ATORVASTATIN

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Safetychecker Summary for Atorvastatin
(for details about the summarized interactions, read the full article)

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
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	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
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known

Interactions with Dietary Supplements

Coenzyme Q10
In a double-blind trial, individuals with high cholesterol who were treated with lovastatin or pravastatin (drugs related to atorvastatin) for 18 weeks had a significant reduction in blood levels of coenzyme Q10 (CoQ10).¹ One study found that supplementation with 100 mg of CoQ10 prevented declines in CoQ10 levels when taken with simvastatin (another HMG-CoA reductase inhibitor drug).² 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 10–30 mg per day, might conceivably be effective in preventing the decline in CoQ10 levels.

Magnesium-containing antacids
A magnesium- and aluminum-containing antacid was reported to interfere with atorvastatin absorption.³ 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.

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).^{4 5} Such problems appear to be uncommon.^{6 7} Moreover, niacin has been successfully combined with statin drugs to reduce cholesterol more effectively than using these drugs without niacin.^{8 9} People taking both atorvastatin and niacin should be monitored for muscle disorders by the prescribing physician.

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 Foods and Other Compounds

Food
Atorvastatin is best absorbed when taken without food¹¹ in the morning.¹² However, it has been reported to be equally well absorbed when taken with or without food.¹³

1. Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997;18(suppl):S137–44.

2. Bargossi AM, Grossi G, Fiorella PL, et al. Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors. Mol Aspects Med 1994;15(suppl):s187–93.

3. 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.

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

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

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

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

8. 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.

9. 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.

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. 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.

12. 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.

13. 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.

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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 pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.

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