--- title: The Drug-Nutrient Interactions that Impact the Two Most Commonly Prescribed Medications description: Statins and metformin, two of the most prescribed drugs in the US, can deplete CoQ10 and vitamin B12, raising myopathy and neuropathy risks. image: https://www.casi.org/hubfs/casi/featured/june-5-the_drug-nutrient-interactions.jpeg --- An **educational publication of Designs for Health** [For Practitioners →](https://www.designsforhealth.com) [![casilogoresize2-2](https://www.casi.org/hubfs/casilogoresize2-2.png)](https://www.casi.org/) [Home](https://www.casi.org/) [Science Update](https://www.casi.org/articles/tag/science-update) [Research & Education](https://www.casi.org/articles/tag/research-education) [Archive](https://www.casi.org/articles/all) Search articles Search Research & Education # The Drug-Nutrient Interactions that Impact the Two Most Commonly Prescribed Medications BM Bri Mesenbring, MS, CNS, LDN Jun 06, 2025 ![The Drug-Nutrient Interactions that Impact the Two Most Commonly Prescribed Medications](https://www.casi.org/hs-fs/hubfs/casi/featured/june-5-the_drug-nutrient-interactions.jpeg?width=960) Data collected between 2017 and March 2020 from the National Health and Nutrition Examination Survey (NHANES) reported that approximately half of the United States population has taken at least one prescription drug in the past 30 days. A look into the [most prescribed medications](https://pmc.ncbi.nlm.nih.gov/articles/PMC6025009/) in the United States reveals the underlying health challenges its citizens face: cardiovascular disease, high cholesterol, diabetes, and high blood pressure. Among the top five most prescribed medications are atorvastatin, simvastatin, and metformin. [Atorvastatin](https://www.drugs.com/atorvastatin.html) and [simvastatin](https://www.drugs.com/simvastatin.html) are commonly called statins, which are medications used to treat high cholesterol and triglycerides and help prevent heart disease, strokes, and heart attacks. It works by reducing the amount of low-density lipoprotein cholesterol (LDL-C) and increasing the amount of high-density lipoprotein cholesterol (HDL-C) the body produces.  [Metformin is an FDA-approved medication](https://www.drugs.com/metformin.html) to support those with dysregulated blood sugar, especially those with diabetes or prediabetes. Metformin reduces glucose absorption, decreases glucose production, and helps improve insulin sensitivity in patients with type 2 diabetes (T2DM).  To that end, some medications are known to deplete nutrient stores — aptly named [drug-nutrient interactions](https://www.designsforhealth.com/drug-nutrient-interaction/). One well-recognized drug-nutrient interaction is the [reduction in coenzyme Q10 (CoQ10) synthesis due to statin drugs](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226312/). Statins [affect the mevalonate pathway](https://www.casi.org/articles/coq10-and-the-mevalonate-pathway-mitochondria-and-myopathy) by inhibiting the hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase enzyme. Cholesterol and CoQ10, also known as ubiquinone, are produced at the end of this pathway, but HMG-CoA reductase is a relatively early step; thus, inhibiting this enzyme [reduces the biosynthesis of everything that follows, not just cholesterol](https://pubmed.ncbi.nlm.nih.gov/26192349/). A common side effect of statin use is myopathy.  A systematic review was performed to [investigate the effects of CoQ10 supplementation on mitigating statin-induced myopathy](https://pmc.ncbi.nlm.nih.gov/articles/PMC11441719/). The authors discuss that [the patients who were given CoQ10 intervention exhibited reduced myopathy-related symptoms](https://pmc.ncbi.nlm.nih.gov/articles/PMC11441719/), including muscular complaints such as myalgia, myopathy, and myositis. Additionally, [serum CoQ10 levels increased compared to the placebo group](https://pmc.ncbi.nlm.nih.gov/articles/PMC11441719/). The CoQ10 intervention and duration varied across the included studies, but included either [liquid or capsules at 100 mg/dL or up to 200 mg daily for one to six months](https://pmc.ncbi.nlm.nih.gov/articles/PMC11441719/). However, further research is needed to understand this interaction fully. As the name implies, ubiquinone (or CoQ10) is found ubiquitously in the food supply. It’s estimated that the [average daily intake is between 3 and 6 mg](https://pubmed.ncbi.nlm.nih.gov/20301015/) based on food frequency questionnaires.  [Sources of CoQ10](https://pubmed.ncbi.nlm.nih.gov/20301015/) include: - Beef - Chicken - Fish, herring, trout - Peanuts - Pistachios - Broccoli - Canola oil - Strawberries - Eggs Metformin is another widely prescribed drug that may result in [reduced B12 absorption](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880159/) in some individuals, with deficiency being [associated with permanent neuropathy](https://www.ncbi.nlm.nih.gov/pubmed/20134380). It is estimated that up to 30% of patients who are prescribed metformin have evidence of reduced B12 absorption. Compared to baseline B12 levels, [patients given daily metformin for three months experienced significantly reduced serum total vitamin B12 levels from approximately 400 pg/ml to 282 pg/ml](https://pubmed.ncbi.nlm.nih.gov/10977010/). Furthermore, levels of holotranscobalamin (holoTCII), an early marker of subnormal vitamin B12 absorption, [decreased from a baseline level 175 pg/ml to 111 pg/ml](https://pubmed.ncbi.nlm.nih.gov/10977010/). These patients were then given one month of 1.2 grams of calcium carbonate (as TUMS®) and [experienced partially recovered holoTCII levels, increasing from 111 pg/ml to 152 pg/ml](https://pubmed.ncbi.nlm.nih.gov/10977010/). The authors discuss that the [mechanism associated with this altered B12 absorption](https://pubmed.ncbi.nlm.nih.gov/10977010/) is likely due to [metformin interfering with the calcium-dependent binding of the intrinsic factor (IF)-vitamin B12 complex](https://pmc.ncbi.nlm.nih.gov/articles/PMC10236989/), which was corroborated by the partial recovery of serum holoTCII levels seen in the group given calcium.  [Food sources of vitamin B12](https://fdc.nal.usda.gov/food-search?type=SR%2520Legacy) include: - Clams - Mussels - Nutritional yeast - Salmon - Turkey - Brie cheese - Eggs [Food sources of calcium](https://fdc.nal.usda.gov/food-search?type=SR%2520Legacy) include:  - Yogurt - Sardines with bones - Milk products - Figs - Tofu - Oranges - Kale - Pinto beans The widespread use of prescription medications such as statins and metformin reflects the significant burden of chronic diseases like cardiovascular disease, hyperlipidemia, and type 2 diabetes in the United States. While these medications may be essential for managing disease, their impact on nutrient status warrants careful consideration by qualified health-care practitioners. By inhibiting the mevalonate pathway, statins can inadvertently reduce CoQ10 synthesis, potentially contributing to myopathy. Similarly, metformin’s interference with the calcium-dependent absorption of B12 can result in clinically significant deficiencies. Evidence that calcium supplementation may partially restore B12 absorption highlights the importance of recognizing and managing drug-nutrient interactions in clinical practice. Ultimately, [understanding common drug-nutrient interactions,](https://www.designsforhealth.com/drug-nutrient-interaction/) proactive monitoring, and individualized strategies are crucial for optimizing the nutritional well-being of patients without compromising the efficacy of commonly prescribed drugs. **To read more about drug-nutrient interactions:**  Drug-Nutrient Depletion How Do Medications Affect B12 Status? CoQ10 and the Mevalonate Pathway: Mitochondria and Myopathy On this page Share [LinkedIn](https://www.linkedin.com/shareArticle?mini=true&url=https%3A%2F%2Fwww.casi.org%2Farticles%2Fdrug-nutrient-interactions-that-impact-two-most-commonly-prescribed-medications) [X](https://twitter.com/intent/tweet?url=https%3A%2F%2Fwww.casi.org%2Farticles%2Fdrug-nutrient-interactions-that-impact-two-most-commonly-prescribed-medications&text=The+Drug-Nutrient+Interactions+that+Impact+the+Two+Most+Commonly+Prescribed+Medications) [Email](mailto:?subject=The%20Drug-Nutrient%20Interactions%20that%20Impact%20the%20Two%20Most%20Commonly%20Prescribed%20Medications&body=https%3A%2F%2Fwww.casi.org%2Farticles%2Fdrug-nutrient-interactions-that-impact-two-most-commonly-prescribed-medications) BM ### Bri Mesenbring, MS, CNS, LDN Clinical Application ## Clinical Considerations in Practice In clinical practice, practitioners considering the topics discussed above may also weigh nutrient form, delivery and formulation, alongside individual patient variability. ### Practitioner Formulation Example ![Q-Evail® 200 Synergy™](https://cdn.sanity.io/images/lemtscrs/production-www/8f586ea73df87152ceb2724c11f15f0cb9f3c405-2000x2000.png?w=128&h=128&fit=max&auto=format) Q-Evail® 200 Synergy™ 200 mg ubiquinone plus GG [Explore Formulations →](https://www.designsforhealth.com/products/q-evail-200-synergy) ## Continue your research #### [Research & Education Hydrolyzed Whey Protein for Athletes: Enhanced Digestibility, Absorption, and Recovery Jun 30, 2026](https://www.casi.org/articles/hydrolyzed-whey-protein-for-athletes-enhanced-digestibility-absorption-and-recovery) #### [Research & Education B Vitamins 101: Functions, Food Sources, and Daily Requirements Jun 25, 2026](https://www.casi.org/articles/b-vitamins-101-functions-food-sources-and-daily-requirements) #### [Research & Education Magnesium Supplementation 101: Choosing the Best Form for Your Patient’s Needs Jun 02, 2026](https://www.casi.org/articles/magnesium-supplementation-101-choosing-the-best-form-for-your-patients-needs) #### [Research & Education Magnesium Glycinate Chelate Buffered: A Smart Approach to Magnesium Supplementation May 21, 2026](https://www.casi.org/articles/magnesium-glycinate-chelate-buffered-a-smart-approach-to-magnesium-supplementation) ![casilogoresize2-2](https://www.casi.org/hubfs/casilogoresize2-2.png) An educational publication of [**Designs for Health**](https://www.designsforhealth.com). 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