NutriStack
Atorvastatin and Tribulus Terrestris, a caution.
A case report described rhabdomyolysis after Tribulus terrestris was started in a patient taking long-term atorvastatin. Causality is not proven, but the outcome is serious enough to flag the combination, especially in older adults or people with kidney disease, high statin doses, or muscle symptoms.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Atorvastatin and Tribulus Terrestris
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. A case report described rhabdomyolysis after Tribulus terrestris was started in a patient taking long-term atorvastatin. Causality is not proven, but the outcome is serious enough to flag the combination, especially in older adults or people with kidney disease, high statin doses, or muscle symptoms.
Mechanism. The mechanism is uncertain. A published case suggests possible additive myotoxicity or pharmacokinetic interaction, while atorvastatin is already vulnerable to interaction-driven myopathy through CYP3A4 and transporter pathways.
Recommendation. Avoid adding Tribulus terrestris to atorvastatin without clinician review. Stop the supplement and seek care urgently for severe muscle pain, weakness, dark urine, or unexplained fever.
Sources (2)
- Huff R, Karpinska-Leydier K, Maddineni G, Begosh-Mayne D. Rhabdomyolysis Risk: The Dangers of Tribulus Terrestris, an Over-the-Counter Supplement. American Journal of Case Reports. 2024;25:e943492. PMID 39012853
- Balasubramanian R, Maideen NMP. HMG-CoA Reductase Inhibitors (Statins) and their Drug Interactions Involving CYP Enzymes, P-glycoprotein and OATP Transporters-An Overview. Current Drug Metabolism. 2021;22(5):328-341. PMID 33459228
Stack Score
How this pair moves the number.
Effect on the composite score
If both Atorvastatin and Tribulus Terrestris are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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