It has been clearly documented that HMG Co-A reductase inhibitors, including lovastatin,1 deplete coenzyme Q10 (CoQ10) levels in the blood, an effect that may be responsible for other side effects of the drug, such as abnormal liver function. In a double-blind trial, blood levels of CoQ10 were measured in 45 people with high cholesterol treated with lovastatin (20–80 mg per day) or pravastatin (10–40 mg per day) for 18 weeks.2 A significant decline in blood levels of CoQ10 occurred with both drugs. Supplementation with 90–100 mg per day CoQ10 has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin.3 , 4 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.5
One of the possible side effects of lovastatin is liver toxicity. Although there are no clinical studies to substantiate its use with lovastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of lovastatin. The suggested use is 200 mg of the extract three times daily.
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.9
Soluble fiber is found primarily in fruit, beans, and oats, but it is also available separately as pectin, oat bran, and glucomannan. Two sources of soluble fiber—pectin (found in fruit) and oat bran (a component of oatmeal also available by itself)—have been reported to interact with lovastatin.10 The fiber from these two sources appears to bind the drug in the gastrointestinal tract and reduce absorption of the drug as a consequence. People taking this drug should avoid concentrated intake of soluble fiber, as taking lovastatin with a high soluble-fiber diet leads to reduced drug effectiveness.
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.
A study of 37 people with high cholesterol treated with diet and HMG-CoA reductase inhibitors found serum vitamin A levels increased over two years of therapy.13 It remains unclear whether this moderate increase should suggest that people taking lovastatin have a particular need to restrict vitamin A supplementation.
Niacin is a vitamin used to lower cholesterol. Large amounts of niacin taken with lovastatin have been reported to cause potentially serious muscle disorders (myopathy or rhabdomyolysis).14 However, niacin also enhances the cholesterol-lowering effect of lovastatin.15 Taking as little as 500 mg three times per day of niacin with lovastatin has been shown to have these complementary, supportive actions with almost none of the side effects seen when higher amounts of niacin are taken.16 Nevertheless, individuals taking lovastatin should consult with their doctor before taking niacin.
Oxidative damage to LDL (“bad”) cholesterol is widely believed to contribute to heart disease. In a double-blind trial, lovastatin was found to increase oxidative damage to LDL cholesterol and vitamin E was reported to protect against such damage, though not to completely overcome the negative effect of lovastatin.17 This study suggests that people taking lovastatin might benefit from supplemental vitamin E.
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.18 , 19 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 lovastatin in the same way that grapefruit juice does.
1. Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci 1990;87:8931–4.
2. Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997;18(suppl):S137–44.
3. Bargossi AM, Grossi G, Fiorella PL, et al. Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors. Molec Aspects Med 1994;15(suppl):s187–93.
4. Miyake Y, Shouzu A, Nishikawa M, et al. Effect of treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on serum coenzyme Q10 in diabetic patients. Arzneimittelforschung 1999;49:324–9.
5. 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.
6. Shewmon DA, Craig JM. Creatine supplementation prevents statin-induced muscle toxicity. Ann Intern Med 2010;153:690–2.
7. Glueck CJ, Budhani SB, Masineni SS, et al. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin 2011;27:1683–90.
8. Agrawal AR, Tandon M, Sharma PL. Effect of combining viscous fibre with lovastatin on serum lipids in normal human subjects. Int J Clin Pract 2007;61:1812-8
9. 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.
10. Richter W, Jacob B, Schwandt P. Interaction between fibre and lovastatin. Lancet 1991;338:706 [letter].
11. Roby CA, Anderson GD, Kantor E, et al. St John's Wort: effect on CYP3A4 activity. Clin Pharmacol Ther 2000;67:451–7.
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. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout two years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
14. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
15. Malloy MJ, Kane JP, Kunitake ST, Tun P. Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med 1987;107:616–23.
16. Gardner SF, Schneider EF, Granberry MG, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacotherapy 1996;16:419–23.
17. Palomäki A, Malminiemi K, Malminiemi O, Solakivi T. Effects of lovastatin therapy on susceptibility of LDL to oxidation durgy alpha-tocopherol supplementation. Arterioscler Thromb Vasc Biol 1999;19:1541–8.
18. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.
19. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472–3.
Last Review: 05-01-2013
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