HMG-CoA reductase inhibitors, also referred to as
“statins,” are a family of drugs used to reduce high blood levels of cholesterol and LDL
(“bad”) cholesterol, and to a lesser extent, triglycerides. Statins may also increase blood levels
of HDL (“good”) cholesterol. These drugs include:
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
May Be Beneficial:Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
May Be Beneficial:Supportive
interaction—Taking these supplements may support or otherwise help your medication
Avoid:Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body.
St. John’s wort (lovastatin, simvastatin)
Avoid:Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Grapefruit or grapefruit juice
Red yeast rice
Check:Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
Vitamin B3 (niacin)
Side effect reduction/prevention
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
Interactions with Dietary Supplements
In patients with high cholesterol, statin
therapy results in decreased CoQ10 levels.1234
Supplementation with 100 mg per day or 10 mg three times per day of CoQ10 has been shown to
prevent reductions in blood levels of CoQ10 due to statin therapy.5 In one study,
people taking CoQ10 along with simvastatin increased their blood CoQ10 concentration by 63%.
Many doctors recommend that people taking HMG-CoA reductase inhibitor drugs also supplement
with approximately 100 mg of CoQ10 per day, although lower amounts, such as 10 to 30 mg per
day, might be effective in preventing the decline in CoQ10 levels.
The omega-3 fatty acid EPA in fish oil may
improve the cholesterol- and
triglyceride-lowering effect of simvastatin. In a preliminary trial, people with high
cholesterol who had been taking simvastatin 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 per day for three months in addition to
simvastatin.6 The authors of the study concluded that the combination of
simvastatin and EPA may prevent coronary heart disease better than simvastatin 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.7
Niacin is the form of vitamin B3 used to lower
cholesterol and triglyceride levels.
Taking large amounts of niacin along with HMG-CoA reductase inhibitors may cause muscle
disorders (myopathy) that can become serious (rhabdomyolysis).89 Such
problems appear to be uncommon.1011 Moreover, concurrent use of niacin
has been reported to enhance the cholesterol-lowering effect of HMG-CoA reductase
inhibitors.1213 People taking statins should consult a doctor before
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.14 Until more is known, people taking HMG-CoA reductase
inhibitors should have blood levels of vitamin A monitored if they intend to supplement with
In a study of seven patients with high serum cholesterol, eight weeks of simvastatin plus
vitamin E 300 IU per day improved markers of blood vessel elasticity more than simvastatin
alone.15 Improved blood vessel elasticity reduces the risk for cardiovascular
damage and death. Additional controlled studies are necessary to determine whether
supplementation with vitamin E enhances the beneficial effects of other statin drugs.
Interactions with Herbs
In one study, supplementing with 15 grams of psyllium per day for eight weeks enhanced the
cholesterol-lowering effect of simvastatin.16 Further research is needed to
determine whether this result applies to other statins.
A supplement containing red yeast rice (Monascus purpureas) has been shown to
effectively lower cholesterol and triglycerides in people with moderately elevated
levels of these blood lipids.17 However, red yeast rice contains small amounts of
naturally occurring HMG-CoA reductase inhibitors and the use of red yeast rice in combination
with a statin drug might increase the adverse effects of the drug. For that reason, red yeast
rice should not be used if you are currently taking a statin medication.
Taking St. John’s wort (Hypericum perforatum) along with lovastatin or
simvastatin may lower blood levels of the drug, resulting in decreased
effectiveness.18 People taking either of these statin drugs should not take St.
John’s wort without the supervision of a doctor.
Interactions with Foods and Other Compounds
Grapefruit contains substances that may inhibit the body’s ability to break down
statins; consuming grapefruit or grapefruit juice might therefore increase the potential
toxicity of these drugs. In a study of healthy volunteers, ingesting 200 ml of grapefruit
juice along with simvastatin increased blood levels of the drug, compared with taking
simvastatin with water.19 There is one case report of a woman developing severe
muscle damage from simvastatin after she began eating one grapefruit per day.20
People taking HMG-CoA reductase inhibitors should not eat grapefruit or drink grapefruit
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.2122 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 statin drugs in the same way
that grapefruit juice does.
Though the absorption of most statins is not affected by taking the drug with food, blood
levels of lovastatin are increased.23 Consequently, lovastatin should be taken with
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Laaksonen R, Ojala JP, Tikkanen MJ, et al. Serum ubiquinone
concentrations after short- and long-term treatment with HMG-CoA reductase inhibitors. Eur
J Clin Pharmacol 1994;46:313–7.
2. 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.
3. Watts GF, Cummings MH, Umpleby M, et al. Simvastatin decreases the
hepatic secretion of very-low-density lipoprotein apolipoprotein B-100 in heterozygous
familial hypercholesterolaemia: pathophysiological and therapeutic implications. Eur J
Clin Invest 1995;25:559–67.
4. Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme
Q levels in humans. Proc Natl Acad Sci USA 1990;87:8931–4.
5. 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.
6. 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
7. 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
8. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A
reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
9. Yee HS, Fong NT. Atorvastatin in the treatment of primary
hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother
10. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and
niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol
11. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering
agents. Br J Pract Suppl 1996;77A:28–32.
12. 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.
13. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvastatin and niacin in
hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J
Med 1994;96(suppl 6A):64S–8S.
14. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout
2 years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
15. Neunteufl T, Kostner K, Katzenschlager R, et al. Additional benefit
of vitamin E supplementation to simvastatin therapy on vasoreactivity of the brachial artery
of hypercholesterolemic men. J Am Coll Cardiol 1998;32:711–6.
16. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber
with simvastatin in lowering cholesterol. Arch Intern Med 2005;165:1161–6.
17. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a
proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr
18. Wolters Kluwer Health, Inc. Facts and Comparisons [online]
2007 [cited 2007 Feb]. Available from www.factsandcomparisons.com.
19. Lilja JJ, Neuvonen M, Neuvonen PJ. Effects of regular consumption of
grapefruit juice on the pharmacokinetics of simvastatin. Br J Clin Pharmacol
20. Dreier JP, Endres M. Statin-associated rhabdomyolysis triggered by
grapefruit consumption. Neurology 2004;62:670 [Letter].
21. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis
associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.
22. Summers KM. Potential drug-food interactions with pomegranate juice.
Ann Pharmacother 2006;40:1472–3.
23. Wolters Kluwer Health, Inc. Facts and Comparisons [online]
2007 [cited 2007 Feb]. Available from www.factsandcomparisons.com.
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