Answer:

Atorvastatin (Lipitor), rosuvastatin (Crestor), and other cholesterol-lowering statin drugs can be affected by taking supplements and can affect your ability to absorb certain vitamins and minerals. Certain herbal supplements, such as St. John's wort, may decrease blood levels of some statin drugs, and when taken with atorvastatin, may actually result in increased cholesterol levels. Certain forms of magnesium may also decrease blood levels of statin drugs -- particularly Crestor. Red yeast rice, which contains a naturally occurring statin, should not be combined with prescription statin drugs without medical supervision.

Berberine should be avoided or used with caution when taking certain statin drugs, such as atorvastatin (Lipitor), lovastatin (Mevacor) and rosuvastatin (Crestor).

While high doses of niacin may help to lower cholesterol, studies show that if you already take a statin drug, adding high-dose niacin does not appear to provide additional benefit and may carry serious risks. Nevertheless, some physicians believe taking niacin in addition to statin medication may be helpful for certain people; however do not try this combination without consulting your physician.

Some fruit juices can also be a problem, particularly grapefruit juice, which impairs the body's normal breakdown of certain statins, allowing them to build up to potentially excessive levels in the blood. Since the effects of grapefruit juice may last as long as 3 days, it should be avoided if you are taking atorvastatin (Lipitor), lovastatin (Mevacor, Altoprev) or simvastatin (Zocor). However, some other statins do not seem to be affected by grapefruit juice, including pravastatin (Pravachol), fluvastatin (Lescol) and rosuvastatin (Crestor). 

Although green tea can help lower cholesterol, it can also decrease absorption of some, but not all, statin drugs. To play it safe, it may be best to take statins at least a couple of hours before consuming a green tea supplement or beverage.

On the other hand, CoQ10 and fish oil may offer particular benefits to people on statin drugs.

These interactions are explained in the Statin Drugs article, which is part of the extensive Drug Interactions section of our website (where you can look up interaction for other drugs you may be taking), and in other reports (linked to above) on ConsumerLab.com.

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16 Comments

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Robert8544
March 23, 2016

The scientific evidence against statins is accumulating rapidly not only with respect to the lack of positive evidence that they lower the incidence of CHD but, more importantly, with respect to the hard evidence that they produce many negative side effects.

In turn, the statin equation rests on growing evidence that chasing HDL-C and LDL-C, as a strategy for reducing CHD, also lacks scientific evidence -- and has for more than a decade.

There *is* scientific evidence linking triglycerides and cholesterol particle counts to CHD in an intermediate causal chain but they are downstream to more fundamental causes, such as inflammation. In other words, most if not all facets of cholesterol metrics are not linked to causing CHD unless certain pre-conditions exist.

My recommendation would be to discuss thoroughly with your physician the scientific rationale for recommending that you take statins.

Dr Jay16276
December 17, 2017

What are the alternatives to statins including non-medication routes?

ConsumerLab.com
December 18, 2017

Hi Dr. Jay - Please see our CL Answer to the question "Which supplements can help lower cholesterol and keep my heart healthy? Are there any to avoid?" ( https://www.consumerlab.com/answers/which-supplements-can-help-keep-my-heart-healthy/supplements_for_heart_health/).

HERMAN16394
January 31, 2018

from early in Framingham studies question not only about adverse effects of statins, but adverse effects of lowered cholesterol- especially for older folks, lower cholesterol levels
show significant cognitive impairment, when compaired to performance of those with
higher levels- not talking about very rare cases of genetic condition hypercholesterolemia
levels as high as 500- think there might be possible brain damage if not enough cholesterol-
might also consider there are many restaurants touting health breakfasts egg white dishes
for those who want to be healthy-yolks do not affect cholesterol levels- however, those
who have swallowed advice of some "experts" deprive selves of important eye nutrients
like lutein and zeaxanthin and enzymes important to digest proteins- egg whites are protein only, so far as I know- how much iatrogenic expert advice has supported other effects for a new-found source of malnutrition to rival poverty effects
herman medow

Carolyn6908
August 26, 2015

I take simvastatin for cholesterol which appears to be genetically based. Simvastatin does increase my blood sugar above 100. I tested it by stopping simvastatin for 1 month and my blood sugar dropped below 100. My blood sugar went up when I resumed taking simvastatin. I did this under my doctor's supervision and she felt it was more important to take simvastatin. At the last testing my A1C was .1 over what is considered ok.

