Ezetimibe-Atorvastatin

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.

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.

In a preliminary trial, supplementation with vitamin D appeared to prevent muscle-related side effects in patients taking statin drugs. 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. This study suggests that people taking lovastatin might benefit from supplemental vitamin E.

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.

In one study, supplementation with 15 grams of psyllium per day for eight weeks enhanced the cholesterol-lowering effect of simvastatin.

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

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.

St. John's wort increases the activity of an enzyme in the body that metabolizes atorvastatin . 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.

A supplement containing red yeast rice (Monascus purpureas) (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.

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. 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.

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

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. 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.

Niacin is the form of vitamin B3 used to lower cholesterol. Ingestion of large amounts of niacin along with lovastatin (a drug closely related to atorvastatin) or with atorvastatin itself may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis). Such problems appear to be uncommon when HMG-CoA reductase inhibitors are combined with niacin. Moreover, concurrent use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the cholesterol-lowering effect of the drugs. Individuals taking atorvastatin should consult their physician before taking niacin.