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Dynamic Chiropractic – February 12, 2010, Vol. 28, Issue 04

Lipitor: Common Drug-Nutrient Interactions

By Todd Mexico, DC and Brandon Blood, DC

According the Centers for Disease Control & Prevention (CDC), nearly half of Americans are currently taking prescription drugs.1 This number is likely not a surprise to anyone reading this article.

Medications, by their very nature, impact the delicate biochemical orchestra that takes place in our bodies. These medications obviously are intended to improve the function of a given system, but we all know that medications have negative side effects as well.

Wouldn't you love to help your patients reduce these side effects and improve their overall wellness? Did you know that many medications can benefit from the addition of specific nutritional supplements to both reduce the side effects of the drug and also improve the drug's overall action? Lets take a look at Lipitor as an example.

According to IMS National Health Perspectives, Lipitor (atorvastatin) led all pharmaceutical sales in 2007, grossing approximately $8 billion. Lipitor is the most commonly prescribed HMG-CoA reductase inhibitor (statin) for reducing cholesterol levels. HMG-CoA reductase is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis. The purpose of this article is not to call into question the effectiveness of Lipitor, but to highlight the fact that this medication is very commonly prescribed and carries various biochemical side effects; and to review research on various nutritional supplements that may improve (or hinder) the intended action of Lipitor when taken in combination with it. Understanding this research will allow you to make specific supplement recommendations to mitigate these side effects and improve the action of the drug.

Potential Positive Supplement Interactions With Lipitor

CoQ10: Co-enzyme Q10 (CoQ10) synthesis is impaired by statin medications. Supplementation with CoQ10 may be recommended for patients taking Lipitor to help restore the enzyme depletion by this drug. Lipitor is also known to cause reduced energy levels in individuals taking it for cholesterol management. This side effect is common since Lipitor reduces the production of CoQ10, which is a key enzyme in ATP synthesis.2

Carnitine: This supplement may provide a synergistic lipid-lowering property when combined with statins.3

Garlic (Allium sativum): Garlic supplementation may increase the effectiveness of Lipitor.4

Fish Oil (Omega 3): In combination with statins, fish oils may help improve lipid profiles.5

Selenium: This supplement may enhance the cholesterol-lowering effect of Lipitor.6

The above-mentioned nutritional supplements may prove to be effective at reducing the side effects of Lipitor while also improving the drug's intended action. These recommendations may provide a benefit to your patients who are currently taking Lipitor or other statin drugs.

It is equally important, however, to make sure that your nutritional supplement recommendations are not contraindicated with a specific drug, as they may cause a negative interaction when combined. Below are a few potentially negative interactions that can occur when certain nutritional supplements are taken in combination with Lipitor.

Potential Negative Supplement Interactions With Lipitor

Magnesium: This supplement may Interfere with Lipitor absorption. For this reason, patients should be advised to take Lipitor and magnesium supplements at different times during the day (at least two hours apart).7

Vitamin B3 (niacin): This is a tricky one since niacin may also increase HDL cholesterol and is often beneficial for patients taking Lipitor. However, too much niacin may lead to an increased risk of rhabdomyolysis when used with Lipitor.8 For this reason, if you are recommending niacin to a patient taking Lipitor, you should be sure to co-manage this recommendation with the patient's primary medical provider.

The findings above are not inclusive of the potential drug-nutrient interactions or benefits of Lipitor. They are just a sample of the information that has been researched. It is important for chiropractors to analyze all of the medications and nutritional supplements their patients are taking for possible beneficial and negative interactions. It is perhaps equally important to document these results in a manner that exhibits due diligence on the part of the observing chiropractor from a medical-legal standpoint. By understanding this research and applying your nutritional knowledge in practice, you will likely also see an increase in patient confidence in you and the care you provide.

References

  1. See www.cdc.gov/nchs/FASTATS/drugs.htm.
  2. 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.
  3. Solfrizzi V, Capurso C, Colacicco AM, et al. Efficacy and tolerability of combined treatment with l-Carnitine and simvastatin in lowering lipoprotein (a) serum levels inpatients with type 2 diabetes mellitus. Atherosclerosis, 2006;188:455-61.
  4. Liu L, Yeh YY. S-alk(en)yl cysteines of garlic inhibit cholesterol synthesis by deactivating HMG-CoA reductase in cultured rat hepatocytes. J Nutr, 2002;132:1129-34.
  5. Davidson MH, Stein EA, Bays HE, et al. Efficacy and tolerability of adding prescription omega-3 fatty acids 4 g/d to simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled study. Clin Ther, 2007;29:1354-67.
  6. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med, 2001;345:1583-92.
  7. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors. In: Facts and Comparisons Drug Information, 1998:172a.
  8. Yee HS, Fong NT. Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother, 1998;32:1030-43.

Dr. Todd Mexico is 2006 graduate of Palmer College of Chiropractic Florida and co-founder of eMedFx.com. Dr. Mexico practices in Baldwinville, Mass.

Dr. Brandon Blood is 2006 graduate of Palmer College of Chiropractic Florida and co-founder of eMedFx.com. Dr. Blood maintains a practice in Canton, Ohio.


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