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 Reference 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 Reference 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 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.⁸

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.⁹ 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 Reference cholesterol and Reference triglycerides in people with moderately elevated levels of these blood lipids.¹¹ 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.¹² 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 Reference cholesterol. Large amounts of niacin taken with lovastatin have been reported to cause potentially serious muscle disorders (myopathy or rhabdomyolysis).¹³ However, niacin also enhances the cholesterol-lowering effect of lovastatin.¹⁴ 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.¹⁵ Nevertheless, individuals taking lovastatin should consult with their doctor before taking niacin.

Oxidative damage to LDL (“bad”) cholesterol is widely believed to contribute to Reference 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.¹⁶ 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.^{17 , 18} 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.