Medication·Interactions & depletion·Reviewed June 9, 2026
Simvastatin interactions.
Simvastatin has 9 documented interactions in the NutriStack database, including 3 flagged to avoid or as a serious conflict. Prolonged use is also associated with lower CoQ10. The full interaction list, depletion table, and replacement suggestions are below. None of this is a substitute for your prescriber's advice.
Simvastatin at a glance.
A quick, data-grounded summary. The full tables are below.
Simvastatin has 9 documented interactions in the NutriStack database, including 3 flagged to avoid or as a serious conflict. Prolonged use is also associated with lower CoQ10. The full interaction list, depletion table, and replacement suggestions are below. None of this is a substitute for your prescriber's advice.
Substances that interact with simvastatin.
Every supplement and medication in the NutriStack database with a documented interaction with this drug, highest-severity first. Open any pair for the mechanism and sources.
| Substance | Interaction | What happens |
|---|---|---|
| Clarithromycin | Contraindicated | Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin plasma levels (up to 10-fold), greatly increasing the risk of... details → |
| Grapefruit Juice | Contraindicated | Grapefruit juice inhibits intestinal CYP3A4 and can substantially increase simvastatin exposure, raising myopathy and rhabdomyolysis risk. details → |
| St. John's Wort | Conflict | St. John's Wort dramatically reduces simvastatin levels through potent CYP3A4 induction. Simvastatin is highly dependent on CYP3A4 for metabolism,... details → |
| Berberine | Caution | Simvastatin is strongly affected by CYP3A4 inhibitors, and berberine has human evidence of inhibiting CYP3A4 activity with repeated dosing. This may... |
| Vitamin B3 | Caution | The combination of high-dose niacin with simvastatin carries an elevated risk of myopathy and rhabdomyolysis. Simvastatin already has a higher... details → |
| Coenzyme Q10 | Synergy | Simvastatin can reduce circulating CoQ10 by inhibiting the same pathway used to make cholesterol. CoQ10 supplementation has mixed but plausible... details → |
| Coenzyme Q10 Ubiquinol | Synergy | Simvastatin inhibits HMG-CoA reductase, reducing endogenous CoQ10 synthesis as a consequence of mevalonate pathway inhibition. Simvastatin may cause... details → |
| Fish Oil | Synergy | Fish oil omega-3 fatty acids can improve triglyceride and non-HDL cholesterol measures when added to simvastatin in patients with residual... details → |
| Psyllium Husk | Synergy | Psyllium husk can enhance LDL lowering when added to simvastatin. In a randomized trial, low-dose simvastatin plus psyllium produced LDL lowering... details → |
What simvastatin can deplete.
Nutrients this medication is associated with lowering over time, with the mechanism, a suggested replacement where one applies, and the biomarker to monitor. Discuss any replacement with your prescriber first.
| Nutrient | Severity | How it happens | Replace with | Monitor |
|---|---|---|---|---|
| CoQ10 | Moderate | HMG-CoA reductase inhibition reduces mevalonate pathway flux, lowering endogenous CoQ10 synthesis alongside cholesterol synthesis. | Coenzyme Q10 Ubiquinol | Plasma CoQ10 |
The full simvastatin profile.
Uses, typical dosing, side effects, and the cited evidence for this medication.
Common simvastatin questions.
Quick answers drawn from the tables above.
What interacts with Simvastatin?
In the NutriStack database, Simvastatin has 9 documented interactions. The most notable include Clarithromycin, Grapefruit Juice, St. John's Wort, Berberine, and Vitamin B3. Check any specific combination before taking it and confirm with your prescriber.
Which substances should I avoid with Simvastatin?
Simvastatin is flagged against 3 substances in the database, including Clarithromycin, Grapefruit Juice, and St. John's Wort. These pairings carry a higher risk and should be reviewed with a clinician before combining.
Does Simvastatin deplete any nutrients?
Simvastatin is associated with lowering CoQ10 with prolonged use. Useful biomarkers to monitor include Plasma CoQ10. Ask your prescriber before adding any replacement supplement.
Is it safe to take Clarithromycin with Simvastatin?
NutriStack classifies the Clarithromycin and Simvastatin pairing as contraindicated: Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin plasma levels (up to 10-fold), greatly increasing the risk of severe rhabdomyolysis,... Contraindicated. Suspend simvastatin during clarithromycin treatment. If statin therapy is needed, use pravastatin or rosuvastatin (not CYP3A4... Always confirm with your prescriber.
Check your whole stack
See how simvastatin fits your supplements.
NutriStack screens your full routine for interactions and depletions, and updates the moment you change it.