What vitamins should not be taken with rosuvastatin?

In this article:

• Vitamins to avoid on rosuvastatin
• General guidelines for statins
• The bottom line

In this article

• Vitamins to avoid on rosuvastatin
• General guidelines for statins
• The bottom line

Rosuvastatin, also sold under the brand name Crestor, is a prescription medication used to treat high cholesterol. As part of a group of drugs called statins, rosuvastatin lowers LDL cholesterol and triglyceride levels while raising HDL cholesterol, helping to reduce your risk for heart attack and stroke. There are several drug interactions with rosuvastatin, like blood thinners, antacids, gemfibrozil, fenofibrate, and the gout medication colchicine. A few over-the-counter (OTC) vitamins and supplements interact as well. The most notable is vitamin B3, or niacin, which can cause unwanted side effects when combined with rosuvastatin. Here’s what to know.

What vitamins should not be taken with rosuvastatin?

Unlike prescription and OTC medications, vitamins and supplements aren’t regulated by the U.S. Food and Drug Administration (FDA) or any other organization. Although many supplement manufacturers have their products tested for quality and safety by third parties, this isn’t a required step before selling them to consumers. 

That means the supplements you take could contain unlisted ingredients or different amounts of active ingredients than what’s indicated on the label. It also means they haven’t been studied as carefully as prescription drugs, so we don’t know exactly how much people should take for their health. In general, most supplements appear to be safe to combine with rosuvastatin, but there are some exceptions. To note, these interactions can occur with other statin medications such as Lipitor (atorvastatin) and Zocor (simvastatin), so seek medical advice from a healthcare professional before taking any supplements if you’re on this class of medication. 

Niacin (B3)

Niacin is a B vitamin that has been shown to lower triglyceride levels and raise HDL cholesterol. Many people try taking niacin instead of or in addition to prescription cholesterol-lowering medications, but it’s considered unsafe to combine with rosuvastatin.

“My general take on niacin is that there are more harms than benefits with this supplement,” says Yu-Ming Ni, MD, cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California. 

Although niacin does affect cholesterol levels in a positive way, Dr. Ni says it’s never been shown in large studies to improve a person’s risk for heart disease or lower their risk of dying from cardiovascular causes. On top of that, he adds, it has some significant side effects, including flushing, dizziness, and increased risk for diabetes.

It may also increase your risk for muscle pain and a rare type of muscle damage called rhabdomyolysis, says Jack Cappitelli, MD, internist and chief medical officer, New Jersey Region, of Summit Health. People taking statins already have a higher risk of muscular symptoms; adding niacin to the mix can increase the chances of this side effect even more.

Red yeast rice  

Red yeast rice is a natural supplement made from a fungus called Monascus purpureus. It contains a compound, monacolin K, that is chemically identical to another statin (lovastatin). This gives red yeast rice its reputation as a “natural statin,” says Dr. Cappitelli, but while it has positive effects on cholesterol, you should never combine red yeast rice with any statins.

Taking it along with your dose of rosuvastatin can increase your risk for statin-related side effects like muscle pain, liver problems, kidney problems, and gastrointestinal distress, including stomach pain, heartburn, and gas.

St. John’s wort 

Statin drugs are metabolized by the liver, says Dr. Ni, so it’s important not to mix them with medications or supplements that affect the enzymes responsible for this metabolization. 

St. John’s wort, for example—an herbal supplement often taken as a way to naturally relieve insomnia, anxiety, and menopause symptoms—is well-known to inhibit enzymes in the CYP family, which helps metabolize statins. St. John’s wort interacts with many different prescription and OTC medications, and at least one study suggests that it could cause your body to clear rosuvastatin too quickly from your system, limiting the medication’s ability to lower your cholesterol levels.  

Magnesium 

In general, people taking rosuvastatin can also take magnesium, but you should always talk about it with your healthcare provider first. Rosuvastatin shouldn’t be taken at the same time as certain antacids, for example, like those containing aluminum hydroxide and magnesium hydroxide. This could affect how well rosuvastatin is absorbed and make it less effective. Instead, take your statin at least 2 hours before or 4 hours after taking these types of antacids.

Otherwise, magnesium is likely safe to combine with rosuvastatin. In fact, Dr. Ni says she sometimes recommends magnesium to her rosuvastatin patients if they are having trouble sleeping, since the supplement can work as a natural sleep aid.

Vitamin D

Similar to magnesium, most people can safely take normal amounts of vitamin D with rosuvastatin. In fact, some studies show that vitamin D raises HDL cholesterol levels and decreases LDL cholesterol levels, potentially making the supplement beneficial to people with high cholesterol. However, these results are strongly debated, and the evidence for—and against—vitamin D’s role in lowering cholesterol is mixed.   

That wouldn’t matter if rosuvastatin and vitamin D didn’t interact at all, but there’s some evidence that statin-related side effects like muscle pain are higher when the medication is combined with vitamin D. Again, we recommend asking your provider before taking the two together.

General guidelines for taking supplements with statins

The most important thing to do when considering taking a supplement with your statin is to talk to your healthcare provider. There are some supplements that are not only safe to combine with statins but also potentially beneficial for people with high cholesterol. However, both Drs. Cappitelli and Ni say there are no supplements that need to be taken with statins, and all of them need your provider’s stamp of approval first.  

Some supplements that may help you manage your high cholesterol alongside a statin include:

• Coenzyme Q10 (CoQ10): Some people find that CoQ10 supplements reduce the muscle-related symptoms of taking statins, but Dr. Ni says it’s hard to predict who will benefit from CoQ10. He adds that many people feel better after adjusting to their statin, so he often recommends his patients take it every other day at first if they’re experiencing muscle pain and skip the CoQ10.
• Omega-3 fatty acids: Dr. Cappitelli says omega-3 fatty acids are a safe addition to your diet, especially if your HDL is low and your triglycerides are high. Omega-3s can lower triglyceride levels and decrease your risk of a heart attack. 
• Vitamin K2: Some animal studies show that this vitamin slows down the build-up of plaque in the arteries, Dr. Ni says, but that hasn’t been supported by human studies yet. “If my patient insists on taking vitamin K2 alongside their statin, I am fine with that,” he adds, “but I don’t routinely recommend it.”

Even though some of these supplements could be beneficial when taken with your statin, we still recommend getting your provider’s approval beforehand.

The bottom line

Taking certain supplements with rosuvastatin can decrease how well the medication works for you or increase your risk of statin-related side effects, especially muscle pain. You should generally avoid niacin (B3), red yeast rice, and St. John’s wort with rosuvastatin. Be sure to talk with your provider before taking any other vitamin or supplement, including magnesium or vitamin D. Your provider can make sure the supplement is appropriate for your overall health and safe to combine with rosuvastatin; they may also suggest specific brands they trust, since supplements aren’t regulated by the FDA.