Pravastatin is a member of the HMG-CoA reductase inhibitor family of drugs, also called “statins,” such as lovastatin and simvastatin. Pravastatin blocks a key step in the body’s production of cholesterol and is used to lower cholesterol levels in people with high cholesterol.
One of the possible side effects of pravastatin is liver toxicity. Although no clinical studies substantiate its use with pravastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of pravastatin. The suggested use is 200 mg of the extract three times daily.
The omega-3 fatty acid EPA present in fish oil may improve the cholesterol and triglyceride-lowering effect of pravastatin. In a preliminary trial, people with high cholesterol who had been taking pravastatin for about three years were able to significantly lower their triglyceride levels and raise their levels of HDL (“good”) cholesterol by supplementing with either 900 mg or 1,800 mg of EPA for three months in addition to pravastatin.3 The authors of the study concluded that the combination of pravastatin and EPA may prevent coronary heart disease better than pravastatin alone.
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.5
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.6 This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used by people who 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.7 It remains unclear whether this moderate increase suggests that people taking lovastatin have a particular need to restrict vitamin A supplementation.
Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin plus niacin to lower cholesterol.8 Niacin was added over a two week period, to a maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin was continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in significantly reduced cholesterol levels. Others have also shown that the combination of pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin alone.9 However, large amounts of niacin taken with pravastatin might cause serious muscle disorders (myopathy or rhabdomyolysis).10 Individuals taking pravastatin should consult a doctor before taking niacin.
In double-blind trials, treatment with pravastatin and other HMG-CoA reductase inhibitors has resulted in depleted blood levels of coenzyme Q10 (CoQ10).11 , 12 Supplementation with 90–100 mg CoQ10 per day has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin, another drug in the same category as pravastatin.13 , 14 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.15
1. Shewmon DA, Craig JM. Creatine supplementation prevents statin-induced muscle toxicity. Ann Intern Med 2010;153:690–2.
2. 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.
3. Nakamura N, Hamazaki T, Ohta M, et al. Joint effects of HMG-CoA reductase inhibitors and eicosapentaenoic acids on serum lipid profile and plasma fatty acid concentrations in patients with hyperlipidemia. Int J Clin Lab Res 1999;29:22–5.
4. REF: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.
5. 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 Cardiol2006;97:376–9.
6. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr1999;69:231–6.
7. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout two years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
8. Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother 1997;31:677–82.
9. O’Keefe JH Jr, Harris WS, Nelson J, Windsor SL. Effects of pravastatin with niacin or magnesium on lipid levels and postprandial lipemia. Am J Cardiol 1995;76:480–4.
10. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
11. 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.
12. Ghirlanda G, Oradei A, Manto A, et al. Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. J Clin Pharmacol 1993;33:226–9.
13. 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.
14. 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.
15. 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.
Last Review: 05-01-2013
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