Niacin-Lovastatin

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. Many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.

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. A double-blind trial also found that CoQ10 (200 mg per day) significantly decreased drug-induced muscle symptoms in people taking statin drugs.

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. 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.

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. 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.

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. 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.

A magnesium- and aluminum-containing antacid was reported to interfere with atorvastatin absorption. People can avoid this interaction by taking atorvastatin two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

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