One of the possible side effects of pravastatin is liver toxicity. Although no clinical studies substantiate its use with pravastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of pravastatin. The suggested use is 200 mg of the extract three times daily.

The omega-3 fatty acid EPA present in fish oil may improve the cholesterol and triglyceride -lowering effect of pravastatin. In a preliminary trial, people with high cholesterol who had been taking pravastatin for about three years were able to significantly lower their triglyceride levels and raise their levels of HDL (“good”) cholesterol by supplementing with either 900 mg or 1,800 mg of EPA for three months in addition to pravastatin.² The authors of the study concluded that the combination of pravastatin and EPA may prevent coronary heart disease better than pravastatin alone.

A synthetic molecule related to beta-sitosterol , sitostanol, is available in a special margarine and has been shown to lower cholesterol levels. In one study, supplementing with 1.8 grams of sitostanol per day for six weeks enhanced the cholesterol-lowering effect of various statin drugs.⁴

Red yeast rice (Monascus purpureas)

A supplement containing red yeast rice (Monascus purpureas) (Cholestin) has been shown to effectively lower cholesterol and triglycerides in people with moderately elevated levels of these blood lipids.⁵ This extract contains small amounts of naturally occurring HMG-CoA reductase inhibitors such as lovastatin and should not be used by people who are currently taking a statin medication.

A study of 37 people with high cholesterol treated with diet and HMG-CoA reductase inhibitors found serum vitamin A levels increased over two years of therapy.⁶ It remains unclear whether this moderate increase suggests that people taking lovastatin have a particular need to restrict vitamin A supplementation.

Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin plus niacin to lower cholesterol.⁷ Niacin was added over a two week period, to a maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin was continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in significantly reduced cholesterol levels. Others have also shown that the combination of pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin alone.⁸ However, large amounts of niacin taken with pravastatin might cause serious muscle disorders (myopathy or rhabdomyolysis).⁹ Individuals taking pravastatin should consult a doctor before taking niacin.

In double-blind trials, treatment with pravastatin and other HMG-CoA reductase inhibitors has resulted in depleted blood levels of coenzyme Q10 (CoQ10).^{10 , 11} Supplementation with 90–100 mg CoQ10 per day has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin , another drug in the same category as pravastatin.^{12 , 13} In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.¹⁴