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Lovastatin is a member of the HMG-CoA reductase inhibitor family of drugs, which blocks the body's production of cholesterol. Lovastatin is used to lower high cholesterol levels . Cholestin, a dietary supplement advertised to help maintain healthy cholesterol, but not to lower high cholesterol, contains several HMG-CoA reductase inhibitor chemicals, including lovastatin.
Common brand names:Altoprev, Mevacor
Summary of Interactions with Vitamins, Herbs, & Foods
Replenish Depleted Nutrients
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 Many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.
Reduce Side Effects
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 A double-blind trial also found that CoQ10 (200 mg per day) significantly decreased drug-induced muscle symptoms in people taking statin drugs.3
However, in another double-blind trial, CoQ10 in the amount of 60 mg twice a day for one month was not more effective than a placebo for relieving muscle pain.4 Although the evidence is conflicting regarding whether supplementing with CoQ10 relieves statin-induced muscle symptoms, many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.
In a preliminary study, ten patients who had to discontinue statin drugs because of muscle-related side effects were given creatine (as creatine monohydrate) in the amount of 5 grams twice a day for five days, then 5 grams per day. Eight of the ten patients experienced no muscle symptoms upon resuming the statin drug.5
In a preliminary trial, supplementation with vitamin D appeared to prevent muscle-related side effects in patients taking statin drugs.6 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.
Oxidative damage to LDL ("bad") cholesterol is widely believed to contribute to 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.7 This study suggests that people taking lovastatin might benefit from supplemental vitamin E.
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.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
In a preliminary trial, taking an HMG-CoA reductase inhibitor ("statin") for about three years significantly lowered triglyceride levels and raised levels of HDL ("good") cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.8 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
In one study, the addition of psyllium (10 grams per day) enhanced the cholesterol-lowering effect of lovastatin9The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
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.10The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
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.11 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.
St. John's Wort
St. John's wort increases the activity of an enzyme in the body that metabolizes lovastatin 12. Consequently, supplementation with St. John's wort may increase the metabolism of, and therefore reduce the activity of, lovastatin.
Potential Negative Interaction
In one study, daily supplementation with a combination of antioxidants (800 IU of vitamin E, 1,000 mg of vitamin C, 25 mg of beta-carotene, and 100 mcg of selenium) blocked the beneficial effect of simvastatin-plus-niacin on HDL cholesterol levels.13 Although there is evidence that some or all of these nutrients may help prevent heart disease, individuals taking simvastatin (or other statin drugs) who wish to take antioxidants should discuss the use of these supplements with their doctor.
Red Yeast Rice
A supplement containing red yeast rice (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids.14 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.15 It remains unclear whether this moderate increase should suggest that people taking lovastatin have a particular need to restrict vitamin A supplementation.
Vitamin B3 (Niacin)
Niacin is a vitamin used to lower cholesterol . Large amounts of niacin taken with lovastatin have been reported to cause potentially serious muscle disorders (myopathy or rhabdomyolysis).16 However, niacin also enhances the cholesterol-lowering effect of lovastatin.17 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.18 Nevertheless, individuals taking lovastatin should consult with their doctor before taking niacin.
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.19 , 20 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.
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. Fedacko J, Pella D, Fedackova P, et al. Coenzyme Q10 and selenium in statin-associated myopathy treatment. Can J Physiol Pharmacol2013;91:165-70.
4. Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol 2012;110:526-9.
5. Shewmon DA, Craig JM. Creatine supplementation prevents statin-induced muscle toxicity. Ann Intern Med 2010;153:690-2.
6. 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.
7. Palomäki A, Malminiemi K, Malminiemi O, Solakivi T. Effects of lovastatin therapy on susceptibility of LDL to oxidation durgy alpha-tocopherol supplementation. Arterioscler Thromb Vasc Biol 1999;19:1541-8.
8. 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.
9. 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.
10. 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.
11. Richter W, Jacob B, Schwandt P. Interaction between fibre and lovastatin. Lancet 1991;338:706 [letter].
12. Roby CA, Anderson GD, Kantor E, et al. St John's Wort: effect on CYP3A4 activity. Clin Pharmacol Ther 2000;67:451-7.
13. Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol 2001;21:1320-6.
14. 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.
15. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout 2 years of cholesterol-lowering therapy. Metabolism 1995;44:398-403.
16. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639-45.
17. Malloy MJ, Kane JP, Kunitake ST, Tun P. Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med 1987;107:616-23.
18. Gardner SF, Schneider EF, Granberry MG, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacotherapy 1996;16:419-23.
19. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705-6.
20. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472-3.
Last Review: 04-29-2014
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