CoQ10, Statins and the Supplements to Avoid

Statin drugs lower the amount of CoQ10 in your blood¹, but whether a CoQ10 supplement eases statin muscle aches is still unsettled: pooled trials range from no benefit² to a modest drop in pain³. CoQ10 has no known interaction with statins, though warfarin users should check first. The supplements to avoid are red yeast rice, high-dose niacin and St John's wort.

This guide is about the drug: what to avoid, what to space out and what is fine. For its other uses and dosing, see our evidence page for this supplement. For the choice between forms, see ubiquinol vs ubiquinone.

Yes, at least in the blood. Statins block HMG-CoA reductase, the enzyme that starts cholesterol production, and the same pathway also makes CoQ10 (coenzyme Q10, a molecule mitochondria use to make energy)⁴. The body makes its own CoQ10, with the highest levels in the heart, liver, kidneys and pancreas⁵.

Two meta-analyses of placebo-controlled trials measured the drop:

• 8 treatment arms (2015): statins lowered plasma CoQ10 by 0.44 µmol/L on average, and the fall was significant for atorvastatin, simvastatin, rosuvastatin and pravastatin alike¹.
• 12 trials, 1,776 people (2018): statins lowered circulating CoQ10 whatever the intensity, whether the statin was fat-soluble or water-soluble, and however long people had taken it⁶.

Whether statins lower CoQ10 inside muscle is unsettled, and blood levels are a poor guide to what is in cells⁴. In a randomized trial of 48 patients, 8 weeks of simvastatin 80 mg cut muscle CoQ10 from 39.7 to 26.4 nmol/g, while atorvastatin 40 mg and placebo did not⁷. In 64 long-term simvastatin users, muscle CoQ10 matched untreated people, and was no lower in those with muscle pain⁸. Oral CoQ10 also isn't proven to raise CoQ10 inside human muscle mitochondria⁹.

Does rosuvastatin reduce CoQ10?

Yes. In the 2015 meta-analysis rosuvastatin lowered plasma CoQ10 by 0.49 µmol/L, about the same as atorvastatin (0.41 µmol/L)¹. Water-soluble statins such as rosuvastatin and pravastatin lowered it as much as fat-soluble ones¹.

The evidence is limited and conflicting. The pooled analyses point in different directions depending on which trials they include:

• No benefit, 6 trials, 302 patients (2015): no significant effect on muscle pain or on creatine kinase, a blood marker of muscle damage, and no dose-response¹⁰.
• Benefit, 12 trials, 575 patients (2018): less muscle pain, weakness, cramps and tiredness, but no change in creatine kinase¹¹.
• No benefit, 7 trials, 321 patients (2020): no improvement in muscle pain, and no more patients stayed on their statin (risk ratio 0.99)².
• Small benefit, 7 trials, 389 patients (2025): pain intensity fell slightly with 100-600 mg a day for 30-90 days; 4 trials were positive and 3 showed no change³.

The individual trials split the same way. In 50 people with mild-to-moderate symptoms, 50 mg twice daily for 30 days cut pain severity from 3.9 to 2.9 points, with no change on placebo¹². In 32 patients, 100 mg a day cut pain severity by 40% over 30 days, while 400 IU of vitamin E did nothing¹³. But in 76 patients, 60 mg twice daily did no better than placebo after 1 month (3.9 vs 4.0 cm on a 10-cm pain scale)¹⁴.

The most rigorous trial was negative. Researchers first confirmed statin myalgia with a blinded simvastatin-or-placebo test: only 36% of 120 people with past muscle pain got pain on the statin and not on placebo¹⁵. The 41 confirmed patients then took 600 mg of ubiquinol or placebo for 8 weeks. Blood CoQ10 rose from 1.3 to 5.2 µg/mL, yet CoQ10 did not reduce pain or improve strength or fitness compared with placebo¹⁵.

The US National Center for Complementary and Integrative Health sums it up: individual studies vary, but the overall evidence does not support CoQ10 for statin muscle pain⁵.

Why don't doctors recommend CoQ10 with statins?

Because the one trial that confirmed statin myalgia before testing CoQ10 found no benefit¹⁵, and pooled trials show no better adherence to the statin². Many people enrolled in earlier CoQ10 studies may have had muscle pain from another cause, which blurs the results⁹.

What happens if you don't take CoQ10 with statins?

