Drug class·Statins·Reviewed June 9, 2026
Statins and supplements: what to avoid, what to replace.
Statins have two recurring supplement stories: substances that raise statin levels by blocking the enzymes that clear them, and the CoQ10 depletion that can accompany long-term use. Both are documented per drug below, because simvastatin and pravastatin do not behave the same.
Statins at a glance.
A quick, data-grounded summary. The per-drug tables are below.
Across the 5 statins in the NutriStack database (Atorvastatin, Simvastatin, Lovastatin, Rosuvastatin, and Pravastatin), 13 substances have a documented interaction, 4 of them flagged to avoid or as a serious conflict. Long-term use of some medications in this class is also associated with lower CoQ10; the depletion table shows exactly which drugs. Interactions are documented per drug, and members of a class do not all behave the same, so check your exact medication below. None of this replaces your prescriber's advice.
The statins we track.
Open any medication for its own full interaction and depletion guide.
Substances that interact with statins.
Merged across the class, highest severity first. The 'Documented for' column shows which members carry the interaction record; an absent drug means no documented record, not proven safety.
| Substance | Interaction | Documented for | What happens |
|---|---|---|---|
| Grapefruit Juice | Contraindicated | Atorvastatin, Simvastatin, Lovastatin | Simvastatin: Grapefruit juice inhibits intestinal CYP3A4 and can substantially increase simvastatin exposure, raising myopathy and rhabdomyolysis risk. |
| Clarithromycin | Contraindicated | Atorvastatin, Simvastatin | Simvastatin: Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin plasma levels (up to 10-fold), greatly increasing the... |
| St. John's Wort | Conflict | Atorvastatin, Simvastatin, Lovastatin +1 more | Atorvastatin: St. John's Wort is a potent CYP3A4 inducer that significantly increases atorvastatin metabolism, reducing its plasma levels and... |
| Green Tea Extract | Conflict | Atorvastatin, Rosuvastatin | Atorvastatin: Green tea extract reduced atorvastatin peak concentration and overall exposure in a human crossover study. The effect appears related to... |
| Vitamin B3 | Caution | All 5 statins | Atorvastatin: High-dose niacin (>1g/day) combined with atorvastatin may increase the risk of myopathy and rhabdomyolysis. The AIM-HIGH and HPS2-THRIVE... |
| Berberine | Caution | Atorvastatin, Simvastatin, Lovastatin | Atorvastatin: Berberine has human evidence of inhibiting CYP3A4 activity after repeated dosing, and atorvastatin is partly cleared through CYP3A4. This... |
| Ginkgo Biloba | Caution | Atorvastatin | A human study found that high-dose Ginkgo biloba extract modestly lowered atorvastatin exposure, including a larger drop in peak... |
| Quercetin | Caution | Pravastatin | Quercetin increased pravastatin exposure in a human study by inhibiting OATP1B1-mediated transport. The average increase was modest, but... |
| Tribulus Terrestris | Caution | Atorvastatin | A case report described rhabdomyolysis after Tribulus terrestris was started in a patient taking long-term atorvastatin. Causality is not... |
| Coenzyme Q10 | Synergy | All 5 statins | Atorvastatin: Atorvastatin can lower circulating CoQ10 because cholesterol and CoQ10 synthesis share the mevalonate pathway. Lower CoQ10 is one proposed... |
| Coenzyme Q10 Ubiquinol | Synergy | All 5 statins | Atorvastatin: Atorvastatin inhibits HMG-CoA reductase, which also reduces endogenous CoQ10 synthesis. Statin-induced CoQ10 depletion may contribute to... |
| Fish Oil | Synergy | Atorvastatin, Simvastatin, Rosuvastatin | Atorvastatin: Fish oil omega-3 fatty acids can add triglyceride lowering to statin therapy. Randomized studies of high-dose omega-3 fatty acids added to... |
| Psyllium Husk | Synergy | Atorvastatin, Simvastatin | Atorvastatin: Psyllium husk can add LDL-lowering benefit to statin therapy through a non-statin mechanism. A randomized atorvastatin study and a... |
What statins can deplete.
Nutrients associated with long-term use somewhere in this class, worst documented severity first. Discuss any replacement with your prescriber.
| Nutrient | Severity | Documented for | Replace with | Monitor |
|---|---|---|---|---|
| CoQ10 | Moderate | All 5 statins | Coenzyme Q10 Ubiquinol | Plasma CoQ10 |
Common statins questions.
Quick answers drawn from the tables above.
What supplements should I avoid with statins?
Across the class, 4 substance pairings are flagged to avoid or as a serious conflict, including Grapefruit Juice, Clarithromycin, St. John's Wort, and Green Tea Extract. The exact risk depends on which medication in the class you take, so check your specific drug's page and confirm with your prescriber.
Do all statins interact with supplements the same way?
No. Interactions are documented per drug, and the 5 statins in the database differ in how they are absorbed and cleared. The class table above shows which members carry each record; a drug without a record is undocumented, not proven safe.
Do statins deplete any nutrients?
Some medications in this class are documented to lower CoQ10 with long-term use; the depletion table on this page shows which specific drugs carry each record. Useful biomarkers to monitor include Plasma CoQ10. Ask your prescriber before adding a replacement supplement.
Is it safe to take Grapefruit Juice with statins?
NutriStack classifies the Grapefruit Juice and Simvastatin pairing as contraindicated: Grapefruit juice inhibits intestinal CYP3A4 and can substantially increase simvastatin exposure, raising myopathy and rhabdomyolysis risk. The interaction is documented for 3 of the 5 statins, and severity differs by drug. Always confirm with your prescriber.
Check your whole stack
See how your medication fits your supplements.
NutriStack screens your full routine for interactions and depletions, and updates the moment you change it.