Helen8543
March 23, 2016

Why does the doctor think you should take symvastatin? why does she assume that genetic cholesterol is necessarily bad? There are other measures, such as C reactive protein, the good vs. bad cholesterol etc to decide this.

Carole8670
May 4, 2016

There is rapidly developing, new scientific information about the reduction and management of cholesterol. From my own experience, I talked with my doctor about lowering my cholesterol - genetically based. I did not want to chance the side effects, nor did I have faith in the research that the drugs, especially with side effects, were actually helpful in reducing the kinds of health risks I was concerned about. My doctor sent me to a cardiologist who suggested supplement alternatives .... and they are working with no side effects!! Since then , I have lost 20 lbs and intend to manage all health related issues first through diet and exercise. I am 65 and am on NO medications.
I am a medical scientist, and I know I would have been put on a traditional drug routine unnecessarily if I had not stopped my doctor and asked questions about statin alternatives. But, all can do the same thing! Ask about the alternatives BEFORE automatically going along with an on-going drug perscription. Doctors are very busy, especially now with Obama care and the new rules for health care. Good doctors no longer have the time necessary to stay up to date and do the research! So, we have to be advocates and get the information for ourselves and bring it to doctors who will work with us. I think ConsumerLab is really important for health information!! Good luck!

ConsumerLab.com
May 5, 2016

Hi Carol - Thank you for your post. It begs the question: which supplements did your cardiologist recommend which you believe are working for you?

Yolanda11095
July 21, 2016

Yes, what recommended supplements worked for you?

Yolanda11096
July 21, 2016

Yes, what recommended supplements worked for you?

nancy15337
July 31, 2017

ConsumerLab.com, did Carole 8670 ever answer your question about what supplements her doctor recommended? I am interested as all my numbers are up and I cannot take a statin. I have tried phytosterols and they have done nothing. I am at my wits end. Need help.

Stephen15338
July 31, 2017

Hi Carole - You stated "My doctor sent me to a cardiologist who suggested supplement alternatives" Which "alternatives" did your cardiologist suggest?

Denise15369
August 7, 2017

What are the alternative supplements your cardiologist agreed to to lower your cholesterol. Thank you

Robin15372
August 8, 2017

Very interesting! I would love to know which supplements as well.

ConsumerLab.com
August 24, 2017

Hi Nancy - Carol has not posted which supplements were recommended by her doctor as of yet.

Inge16284
December 17, 2017

Well, Carol has not responded so I will comment hoping to help somebody.
About 30 years ago I was diagnosed with Hypercholesterolmia. My total was 360 and my LDL over 200 but my good one was around 80. I got this from my mother who’s reading was in the 900. Yes, in the 900 but she turned 85.
I was put on statin drugs but did not handle them well. These took my sleep. I tried red yeast rice and the same happened. No sleep. I finally gave up on trying to reduce my cholesterol. I exercise and eat healthy. No processed food.
Then I ran into a book which explained that we do need fat and ithe liver will produce fat if we don’t eat it. So, I increased my fat intake and even added coconut oil into my coffee and that reduced my cholesterol. I am now around 260 but my HDL stayed at that nice 80+.
I don’t have to worry about interaction. Next year I will turn 80 and been doing just fine. There are only two things I control and that is sugar and inflammation and these can be controlled easy with herbs and supplements.

