In a group of patients beginning treatment with atorvastatin, the average concentration of coenzyme Q10 in blood plasma decreased within 14 days, and had fallen by approximately 50% after 30 days of treatment. Many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.

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. 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.

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.

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. A double-blind trial also found that CoQ10 (200 mg per day) significantly decreased drug-induced muscle symptoms in people taking statin drugs.

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. 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.

One of the possible side effects of lovastatin is liver toxicity. Although there are no clinical studies to substantiate its use with lovastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of lovastatin. The suggested use is 200 mg of the extract three times daily.

This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.

Oxidative damage to LDL (“bad”) cholesterol is widely believed to contribute to heart disease. In a double-blind trial, lovastatin was found to increase oxidative damage to LDL cholesterol and vitamin E was reported to protect against such damage, though not to completely overcome the negative effect of lovastatin. This study suggests that people taking lovastatin might benefit from supplemental vitamin E.