% of people. However, most of the time these elevations are only temporary and not usually dangerous.

Since moderate to high alcohol intake can also elevate liver enzymes, the combination of heavy drinking and statins will increase the chances of abnormal test results.

Clinically apparent liver injury—injury enough to cause symptoms rather than simply abnormal liver function tests alone—is very uncommon with statins.

Serious liver injury is possible on statins, but this is quite rare. As of 2017, there were approximately 50 case reports of liver injury in people taking statins that led to death or the need for liver transplantation.

Looking at these numbers, however, it's important to note that, as of 2019, Lipitor has been the most prescribed drug worldwide.

When talking about the effect of alcohol on liver disease related to Lipitor, it's important to note that severe liver injury is not usually due to the cumulative effect of statins.

Rather, drug-induced liver disease is usually an autoimmune condition, in which the drug prompts some people's bodies to make antibodies that attack their own liver tissue. This is considered an "idiosyncratic" reaction, something that isn't well understood and can't be predicted.

Despite the recommendation to monitor liver tests, and the uncommon risk of severe liver injury, statins may be helpful for some people with liver disease.

In one study looking at people with severe alcoholic liver disease, the use of statins cut the risk of death from alcoholic cirrhosis in half.

The conclusion of a 2017 study was that statins used for people with cirrhosis might actually reduce liver failure and complications of liver failure such as portal hypertension. Statins are being evaluated for their ability to reduce the worsening of liver disease in people with non-alcoholic fatty liver disease.

In addition, those who have liver disease due to chronic hepatitis C infections may respond better to medications (interferon) when they are given statins. However, it's important to note that alcohol worsens hepatitis C, and should be avoided in general in patients with the disease.

If you drink alcohol and are taking Lipitor, let your healthcare provider know. Many people underestimate their alcohol intake, but being honest with your healthcare provider will ultimately help them take care of you as well as possible. Your healthcare provider knows your medical history and current health status and can advise you on whether or not it is safe to drink while on Lipitor.

Lipitor is the most commonly prescribed prescription medication worldwide. It is used to lower cholesterol levels, thus guarding against heart attack and stroke. Lipitor and alcohol consumption each affect the health of the liver and drinking excessive amounts of alcohol while on this medication can potentially increase the likelihood of liver problems. In general, though, drinking low to moderate amounts of alcohol has not been shown to be harmful.

Liver function tests are recommended before and during statin therapy because statins can raise liver enzymes. In roughly 3% of people taking statins, liver enzymes can increase to three times the normal levels. In very rare cases, statin use can result in liver damage.

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Centers for Disease Control and Prevention. Fact sheets—moderate drinking.

By Michael Bihari, MDMichael Bihari, MD, is a board-certified pediatrician, health educator, and medical writer, and president emeritus of the Community Health Center of Cape Cod.