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.

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.⁴

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.⁶ 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.

A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids.⁷ 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.

Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.^{8 , 9} 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.

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.¹⁰ 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.

A magnesium- and aluminum-containing antacid was reported to interfere with atorvastatin absorption.¹¹ 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.

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).^{12 , 13} Such problems appear to be uncommon when HMG-CoA reductase inhibitors are combined with niacin.^{14 , 15} Moreover, concurrent use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the cholesterol-lowering effect of the drugs.^{16 , 17} Individuals taking atorvastatin should consult their physician before taking niacin.