Pamela16298
December 23, 2017

It would be helpful if Carol responded, so those of us who are having negative effects from statins would have some alternatives to discuss with physicians.

Pamela16304
December 27, 2017

I also have hereditary high ELL
Can you please share any other natural supplements that have helped your levels. I have tried Red Yeast rice, garlic, and was advised not to try fish oil, as I am on blood thinners. I will check out anything with my MD..

Earl18692
December 1, 2019

Could you explain why you wrote "Berberine should be avoided or used with caution when taking certain statin drugs"? I understand that both lower cholesterol and the effect might be additive. Is the concern that cholesterol might be lowered too much? Or something else? The Berberine article does not clarify.

ConsumerLab.com
December 16, 2019

Hi Earl - Berberine can potentially increase blood levels of certain statin drugs, which, in turn, can increase the risk of side effects from these drugs. Please see the "Concerns and Cautions" section of the Berberine Supplements Review for more details https://www.consumerlab.com/reviews/berberine-goldenseal-supplements-review/berberine/#cautions.

Zendia Chow18210
August 18, 2019

My husband is taking 5mg Rosuvastatin to control his cholesterol. About a month and half ago him and I are taking reishi mushroom pills, hoping to lower both of our blood sugar level, he is very high and I am at boarder line. Just had a blood test last week, the doctor is happy with our result, and ask that we keep on the same diet (we haven't changed our diet). This is encouraging, he plans on continue to take the reishi pills. My question is can he take reishi mushroom pill while he is on Rosuvastatin?

ConsumerLab.com
August 23, 2019

Hi Zendia - We are not aware of any reports or studies on interactions between reishi and statin medications.

Richard17881
May 30, 2019

I had a heart attack in the 60's. My MD's put me on meds. In the 80's I was told to take statin drugs. In 2015 I started to notice I was hurting. Loss of strength in my legs, and arms, etc., thinking slower, and pretty soon I began talking with my MD. about statins. He moved me from one statin to the next. Some were worst than others. Finally we realized, this was a situation of "quality of life". I was a very active person in my youth, now couldn't even walk a mile, so we tried a bunch of fish oils to control my triglycerides. The $500 prescription fish oils were ridiculously expensive and may have worked, but Big Pharma and I don't get along. I recently found a 3 x strength fish oil on the market and started taking that. Right now, since coming off statins in 2016, I feel a heck of a lot better. Be careful for long term side effects of Statins. The results for me were devastating.

marietta18206
August 18, 2019

I took Crestor for about 6 months and experienced muscle weakness. Researched that and found that was a side affect. Others told me the same thing happened to them. Got off of all statins, no thank you.

Carl20216
June 21, 2020

There is a lot of research that shows some patients get profound muscle weakness after taking statins. You should always discuss this with your doctor, however another branch of research suggests taking Co-Q 10 or ubiquinol alleviates that risk. I checked with my doc and he strongly suggested trying to take the Co-Q10 before ditching the atorvastatin.

Loe and behold no more muscle pains beyond that associated with getting older, almost 70, and maintaining an hour a day of cardiac exercise.

You can check out ubiquinol here on Consumer Labs and see what they say. It has other energy benefits, at least for me, but I don’t know how common that is.

Mary17800
April 29, 2019

7 years ago I began taking simvastatin for high cholesterol. 10 years ago I had had a bilateral mastectomy and my oncologist did not like the fact that my liver enzymes were above normal.
My oncologist wanted me to stop taking the statin but my primary care physician did not like that idea.

I found out the taking omega 3-6-9 might help lower my cholesterol. I purchased it from Amazon and a year later during my annual physical my annual physical my good cholesterol was out standing & my bad cholesterol was almost non existent.
My PCP told me to stop taking the Staten drug. My oncologist is now pleased with my liver enzyme test.

As long as my blood work looks this good I'll stick to omega 3, 6 and 9, which does not use Fish oil.