Nothing harmful has been shown. Blood CoQ10 falls, but muscle studies disagree on whether tissue levels drop^{7, 8}, no study has shown that a drop causes harm⁴, and patients given CoQ10 were no more likely to stay on their statin than those given placebo².

Related conditions

• High Cholesterol (Dyslipidemia)
• Muscle Weakness
• Muscle Cramps

The statin trials used 100-600 mg a day³, and higher doses did not work better: the 2015 meta-analysis found no link between dose and effect on pain¹⁰. The two positive trials above used 100 mg a day, the null ones 120 mg and 600 mg^{12, 13, 14, 15}.

No trial tested timing against the statin dose. In the trials, CoQ10 was taken alongside the daily statin, and in one trial cholesterol, liver enzymes and muscle enzymes did not change over 30 days of CoQ10¹². So CoQ10 does not appear to blunt the statin's effect.

Can you take CoQ10 with atorvastatin or rosuvastatin?

Yes. Both statins lower blood CoQ10¹, and we found no evidence that CoQ10 makes either drug less effective. The NCCIH lists possible interactions with warfarin and insulin, not statins, and says CoQ10 may not be compatible with some cancer treatments⁵.

Avoid anything that adds a second statin, raises statin levels or cancels the statin out. These have the clearest evidence:

• Red yeast rice. Its monacolin K is structurally identical to the prescription statin lovastatin, and products rich in it carry the same side effects as statins, including muscle, kidney and liver damage, and the same drug interactions¹⁶. Of 28 US brands, 2 had no monacolin K and the other 26 ranged more than 60-fold, from 0.09 to 5.48 mg per 1,200 mg of red yeast rice¹⁷. Some products also contain citrinin, a contaminant that can damage the kidneys¹⁶. Italy's surveillance system logged 55 suspected reactions, including 19 muscle reactions, 1 rhabdomyolysis and 10 liver injuries¹⁸. Taking it with a statin doubles up on the same drug class. Our red yeast rice for high cholesterol page covers it on its own.
• Niacin at lipid-lowering doses. The rosuvastatin label warns that 1 g a day or more of niacin raises the risk of myopathy (muscle damage) and rhabdomyolysis (severe muscle breakdown)¹⁹. In the HPS2-THRIVE trial of 25,673 high-risk patients, 2 g of extended-release niacin (combined with laropiprant) added to simvastatin 40 mg raised definite myopathy from 0.04% to 0.16% a year²⁰. See vitamin B3 (niacin).
• St John's wort. In 8 healthy men, 300 mg three times daily for 14 days cut exposure to simvastatin's active form by about half; in 8 others it had no effect on pravastatin²¹. In 16 patients on atorvastatin, LDL cholesterol was 2.66 mmol/L after 4 weeks of St John's wort, against 2.34 mmol/L after 4 weeks of a control tablet²². See St John's wort.
• High-dose antioxidant mixes with statin plus niacin. In a 3-year trial of 160 patients with coronary disease, vitamins E and C, beta-carotene and selenium blunted the protective rise in HDL2 (a subtype of HDL cholesterol) from simvastatin plus niacin²³. Stenosis regressed by 0.4% on the drugs alone but progressed by 0.7% when the antioxidants were added²³. This tested the statin-niacin pair, not a statin alone.

Is grapefruit juice a problem?

For some statins, yes. The FDA requires grapefruit warnings on some statins and names simvastatin and atorvastatin as examples²⁴. Grapefruit juice blocks the gut enzyme CYP3A4, so more of the drug reaches the blood and the risk of liver and muscle damage rises²⁴.

• Simvastatin: large amounts of double-strength juice raised simvastatin exposure 16-fold²⁵. A daily glass raises simvastatin levels by about 260% if taken at the same time, or about 90% if taken 12 hours apart²⁶.
• Atorvastatin: the same heavy intake raised exposure to the active drug 2.5-fold²⁷. A daily glass raises atorvastatin by about 80%, whenever it is taken²⁶.
• Pravastatin: no meaningful change²⁷.

The FDA adds that Seville oranges, pomelos and tangelos may act the same way²⁴. One review argues that a single daily glass is not a reason to refuse a statin²⁶. Ask your pharmacist how much, if any, is safe with your statin.

Antacids that combine aluminum hydroxide and magnesium hydroxide cut rosuvastatin exposure by 50% when taken together¹⁹. The label says to take rosuvastatin at least 2 hours before the antacid¹⁹.

Can you take magnesium with rosuvastatin?

