Try these helpful products which may be beneficial if taken with this medicine
CoQ10
Supplementing with 30 to 100 mg of coenzyme Q10 per day may maintain adequate blood levels of this heart-healthy
nutrient
Cholesterol-lowering margarine
Using margarines containing sitostanol
(Benecol), which is made from pine tree wood pulp and naturally occurring unsaturated sterols
obtained from soybean oil (Take Control), can help lower LDL (“bad”)
cholesterol
These recommendations are not comprehensive and are not intended to
replace the advice of your doctor or pharmacist. Continue reading the full article for more
information on interactions with vitamins, herbs, and foods.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
May Be Beneficial:Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
Coenzyme Q10
May Be Beneficial:Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication.
Coenzyme Q10
May Be Beneficial:Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better.
Sitostanol
Avoid:Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Grapefruit or grapefruit juice
Pomegranate juice*
Red yeast rice
Vitamin A*
Check:Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
Magnesium hydroxide
Magnesium oxide
Magnesium-containing antacids
Vitamin B3 (niacin)
Reduced drug
absorption/bioavailability
None known
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Coenzyme
Q10
In a group of patients beginning treatment with atorvastatin, the average concentration of
coenzyme Q10 in blood plasma decreased within 14 days, and had fallen by approximately 50%
after 30 days of treatment.1 In a preliminary study, supplementation with 100 mg of
CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by
a statin drug.2 Many doctors recommend that people taking HMG-CoA reductase
inhibitor drugs such as atorvastatin also supplement with approximately 100 mg CoQ10 per day,
although lower amounts, such as 10 to 30 mg per day, might conceivably be effective in
preventing the decline in CoQ10 levels.
Magnesium-containing antacids
A magnesium- and aluminum-containing antacid
was reported to interfere with atorvastatin absorption.3 People can avoid this
interaction by taking atorvastatin two hours before or after any aluminum/magnesium-containing
antacids. Some magnesium supplements such as
magnesium hydroxide are also antacids.
Vitamin B3
(niacin)
Niacin is the form of vitamin B3 used to lower
cholesterol. Ingestion of large amounts of niacin along with lovastatin (a drug closely related to atorvastatin) or
with atorvastatin itself may cause muscle disorders (myopathy) that can become serious
(rhabdomyolysis).45 Such problems appear to be uncommon when HMG-CoA
reductase inhibitors are combined with niacin.67 Moreover, concurrent
use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the
cholesterol-lowering effect of the drugs.89 Individuals taking
atorvastatin should consult their physician before taking niacin.
Sitostanol
A synthetic molecule related to
beta-sitosterol, sitostanol, is available in a special margarine and has been shown to lower cholesterol levels. In one study, supplementing
with 1.8 grams of sitostanol per day for six weeks enhanced the cholesterol-lowering effect of
various statin drugs.10
Vitamin
A
A study of 37 people with high cholesterol treated with diet and HMG-CoA reductase inhibitors
found blood vitamin A levels increased over two years of therapy.11 Until more is
known, people taking HMG-CoA reductase inhibitors, including atorvastatin, should have blood
levels of vitamin A monitored if they intend to supplement vitamin A.
Interactions with Herbs
Red yeast rice(Monascus purpureas)
A supplement containing red yeast rice (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated
levels of these blood lipids.12 This extract contains small amounts of naturally
occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used if you are
currently taking a statin medication.
Interactions with Foods and Other Compounds
Food
Atorvastatin is best absorbed when taken without food13 in the
morning.14 However, it has been reported to be equally well absorbed when taken
with or without food.15
Grapefruit or
grapefruit juice
Grapefruit contains substances that may inhibit the body’s ability to break down
atorvastatin; consuming grapefruit or grapefruit juice might therefore increase the potential
toxicity of the drug. There is one case report of a woman developing severe muscle damage from
simvastatin (a drug similar to atorvastatin) after she began eating one grapefruit per
day.16 Although there have been no reports of a grapefruit–atorvastatin
interaction, to be on the safe side, people taking atorvastatin should not eat grapefruit or
drink grapefruit juice.
Pomegranate
juice
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.1718 The
degree of inhibition is about the same for each of these juices. Therefore, it would be
reasonable to expect that pomegranate juice might interact with atorvastatin in the same way
that grapefruit juice does.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Rundek T, Naini A, Sacco R, et al. Atorvastatin decreases the coenzyme
Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch
Neurol 2004;61:889–92.
2. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme Q10 on
myopathic symptoms in patients treated with statins. Am J Cardiol
2007;99:1409–12.
3. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic
Agents, HMG-CoA Reductase Inhibitors. In Facts and Comparisons Drug Information. St.
Louis, MO: Facts and Comparisons, Sep 1998, 172a.
4. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A
reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
5. Yee HS, Fong NT. Atorvastatin in the treatment of primary
hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother
1998;32:1030–43.
6. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and
niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol
1994;73:25D–9D.
7. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering
agents. Br J Clin Pract Suppl 1996;77A:28–32.
8. Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and
safety of pravastatin, Nicotinic acid and the two combined in patients with
hypercholesterolemia. Am J Cardiol 1994;73:339–45.
9. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvistatin and niacin in
hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J
Med 1994;96(suppl 6A):64S–8S.
10. Goldberg AC, Ostlund RE Jr, Bateman JH, et al. Effect of plant stanol
tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J
Cardiol 2006;97:376–9.
11. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout
2 years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
12. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a
proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr
1999;69:231–6.
13. Radulovic LL, Cilla DD, Posvar EL, et al. Effect of food on the
bioavailability of atorvastatin, an HMG-CoA reductase inhibitor. J Clin Pharmacol
1995;35:990–4.
14. Cilla DD Jr, Gibson DM, Whitfield LR, Sedman AJ. Pharmacodynamic
effects and pharmacokinetics of atorvastatin after administration to normocholesterolemic
subjects in the morning and evening. J Clin Pharmacol 1996;36:604–9.
15. Radulovic LL, Cilla DD, Posvar EL, et al. Effect of food on the
bioavailability of atorvastatin, an HMG-CoA reductase inhibitor. J Clin Pharmacol
1995;35:990–4.
16. Dreier JP, Endres M. Statin-associated rhabdomyolysis triggered by
grapefruit consumption. Neurology 2004;62:670 [Letter].
17. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis
associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.
18. Summers KM. Potential drug-food interactions with pomegranate juice.
Ann Pharmacother 2006;40:1472–3.
The information presented in Healthnotes is for informational purposes
only. It is based on scientific studies (human, animal, or in vitro), clinical
experience, or traditional usage as cited in each article. The results reported may not
necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over the counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires June 2009.