ConsumerLab.com
April 29, 2019

Hi Mary - Glad that your cholesterol is under control without medication. We are not aware, however, of clinical evidence that plant-based omegas from supplements lower cholesterol (we are assuming the 3-6-9 to which you are referring are plant-based) (see our Review of these at https://www.consumerlab.com/reviews/Black_Currant_Borage_Evening_Primrose_and_Flaxseed_Oils_Sources_of_ALA_and_GLA_Omega-3_and_-6_Fatty_Acids/flaxseed/). High-dose omega-3 (derived from fish oil) has been shown to reduce triglycerides, a component of total cholesterol.

George17219
October 7, 2018

Currently taking Pravastatin 40 mg and added nicotinamide riboside 250 mg daily to the regimen. Is this amount of this form of niacin (NR) safe to take concurrently with statins?

ConsumerLab.com
October 8, 2018

Hi George - We are not aware of studies specifically on the combination of this form of niacin (nicotinamide riboside) with statin medications, but, as noted above, adding high-dose niacin to statin medication does not have clear benefit and may carry serious risks. Please see the Niacin section of B Vitamins Review ( https://www.consumerlab.com/reviews/Review_Best_B_Vitamins_and_Complexes_Energy_B6_B12_Biotin_Niacin_Folic_Acid/bvitamins/#niacin) for more information.

Barbara167
September 21, 2014

If a low dosage of Crestor is taken at about 9 P.M.in the evening,
can a quarter of a cup of fresh grapefruit juice be negative to
have at 7 in the A.M.?
Thank You

ConsumerLab.com
September 22, 2014

Hi Barbara - that's a good question! We've added some information to clarify this issue. Certain statins, including Crestor, do not seem to be affected by grapefruit juice, although others are. See the second paragraph in the Answer above for more information.

Barbara171
September 22, 2014

My Thanks and Smile...I enjoy freshly squeezed grapefruit juice.

ConsumerLab.com
September 22, 2014

You're welcome - that's good news, then!

Grapefruit juice can interact with other types of medications, though, so be sure to check each medication you might be taking, or if you start a new one.

A search for "grapefruit" on our search page leads to a list of Encyclopedia articles about other medications that can be affected: https://www.consumerlab.com/Search/grapefruit-Review.

Linda542
February 12, 2015

Does eating a half grapefruit have the same effect?

ConsumerLab.com
February 24, 2015

Eating grapefruit can have the same effect as grapefruit juice. It has been estimated that as little as 200 mL of grapefruit juice can cause an interaction (Purmohamed, BMJ 2013 -- http://www.bmj.com/content/346/bmj.f1). One-half of a medium-size grapefruit is estimated to contain approximately 120 mL of juice. However, since grapefruit size -- and therefore the amount of juice -- may vary, it would seem that eating 1/2 a grapefruit may put you close the point where there is an interaction, so be careful.

Harriet 16424
February 4, 2018

Is it safe to eat grapefruit if taking livalo? Thank you.

ConsumerLab.com
February 7, 2018

Hi Harriet - The prescribing information for pitavastatin (Livalo) (http://www.kowapharma.com/documents/livalo_pi_current.pdf) shows an effect when drinking grapefruit juice, but does not state not to drink grapefruit juice, or not to eat grapefruit.

CAROL ANN16395
January 31, 2018

Your Brain Needs Cholesterol My Mum lived to 100 year and she had High Blood pressure
died of the Flesh eating disease do to a Fall.

ConsumerLab.com
February 2, 2018

Hi Carol - Thank you for sharing this. However, we are aware of one study suggesting high "bad" LDL is associated with poorer working memory https://www.ncbi.nlm.nih.gov/pubmed/27869302.

Niela16388
January 31, 2018

What regimen a person follows is a very individual thing. When I stopped my statin drug after reading how bad it was in general, even though I have had no side effects from it, and switched to red yeast rice, my cholesterol shot up to 300. When I went back on it, it dropped significantly. Since I have always had a high HDL (over 70), and now also take baby aspirin, this seems to be the best protocol for me. One size does not fit all! My doctor and I work together to figure out the best program for me.