The label's tested interaction is with that combined antacid¹⁹; it says nothing about magnesium supplements such as glycinate or citrate, and we found no study of them with rosuvastatin. Taking the statin 2 hours before any magnesium product costs nothing and matches the label's advice for antacids. See magnesium for its own evidence.

Several common supplements have been tested with statins without harm. Psyllium has the clearest evidence of adding to the effect, and berberine showed added lowering in lower-quality trials:

• Psyllium. In a 12-week trial of 68 patients, simvastatin 10 mg plus 15 g of psyllium a day had lowered LDL by 63 mg/dL at 8 weeks, against 55 mg/dL on simvastatin 10 mg alone²⁸. That matched simvastatin 20 mg²⁸. See psyllium for high cholesterol.
• Vitamin D. Safe, but it does not prevent statin muscle symptoms. Among 2,083 new statin users in a randomized trial, 2,000 IU a day left muscle symptoms at 31% in both groups and statin discontinuation at 13% in both²⁹. A smaller 2024 trial also found no benefit³⁰. See vitamin D.
• Berberine. In 63 patients, berberine with simvastatin lowered LDL by 31.8%, more than either alone³¹. A meta-analysis of 11 trials in 1,386 patients found fewer liver-enzyme rises and muscle aches with berberine than with control treatments, but more constipation, and rated the trials' quality as poor³². See berberine for high cholesterol.
• CoQ10. No serious side effects have been reported; mild insomnia or stomach upset can occur⁵.

Supplements in this guide

• CoQ10
• Red Yeast Rice
• Vitamin B3
• St. Johns Wort
• Psyllium Husk
• Berberine

The people at most risk are those who stack a second cholesterol drug on top of the statin:

• Anyone taking red yeast rice or lipid-dose niacin as well: both add muscle and liver risk^{16, 19}.
• People aged 65 or older, with kidney impairment, with untreated underactive thyroid, or of Asian ancestry: the rosuvastatin label lists these as risk factors for statin muscle damage, so adding niacin or red yeast rice carries extra risk¹⁹. With severe kidney impairment, the label caps rosuvastatin at 10 mg a day¹⁹.
• Patients in China taking niacin with simvastatin: any myopathy was 0.66% a year on niacin against 0.13% on placebo, much higher than in Europe²⁰.
• People on simvastatin, lovastatin or atorvastatin who drink a lot of grapefruit juice: blood levels of the drug rise²⁶.
• People on warfarin or insulin, or having cancer treatment, who add CoQ10: CoQ10 may interact with warfarin and insulin and may not be compatible with some cancer treatments⁵.
• Pregnant or breastfeeding women: red yeast rice is not recommended¹⁶.

Use these rules, and take the bottle to your pharmacist when in doubt:

• If you have muscle aches: don't stop the statin on your own. In one trial only 36% of people with past statin myalgia had pain on the statin and not on placebo¹⁵, so your doctor may test or switch the statin first.
• If you want to try CoQ10: the positive trials used 100 mg a day for 30 days^{12, 13}. Judge it after a month, and expect a small effect at most³.
• If you take rosuvastatin and an aluminum and magnesium hydroxide antacid: statin first, antacid at least 2 hours later¹⁹.
• If you like grapefruit: ask whether your statin is one the FDA flags; pravastatin was unaffected in testing^{24, 27}.
• If a product lists red yeast rice, monacolin, or niacin at 1 g or more a day: don't combine it with a statin unless your doctor prescribed it^{16, 19}.
• If you want extra LDL lowering: psyllium has a trial showing it adds to a statin²⁸.

We searched PubMed and a biomedical paper index for meta-analyses, randomized trials and interaction studies on statins with CoQ10, vitamin D, red yeast rice, niacin, St John's wort, grapefruit, antioxidants, psyllium and berberine. We also read NCCIH fact sheets, an FDA consumer update and the current rosuvastatin label. We read the records of 28 studies and cited all of them, giving most weight to meta-analyses and randomized trials in adults. An independent reviewer then checked every number against its source before publication.

What the evidence can't tell us: whether CoQ10 helps people with confirmed statin myalgia at doses below 600 mg, and how magnesium supplements or turmeric interact with specific statins, since we found no trials of those pairs. Researched 25 October 2026.

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2. Kennedy C, et al. Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis. Atherosclerosis. 2020;299:1-8. doi:10.1016/j.atherosclerosis.2020.03.006
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