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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.

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

Summary of Interactions for Atorvastatin

Depletion or interference Coenzyme Q10
Adverse interaction Vitamin A*
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Other (see text) Magnesium hydroxide
Magnesium oxide
Magnesium-containing antacids
Niacin

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

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.