Better together: Using nutraceuticals to reduce prescription drug side effects

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Integrative medicine is defined as “an approach to medical care that combines standard medicine with CAM (complementary and alternative medicine) practices that have shown through science to be safe and effective.”¹ One area in which integrative medicine can be particularly useful is when specific nutraceuticals are used to help compensate for certain side effects caused by some prescription drugs. Due to space limitations, this article will address two common examples in detail and then list several others in a table.

Statins and Coenzyme Q10

Physicians often use statin medications as an important therapy in reducing and maintaining serum cholesterol levels in patients with hypercholesterolemia (i.e., high cholesterol levels). However, in addition to reducing cholesterol levels, statin medications also reduce the body’s production of coenzyme Q10 (CoQ10). In turn, this can lead to a myopathy marked by muscle pain in those patients prescribed a high statin dose.²

In fact, the pharmaceutical suppliers of Lipitor (Pfizer)³, Zocor (Merck)⁴, and Crestor (AstraZeneca)⁵ all state that significant decreases in circulating CoQ10 levels in patients treated with statins have been observed and that the clinical significance of a potential long-term, statin-induced deficiency of CoQ10 has not been established. This recognition is especially evident in the fact that Merck has even gone so far as to obtain two patents to combine CoQ10 with its statin drug.⁶

Given the potential adverse effects of statin therapy, co-administration with CoQ10 makes a great deal of medical sense. In vitro research⁷ has established that pretreatment with CoQ10 reduced the toxic effects of statins and may protect cells from statin-induced injuries and alleviate their side effects. Likewise, animal research⁸ demonstrated that CoQ10 supplementation improved metabolic parameters, liver function, and mitochondrial respiration in rats with high doses of atorvastatin and a cholesterol-rich diet. Evidence from a review of human studies⁹ showed a benefit in symptoms of myalgia or improvement of serum levels of CoQ10 with supplementation of 30-200 mg daily of CoQ10, with no reported risks, in patients prescribed statins. In older athletes taking statins, 200 mg of CoQ10 daily improved muscle performance as measured by time to anaerobic threshold and leg strength. Many other measures of mitochondrial function also tended to improve.¹⁰ Other research¹¹ found that 200 mg of CoQ10 supplementation daily improved endothelial dysfunction in statin-treated type 2 diabetic patients, compared to placebo, possibly by altering local vascular oxidative stress.

Gene Bruno

Fluoxetine (Prozac) and Saffron Extract

Pharmaceutical treatments for depression are often associated with side effects. For example, common side effects of fluoxetine (e.g., Prozac) may include sexual dysfunction (decreased sex drive, erectile dysfunction, or difficulty having an orgasm).

Since saffron has shown aphrodisiac effects in some animal and human studies, a 4-week, randomized, double-blind, placebo-controlled study¹² was conducted to assess the efficacy and tolerability of saffron stigma extract in treating fluoxetine-related sexual dysfunction. Thirty married male patients with major depressive disorder whose depressive symptoms had been stabilized on fluoxetine, and who had subjective complaints of sexual impairment, entered the study. The patients were randomly assigned to 30 mg/day of saffron stigma extract or placebo for 4 weeks. The International Index of Erectile Function scale was used to assess sexual function at baseline and weeks 2 and 4. Baseline characteristics, as well as baseline and final depressive symptoms scores, were similar between the two groups.

At the end of the study, saffron subjects saw significant improvements in sexual dysfunction (P = 0.009). By week 4, saffron supplementation resulted in significantly greater improvement in erectile function (P < 0.001), intercourse satisfaction (P = 0.001), and total sexual health scores (P < 0.001) compared to the placebo group. Nine patients (60%) in the saffron group and one patient (7%) in the placebo group achieved normal erectile function (score > 25 on erectile function domain) at the end of the study (P = 0.005). Frequency of side effects was similar between the two groups. In conclusion, saffron is a tolerable and efficacious treatment for fluoxetine-related erectile dysfunction.

A similar randomized, double-blind, placebo-controlled study¹³ was conducted with 34 women with major depression who were stabilized on 40 mg/day of fluoxetine for a minimum of 6 weeks and who had experienced subjective feeling of sexual dysfunction. The patients were randomly assigned to saffron (30 mg/daily) or placebo for 4 weeks. Measurement was performed at baseline, week 2, and week 4 using the Female Sexual Function Index (FSFI).

