Can taking graviola capsules with psyllium and atorvastatin (lipitor) cause liver harm?

From the Guidelines

Taking graviola capsules with psyllium and atorvastatin (Lipitor) could potentially cause liver harm, and this combination should be approached with caution. Graviola (also known as soursop or Annona muricata) contains compounds that may affect liver enzyme activity, which could interfere with how your liver processes atorvastatin 1. Atorvastatin itself can occasionally cause liver enzyme elevations, and combining it with graviola might increase this risk. According to a study published in Circulation, elevated hepatic transaminases generally occur in 0.5% to 2.0% of cases and are dose-dependent 1. Psyllium fiber generally doesn't cause liver issues but can affect the absorption of medications when taken simultaneously.

If you're currently taking atorvastatin, you should consult your healthcare provider before adding graviola supplements to your regimen. If you decide to take these together, it would be prudent to have periodic liver function tests to monitor for any adverse effects. The timing of these supplements matters too - take psyllium at least 2 hours before or after other medications to prevent interference with absorption. Many herbal supplements like graviola lack rigorous safety testing, especially regarding drug interactions, which is why medical supervision is particularly important when combining them with prescription medications that affect the liver.

Some key points to consider:

• Graviola may affect liver enzyme activity, potentially increasing the risk of liver harm when combined with atorvastatin
• Atorvastatin can cause liver enzyme elevations, and combining it with graviola may increase this risk
• Psyllium fiber can affect the absorption of medications, so timing is important
• Periodic liver function tests are recommended if you decide to take these supplements together
• Medical supervision is crucial when combining herbal supplements with prescription medications that affect the liver 1.

From the FDA Drug Label

17 PATIENT COUNSELING INFORMATION

Patients taking atorvastatin calcium tablets should be advised that cholesterol is a chronic condition and they should adhere to their medication along with their National Cholesterol Education Program (NCEP)-recommended diet, a regular exercise program as appropriate, and periodic testing of a fasting lipid panel to determine goal attainment Patients should be advised about substances they should not take concomitantly with atorvastatin [see Warnings and Precautions (5.1)]. 17. 2 Liver Enzymes It is recommended that liver enzyme tests be performed before the initiation of atorvastatin calcium tablets and if signs or symptoms of liver injury occur.

The FDA drug label does not answer the question.

From the Research

Potential Liver Harm from Graviola, Psyllium, and Atorvastatin

• The use of atorvastatin has been associated with liver disease, including a transient rise in serum transaminases in up to 3% of patients, although this is usually self-limiting 2.
• More serious but rare idiosyncratic reactions related to atorvastatin have been reported, with 14 patients experiencing significant liver dysfunction, including three deaths 2.
• The combination of ezetimibe and atorvastatin has been shown to be effective in lowering LDL-c and reducing inflammatory markers and atherosclerosis, but its effects on the liver are not fully understood 3.
• Statin drugs, including atorvastatin, have been linked to jaundice and liver injury in rare cases, with a calculated risk of one in 17,434 users per year 4.
• Graviola (Annona muricata) has been shown to have antioxidant, anti-inflammatory, and anti-apoptotic properties, and may have a protective effect on the liver against mono sodium glutamate-induced hepatic injury in rats 5.
• However, there is limited human data on the safety and efficacy of graviola, and caution is required when using it as a complementary therapy 6.
• There is no direct evidence on the interaction between graviola, psyllium, and atorvastatin, and their combined effect on the liver is not well understood.
• Psyllium is generally considered safe and is not typically associated with liver harm, but its interaction with atorvastatin and graviola is not well studied.