In a randomized, double-blind trial, blood levels of coenzyme Q10 (CoQ10) were measured in 45 people with high cholesterol treated with lovastatin or pravastatin (drugs related to fluvastatin) for 18 weeks.¹ A significant decline in blood levels of CoQ10 occurred with either drug. One study found that supplementation with 100 mg of CoQ10 prevented declines in CoQ10 when taken with simvastatin (another HMG-CoA reductase inhibitor drug).² Many doctors recommend that people taking HMG-CoA reductase inhibitor drugs such as fluvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10–30 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.⁵

In a case report, a man taking rosuvastatin developed severe muscle damage (rhabdomyolysis), a known side effect of rosuvastatin, after he began drinking pomegranate juice (about 6 ounces twice a week). While a cause–effect relationship was not proven, the authors of this report suggested that pomegranate may have increased the toxicity of rosuvastatin by slowing the rate at which the body broke it down.⁶

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.

A recent blinded study showed that individuals taking both rosuvastatin and niacin had a greater increase in HDL (“good”) cholesterol and apolipoprotein A-I than did those taking rosuvastatin alone.⁸ People taking rosuvastatin might benefit from taking niacin, though they should consult with their healthcare provider before starting the supplement. When taken with niacin, some statin drugs may become more toxic so there is a possibility of an adverse interaction.