At the end of the fourth week, patients in the saffron group had experienced significantly more improvement in total FSFI (p < 0.001), arousal (p = 0.028), lubrication (p = 0.035), and pain (p = 0.016) domains. Frequency of side effects was similar between the two groups. In conclusion, it seems saffron may safely and effectively improve some of the fluoxetine-induced sexual problems, including arousal, lubrication, and pain.

Other Medications and Nutraceutical Relationships

The following information comes from previous research that I published¹⁴:

Conclusion

Clearly, there are far more nutraceuticals that can be used to help compensate for certain side effects caused by other prescription drugs than can be addressed in the scope of this article. Nevertheless, the examples given—especially the relationship between statins and CoQ10—represent an integrative medicine approach to some common drugs and nutraceuticals.

Gene Bruno, MS, MHS, RH (AHG) possesses 42 years of dietary supplement industry experience. With a master’s degree in nutrition and a second master’s degree in herbal medicine, he has a proven track record of formulating innovative, evidence-based dietary supplements. Mr. Bruno currently serves as both the Vice President of Scientific and Regulatory Affairs at NutraScience Labs and Professor of Nutraceutical Science at Huntington University of Health Sciences.

References

1. “Complementary and Alternative Medicine.” National Cancer Institute, National Institutes of Health. Updated November 24, 2020. Retrieved April 7, 2021. Accessed here.
2. Ginter E. “Statins, coenzyme Q10 and diabetes type 2.” Bratislavské Lekárske Listy, vol. 115, no. 2 (2014): 112
3. Product Monograph. ^PrLipitor® (atorvastatin calcium tablets) 10 mg, 20 mg, 40 mg and 80 mg atorvastatin. Lipid Metabolism Regulator. T.M. Pfizer Ireland Pharmaceuticals. Licensee: Pfizer Canada Inc. (Kirkland, QC, Canada). Date of Revision: May 29, 2013. Submission Control No: 163180. Page 7, Effect on Ubiquinone (CoQ10) Levels.
4. Product Monograph. ^PrZocor® simvastatin tablets, 5, 10, 20 and 40 mg. Merck Standard Lipid Metabolism Regulator. Licensee: Merck Canada Inc. (Kirkland, QC, Canada). Date of Revision: February 21, 2014. Submission Control No: 170366. Internal Filing May 6, 2014. Page 6, Endocrine and Metabolism.
5. Product Monograph. ^PrCrestor® rosuvastatin calcium tablets, 5, 10, 20 and 40 mg. Lipid Metabolism Regulator. Licensee: AstraZeneca Canada Inc (Mississauga, ON, Canada). Date of Revision: April 28, 2010. Submission Control No: 130015. Page 5, Cardiovascular Co-enzyme Q10.
6. Patent No. US 4,929,437 and US 4,933,165. Patent date: January 18, 1989
7. Eghbal MA et al. “Efficiency of hepatocyte pretreatment with coenzyme Q10 against statin toxicity.” Arhiv Za Higijenu Rada I Toksikologiju, vol. 65, no. 1 (March 2014): 101-108
8. Jiménez-Santos MA et al. “Coenzyme Q10 supplementation improves metabolic parameters, liver function and mitochondrial respiration in rats with high doses of atorvastatin and a cholesterol-rich diet.” Lipids in Health and Disease. Published January 25, 2014.
9. Littlefield N et al. “Statins' effect on plasma levels of coenzyme Q10 and improvement in myopathy with supplementation.” Journal of the American Association of Nurse Practitioners, vol. 26, no. 2 (February 2014): 85-90
10. Deichmann RE et al. “Impact of coenzyme Q-10 on parameters of cardiorespiratory fitness and muscle performance in older athletes taking statins.” The Physician and Sports Medicine, vol. 40, no. 4 (November 2012): 88-95
11. Hamilton SJ et al. “Coenzyme Q10 improves endothelial dysfunction in statin-treated type 2 diabetic patients.” Diabetes Care, vol. 32, no. 5 (May 2009): 810-812
12. Modabbernia A et al. “Effect of saffron on fluoxetine-induced sexual impairment in men: randomized double-blind placebo-controlled trial.” Psychopharmacology, vol. 223, no. 4 (October 2012): 381-388
13. Kashani L et al. “Saffron for treatment of fluoxetine-induced sexual dysfunction in women: randomized double-blind placebo-controlled study.” Hum Psychopharmacology, vol. 28, no. 1 (January 2013): 54-60
14. Bruno G, Rich M. “Dietary Supplement & Drug Interactions Primer.” Rancho Cucamonga, CA: Fifty-Ninth Street Bridge Publishing Corp; 2002.