Does Lipitor Interact With Lion's Mane Or CDP Choline (Citicoline)?

Jeff asked

Hello, I am taking atorvastatin (10mg) and I wanted to know if there are any interactions with the mushroom herbal supplement Lion's Mane (500mg) or CDP Choline (citicoline) supplement (500mg)? Thank you!

Answer

Hi Jeff and thanks for writing to us.  

I searched around quite a bit but unfortunately, I came up empty. I have access to a handful of drug databases with known interactions for herbals and supplements, but unfortunately, I was not able to find much.

Regarding Lion's Mane or Hericium Erinaceus, I found a few references stating that Lion’s Mane can inhibit platelet function, so I would recommend caution using it with any anti-platelet drug (like aspirin or clopidogrel (Plavix)). Additionally, it may lower glucose levels (at least in rats, so potentially in humans), so it should be used cautiously with diabetes medications to make sure that blood glucose does not fall too low.

Citicoline seems to have a good amount of research behind it and appears to be relatively free of drug interactions. It actually is formed endogenously (i.e. naturally) in our body when we synthesize a compound known as phosphatidylcholine, which is important in the biosynthesis of neuronal membranes. For this reason, citicoline supplements are used to treat conditions like age-related cognitive decline and reduce stroke risk (remember these are not FDA-approved indications and more research needs to be conducted to understand both potential efficacy and safety risks).

The only drug interaction that I could find with citicoline was with carbidopa-levodopa, a drug used to manage Parkinson’s disease, but nothing else. As I mentioned, it appears to be relatively safe.

As an overall point here, however, we really don’t know if many herbals or supplements have interactions with medications.

Part of the FDA approval process for a drug is that the manufacturer must study the metabolism, theoretical interactions, and any reported interactions. Additionally, if they become aware of interactions after the drug is launched, they are required to report them to the FDA and the prescribing information gets updated. Generally, dietary supplements aren't included in drug interaction studies, aside from a few of the more well-known ones, like St. John's Wort.

Herbals and supplements on their own, don’t have as rigorous a process in place, nor do they have to seek FDA approval when they go to market (i.e. they don't have to do drug interaction studies). Since they are less regulated, typically less information is available for them. It looks like that’s the case here.

While I can’t give you the answers that you are looking for, if you are only taking both of these supplements one daily, I would suggest taking them in the morning and taking your atorvastatin at bedtime. If there is an unknown interaction, this would avoid it as much as possible.

Thank you again and feel free to write back with any additional questions!