Can I take Atorvastatin and Pyridostigmine together?
Drug interaction guide
Originally published 25 Jan 2026
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There is a potential for increased muscle-related side effects when taking these two medicines together. Both drugs can independently affect muscle function; atorvastatin can cause muscle aches or weakness (myopathy), and pyridostigmine is used to treat muscle weakness in conditions like myasthenia gravis. Taking them together might make it harder to tell if muscle symptoms are due to your condition or a side effect of the statin.
Why this happens
This is a pharmacodynamic interaction. Atorvastatin can occasionally cause muscle damage or inflammation. Pyridostigmine works by increasing levels of a chemical (acetylcholine) to help muscles contract. While they don't interfere with how the body breaks each drug down, their combined effects on muscle tissue may increase the risk of muscle pain or weakness.
What you should do
You can usually take these medicines together, but you should be extra vigilant. Report any new or worsening muscle pain, tenderness, or weakness to your doctor immediately, especially if you also feel generally unwell or have a fever. Your doctor may want to monitor your muscle enzyme levels (CK levels) via a blood test.
Important precautions
Pregnancy
You must not take atorvastatin if you are pregnant or planning to become pregnant, as it can cause serious harm to an unborn baby. Use effective contraception while taking this medicine.
Muscle disorders - atorvastatin
Seek immediate medical advice if you experience unexplained muscle pain, tenderness, or weakness. In rare cases, this can lead to a serious condition called rhabdomyolysis which causes kidney damage.
Asthma or COPD
Pyridostigmine can narrow your airways and worsen breathing difficulties; use with extreme caution if you have asthma or chronic obstructive pulmonary disease.
Food and drink warnings
Grapefruit juice
Grapefruit juice contains compounds that can increase the level of atorvastatin in your blood. This may increase your risk of side effects, such as muscle pain or damage. Avoid drinking large quantities (more than 1.2 litres per day), though it is safest to avoid it altogether or keep intake to very small amounts.
Alcohol
While alcohol does not directly interact with atorvastatin, drinking large amounts of alcohol can increase the risk of liver problems and muscle side effects. It is best to keep your intake within the recommended limits (no more than 14 units per week).
Using other medicines
Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.
Disclaimer
This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.
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Article history
The information on this page is written and peer reviewed by qualified clinicians.
Article also available in English, German, Spanish, French, Italian, Portuguese, Hindi, Hebrew, Arabic, and Swedish.
25 Jan 2026 | Originally published
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