MODERATE — Monitor Closely
CAUTION — rare additive hepatotoxicity risk
Evidence level: THEORETICAL
Both black cohosh and statins can affect the liver — rare but worth monitoring.
Both have hepatotoxic potential. Black cohosh rare hepatotoxicity combined with statin-related liver effects.
Monitor liver enzymes if using both. Report any liver symptoms.
Take Atorvastatin in the evening. Black Cohosh can be taken with breakfast or lunch. Red yeast rice contains natural lovastatin — never combine it with a prescription statin. Grapefruit extract and St. John's Wort both affect CYP3A4, which metabolizes most statins.
Pre-existing liver disease, alcohol use, high statin dose
Dark urine, yellowing skin, abdominal pain, fatigue
Request liver function monitoring.
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Both black cohosh and statins can affect the liver — rare but worth monitoring.
Take Atorvastatin in the evening. Black Cohosh can be taken with breakfast or lunch. Red yeast rice contains natural lovastatin — never combine it with a prescription statin. Grapefruit extract and St. John's Wort both affect CYP3A4, which metabolizes most statins.
Dark urine, yellowing skin, abdominal pain, fatigue
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Request liver function monitoring.
Or browse the full interaction database (121,000+ pairs).