Patricia16887
June 6, 2018

Thank God for people like Niela.

David16279
December 17, 2017

If statins were created to reduce the rate of heart attack deaths, is there any evidence to prove they have been effective at that (I think not). What is the true number needed to treat (NNT) for Lipitor or any other statin? How did the Lipitor folks derive their claim of 36% reduction? I think you will be shocked.

Disclosure: I am the author of the book, A (Patented) Heart Disease Cure that Works (Amazon) and have been off statins for ten years -- but their side effects are still with me.

Dave Leake

Kristen16396
January 31, 2018

Yes, there is evidence for reduction in events, and in mortality, especially in high risk individuals, with multiple risk factors.
Shepherd J, Cobbe S, Ford I, et al. Prevention of coronary heart disease with
pravastatin in men with hypercholesterolemia. N Eng J Med 1995;333:1301-
1307
Evidence for secondary prevention is numerous, especially in high risk individuals.

Nathaniel17785
April 24, 2019

David, thanks for your openness. I liked and found the Amazon reviews credible from personal experiences. Bought the 2nd edition today. Please check your links to Amazon from your blogspot page -- they are broken. Keep it up ... May see you in FL once I relocate.

Claudia11746
February 21, 2017

Can you give me the reason why with Berberine used with Mevacor or Crestor? Specific pathway concerns?
Thank you,
Claudia Ayon, R.N.

ConsumerLab.com
February 27, 2017

Hi Claudia - There is preliminary evidence of interactions between berberine and rosuvastatin, and evidence that berberine may decrease the activity of one of the enzymes which metabolizes this drug (CYP2C9), as well as one of the enzymes which metabolizes lovastatin (CYP3A4):
https://www.ncbi.nlm.nih.gov/pubmed/26068524
https://www.ncbi.nlm.nih.gov/pubmed/21870106?dopt=Abstract

ConsumerLab.com
February 27, 2017

Hi Claudia - This is now explained in the "Cautions" section of the CL Answer about berberine: https://www.consumerlab.com/answers/_/berberine_blood_sugar/

Claudia11673
February 12, 2017

Can Berberine be taken with Crestor
Claudia

ConsumerLab.com
February 21, 2017

Hi Claudia - We've added information about this to the answer above. Please also see the "Cautions" section of the CL Answer about berberine: https://www.consumerlab.com/answers/_/berberine_blood_sugar/

Herbert11089
July 20, 2016

Which forms of magnesium should not be taken when also taking red rice yeast? I am taking NatureMade magnesium oxide in the AM along with red rice yeast. In the evening I plan to take two out of three caps of Magtein (Magnesium L-Threonate. What do you think?
Thanks,
Herb Walcoe

ConsumerLab.com
July 20, 2016

Hi Herbert - There don't appear to be studies looking at the effect of magnesium intake on lovastatin -- the statin in red yeast rice. However, to play it safe, if you use magnesium oxide or other forms of magnesium which have an antacid effect (listed in the Magnesium Review -- https://www.consumerlab.com/reviews/_/magnesium/#forms) take the magnesium at least two hours after taking red yeast rice.

Jane16389
January 31, 2018

It is my understanding that your liver makes cholesterol at night and might be a better idea to take the red rice yeast before going to be and the Mg in the am.

ConsumerLab.com
January 31, 2018

Thanks Jane, please see our CL Answer about the best time of day to take red yeast rice: https://www.consumerlab.com/answers/when-is-the-best-time-of-day-to-take-red-yeast-rice/when-to-take-red-yeast-rice/.

Ronda11086
July 20, 2016

I wanted to thank Consumer Lab for being so honest in your answers to questions. I appreciate all the information you have on your website and how comprehensive it is.

ConsumerLab.com
July 20, 2016

Thank you for your kind words Ronda!

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