Health Information

Atorvastatin

Drug Information

Atorvastatin is a member of the HMG-CoA reductase inhibitor family of drugs that blocks the body’s production of cholesterol. Atorvastatin is used to lower Reference high cholesterol.

Common brand names:

Lipitor

Summary of Interactions with Vitamins, Herbs, & Foods

Reference What Are Nutrient Interactions

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

Reference 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.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

Reference Vitamin D

In a preliminary trial, supplementation with vitamin D appeared to prevent muscle-related side effects in patients taking statin drugs.³ The amount of vitamin D used in this study was very large (up to 50,000 IU twice a week) and potentially toxic. People taking statin drugs should consult with their doctor regarding how much vitamin D can be taken.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

Reference Fish Oil

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Reference Psyllium

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Sitostanol

A synthetic molecule related to Reference beta-sitosterol, sitostanol, is available in a special margarine and has been shown to Reference 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

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

Reference St. John’s Wort

St. John's wort increases the activity of an enzyme in the body that metabolizes atorvastatin ⁵. Consequently, supplementation with St. John's wort may increase the metabolism of, and therefore reduce the activity of, atorvastatin.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potential Negative Interaction

Grapefruit

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.
Reference Red Yeast Rice

A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively Reference lower cholesterol and Reference 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.
Reference Antioxidant Formulas

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Pomegranate

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.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Reference 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.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.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required

Reference Magnesium

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 Reference magnesium supplements such as Reference magnesium hydroxide are also antacids.
Reference Vitamin B3

Niacin is the form of vitamin B3 used to lower Reference cholesterol. Ingestion of large amounts of niacin along with Reference 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.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

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. 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.

4. 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.

5. Roby CA, Anderson GD, Kantor E, et al. St John's Wort: effect on CYP3A4 activity. Clin Pharmacol Ther 2000;67:451–7.

6. Dreier JP, Endres M. Statin-associated rhabdomyolysis triggered by grapefruit consumption. Neurology 2004;62:670 [Letter].

7. 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.

8. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.

9. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472–3.

10. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout 2 years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.

11. 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.

12. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.

13. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother 1998;32:1030–43.

14. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol 1994;73:25D–9D.

15. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J Clin Pract Suppl 1996;77A:28–32.

16. 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.

17. 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.

Last Review: 11-07-2012

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The information presented in Aisle7 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 2013.

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