About simvastatin
Simvastatin is a member of the HMG-CoA reductase inhibitor family of drugs that blocks the
body’s production of cholesterol. Simvastatin is used to lower elevated cholesterol and to reduce the risk of heart attack and death.
Helpful Products
Try these helpful products which may be beneficial if taken with this medicine
- CoQ10
- Supplementing with 30 to 100 mg of coenzyme Q10 per day may maintain adequate blood levels
of this heart-healthy nutrient
- Cholesterol-lowering margarine
- Using margarines containing sitostanol (Benecol), which is made from pine tree wood pulp
and naturally occurring unsaturated sterols obtained from soybean oil (Take Control), can help
lower LDL (“bad”) cholesterol
- Fish oil
- The omega-3 fatty acid EPA, found in fish oil, may improve the cholesterol- and
triglyceride-lowering effect of simvastatin; taking 900 to 1,800 mg of EPA each day might be
beneficial
These recommendations are not comprehensive and are not intended to
replace the advice of your doctor or pharmacist. Continue reading the full article for more
information on interactions with vitamins, herbs, and foods.
Summary of
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
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. |
Fish oil (EPA)
Psyllium
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. |
Vitamin B3 (niacin)
Vitamin E*
|
| 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 patients with high cholesterol, simvastatin
therapy results in decreased serum coenzyme Q10 (CoQ10) levels.1 2
Several trials, including double-blind trials, have confirmed this effect of simvastatin and
other HMG-CoA reductase inhibitors, such as
lovastatin and pravastatin.3
4 5 Supplementation with 100 mg6 per day or 10 mg three times
daily7 of CoQ10 has been shown to prevent reductions in blood levels of CoQ10 due
to simvastatin. In the latter 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 such as simvastatin 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.
Fish Oil
(EPA)
The omega-3 fatty acid EPA, present 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 1800 mg of EPA for three months in addition to
simvastatin.8 The authors of the study concluded that the combination of
simvastatin and EPA may prevent coronary heart disease better than simvastatin alone.
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 B3
(niacin)
Niacin is the form of vitamin B3 used to lower cholesterol. Taking large amounts of niacin
along with HMG-CoA reductase inhibitors may cause muscle disorders (myopathy) that can become
serious (rhabdomyolysis).10 11 Such problems appear to be
uncommon.12 13 Moreover, concurrent use of niacin has been reported to
enhance the cholesterol-lowering effect of HMG-CoA reductase inhibitors.14
15 Individuals taking simvastatin should consult a doctor before taking niacin.
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.16 Until more is known, people taking HMG-CoA reductase
inhibitors, including simvastatin, should have blood levels of vitamin A monitored if they
intend to supplement vitamin A.
Vitamin
E
In a study of seven patients with hypercholesterolemia, eight weeks of simvastatin plus
vitamin E 300 IU improved markers of blood vessel elasticity more than simvastatin
alone.17
Antioxidants
In another 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.18 Although
there is evidence that some or all of these nutrients may help prevent heart disease,
individuals taking simvastatin who wish to take antioxidants should discuss the use of these
supplements with their doctor.
Interactions with Herbs
Psyllium
In one study, supplementation with 15 grams of psyllium per day for eight weeks enhanced the
cholesterol-lowering effect of simvastatin.19
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.20 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
Simvastatin may be taken with or without food.21
Grapefruit or
grapefruit juice
Grapefruit contains substances that may inhibit the body’s ability to break down
simvastatin; consuming grapefruit or grapefruit juice might therefore increase the potential
toxicity of the drug. 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.22 There is one case report of a woman developing severe muscle damage
from simvastatin after she began eating one grapefruit per day.23 Although there
have been no reports of a grapefruit–simvastatin interaction, to be on the safe side,
people taking simvastatin should not eat grapefruit or drink grapefruit juice.
References:1. Laaksonen R, Jokelainen K, Sahi T, et al. Decreases in serum
ubiquinone concentrations do not result in reduced levels in muscle tissue during short-term
simvastatin treatment in humans. Clin Pharmacol Ther 1995;57:62–6.
2. 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.
3. 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.
4. 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.
5. Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme
Q levels in humans. Proc Natl Acad Sci USA 1990;87:8931–4.
6. Bargossi AM, Grossi G, Fiorella PL, et al. Exogenous CoQ10
supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors.
Molec Aspects Med 1994;15(suppl):s187–93.
7. 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.
8. 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
1999;29:22–5.
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. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A
reductase inhibitors. Am J Health Syst Pharm 1995;52:1639–45.
11. Yee HS, Fong NT. Atorvastatin in the treatment of primary
hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother
1998;32:1030–43.
12. Jacobson TA, Amorosa LF. Combination therapy with fluvastatin and
niacin in hypercholesterolemia: a preliminary report on safety. Am J Cardiol
1994;73:25D–9D.
13. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering
agents. Br J Pract Suppl 1996;77A:28–32.
14. 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.
15. 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.
16. Muggeo M, Zenti MG, Travia D, et al. Serum retinol levels throughout
2 years of cholesterol-lowering therapy. Metabolism 1995;44:398–403.
17. 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.
18. Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the
response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low
HDL. Arterioscler Thromb Vasc Biol 2001;21:1320–6.
19. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber
with simvastatin in lowering cholesterol. Arch Intern Med 2005;165:1161–6.
20. 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.
21. 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, 172.
22. Lilja JJ, Neuvonen M, Neuvonen PJ. Effects of regular consumption of
grapefruit juice on the pharmacokinetics of simvastatin. Br J Clin Pharmacol
2004;58:56–60.
23. Dreier JP, Endres M. Statin-associated rhabdomyolysis triggered by
grapefruit consumption. Neurology 2004;62:670 [Letter].