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Topic Contents

Rosuvastatin

Drug Information

Rosuvastatin is used along with dietary changes to reduce total and LDL ("bad") cholesterol and fat levels in the blood, and to increase HDL ("good") cholesterol levels. It belongs to a class of drugs called HMG-CoA reductase inhibitors.

Common brand names:

Crestor

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Coenzyme Q10

    In a group of patients beginning treatment with atorvastatin (a drug similar to rosuvastatin), 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 In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.2 A double-blind trial also found that CoQ10 (200 mg per day) significantly decreased drug-induced muscle symptoms in people taking statin drugs.3

    However, in another double-blind trial, CoQ10 in the amount of 60 mg twice a day for one month was not more effective than a placebo for relieving muscle pain.4 Although the evidence is conflicting regarding whether supplementing with CoQ10 relieves statin-induced muscle symptoms, many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.

Reduce Side Effects

  • Coenzyme Q10

    In a group of patients beginning treatment with atorvastatin (a drug similar to rosuvastatin), the average concentration of coenzyme Q10 in blood plasma decreased within 14 days, and had fallen by approximately 50% after 30 days of treatment.5 In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.6 A double-blind trial also found that CoQ10 (200 mg per day) significantly decreased drug-induced muscle symptoms in people taking statin drugs.7

    However, in another double-blind trial, CoQ10 in the amount of 60 mg twice a day for one month was not more effective than a placebo for relieving muscle pain.8 Although the evidence is conflicting regarding whether supplementing with CoQ10 relieves statin-induced muscle symptoms, many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.

  • Creatine Monohydrate
    In a preliminary study, ten patients who had to discontinue statin drugs because of muscle-related side effects were given creatine (as creatine monohydrate) in the amount of 5 grams twice a day for five days, then 5 grams per day. Eight of the ten patients experienced no muscle symptoms upon resuming the statin drug.9
  • Vitamin D
    In a preliminary trial, supplementation with vitamin D appeared to prevent muscle-related side effects in patients taking statin drugs.10 The amount of vitamin D used in this study was very large (up to 50,000 IU twice a week) and potentially toxic. People taking statin drugs should consult with their doctor regarding how much vitamin D can be taken.

Support Medicine

  • Fish Oil

    In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.11 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Psyllium
    In one study, the addition of psyllium (10 grams per day) enhanced the cholesterol-lowering effect of lovastatin12.
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • 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.13

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Pomegranate

    In a case report, a man taking rosuvastatin developed severe muscle damage (rhabdomyolysis), a known side effect of rosuvastatin, after he began drinking pomegranate juice (about 6 ounces twice a week). While a cause–effect relationship was not proven, the authors of this report suggested that pomegranate may have increased the toxicity of rosuvastatin by slowing the rate at which the body broke it down.14

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Red Yeast Rice

    A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids.15 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Vitamin B3

    A recent blinded study showed that individuals taking both rosuvastatin and niacin had a greater increase in HDL (“good”) cholesterol and apolipoprotein A-I than did those taking rosuvastatin alone.16 People taking rosuvastatin might benefit from taking niacin, though they should consult with their healthcare provider before starting the supplement. When taken with niacin, some statin drugs may become more toxic so there is a possibility of an adverse interaction.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

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. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.

3. Fedacko J, Pella D, Fedackova P, et al. Coenzyme Q10 and selenium in statin-associated myopathy treatment. Can J Physiol Pharmacol2013;91:165–70.

4. Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol 2012;110:526-9.

5. 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.

6. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.

7. Fedacko J, Pella D, Fedackova P, et al. Coenzyme Q10 and selenium in statin-associated myopathy treatment. Can J Physiol Pharmacol2013;91:165–70.

8. Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol 2012;110:526-9.

9. Shewmon DA, Craig JM. Creatine supplementation prevents statin-induced muscle toxicity. Ann Intern Med 2010;153:690-2.

10. Glueck CJ, Budhani SB, Masineni SS, et al. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin 2011;27:1683-90.

11. 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.

12. Agrawal AR, Tandon M, Sharma PL. Effect of combining viscous fibre with lovastatin on serum lipids in normal human subjects. Int J Clin Pract 2007;61:1812-8.

13. 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.

14. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705-6.

15. 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.

16. Capuzzi DM, Morgan JM, Weiss RJ, et al. Beneficial effects of rosuvastatin alone and in combination with extended-release niacin in patients with a combined hyperlipidemia and low high-density lipoprotein cholesterol levels. Am J Cardiol 2003;91:1304-10.

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