Atorvastatin

Also indexed as: Lipitor®

Atorvastatin is a member of the HMG-CoA reductase inhibitor family of drugs that blocks the body’s production of cholesterol. Atorvastatin is used to lower elevated cholesterol.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a 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 interactions.

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.	Coenzyme Q10
May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.	Sitostanol
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 Vitamin A*
Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.	Magnesium hydroxide Magnesium oxide Magnesium-containing antacids Niacin
Side effect reduction/prevention	None known
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Coenzyme Q10
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 that people taking HMG-CoA reductase inhibitor drugs such as atorvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10 to 30 mg per day, might conceivably be effective in preventing the decline in CoQ10 levels.

Magnesium-containing antacids
A magnesium- and aluminium-containing antacid was reported to interfere with atorvastatin absorption.² People can avoid this interaction by taking atorvastatin two hours before or after any aluminium/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

Niacin
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).³ ⁴ Such problems appear to be uncommon when HMG-CoA reductase inhibitors are combined with niacin.⁵ ⁶ Moreover, concurrent use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the cholesterol-lowering effect of the drugs.⁷ ⁸ Individuals taking atorvastatin should consult their physician before taking niacin.

Sitostanol
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.⁹

Vitamin A
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.¹⁰ 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.

Interactions with Herbs

Red yeast rice(Monascus purpureas)
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.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.

Interactions with Foods and Other Compounds

Food
Atorvastatin is best absorbed when taken without food¹² in the morning.¹³ However, it has been reported to be equally well absorbed when taken with or without food.¹⁴

Grapefruit or grapefruit juice
Grapefruit contains substances that may inhibit the body’s ability to break down atorvastatin; consuming grapefruit or grapefruit juice might therefore increase the potential toxicity of the drug. There is one case report of a woman developing severe muscle damage from simvastatin (a drug similar to atorvastatin) after she began eating one grapefruit per day.¹⁵ Although there have been no reports of a grapefruit–atorvastatin interaction, to be on the safe side, people taking atorvastatin should not eat grapefruit or drink grapefruit juice.

References
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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. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Sep 1998, 172a.

3. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.

4. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother 1998;32:1030–43.

5. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol 1994;73:25D–9D.

6. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J Clin Pract Suppl 1996;77A:28–32.

7. 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.

8. Jacobson TA, Jokubaitis LA, Amorosa LF. Fluvistatin and niacin in hypercholesterolemia: a preliminary report on gender differences in efficacy. Am J Med 1994;96(suppl 6A):64S–8S.

9. 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.

10. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout 2 years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.

11. 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.

12. Radulovic LL, Cilla DD, Posvar EL, et al. Effect of food on the bioavailability of atorvastatin, an HMG-CoA reductase inhibitor. J Clin Pharmacol 1995;35:990–4.

13. Cilla DD Jr, Gibson DM, Whitfield LR, Sedman AJ. Pharmacodynamic effects and pharmacokinetics of atorvastatin after administration to normocholesterolemic subjects in the morning and evening. J Clin Pharmacol 1996;36:604–9.

14. Radulovic LL, Cilla DD, Posvar EL, et al. Effect of food on the bioavailability of atorvastatin, an HMG-CoA reductase inhibitor. J Clin Pharmacol 1995;35:990–4.

15. Dreier JP, Endres M. Statin-associated rhabdomyolysis triggered by grapefruit consumption. Neurology 2004;62:670 [Letter].

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.

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The information presented in Healthnotes 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 chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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