Lovastatin with Niacin Interaction Details

Brand Names Associated with Lovastatin

Brand Names Associated with Niacin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

Increased risk of myopathy or rhabdomyolysis

Interaction Summary

The concurrent use of lovastatin and niacin in lipid-lowering doses (greater than 1 gram daily) has resulted in reversible myopathy and rhabdomyolysis. However, two short-term studies have found that the combination of low-dose lovastatin plus niacin resulted in no reports of myopathy or rhabdomyolysis . Use caution with the concomitant use of both drugs. Monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness); consider periodic monitoring of creatine kinase (CK) levels. Discontinue lovastatin if CK levels are markedly elevated or if myopathy or rhabdomyolysis is diagnosed or suspected .

Severity

Major

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Use caution with the concomitant use of lovastatin with lipid-lowering doses of niacin (1 g/day or more) due to a potentially increased risk of myopathy or rhabdomyolysis; benefits of combined use should be weighed against potential risks. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Periodic creatine kinase (CK) determinations may be advisable in patients who are just starting or are increasing their dose of lovastatin, and in patients with complicated medical histories. Discontinue lovastatin if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.

Mechanism Of Interaction

Unknown

Literature Reports

A) A clinical trial involving 25 hyperlipidemic patients found no serious side effects and no statistically significant difference in adverse events reported between patients treated with placebo compared to patients receiving the combination of 1.2 g sustained-release nicotinic acid and 20 mg lovastatin. Subjects were randomized to a treatment sequence: three months of nicotinic acid plus placebo; three months of lovastatin plus placebo; and three months of nicotinic acid plus lovastatin, with each treatment period separated by a 2-month placebo washout. There were no statistically significant changes in hepatic or muscle enzyme serum tests. The authors noted that slow-release nicotinic acid may be associated with a risk of hepatotoxicity, and, therefore, the immediate-release form should now be used instead .

B) A short-term prospective, randomized clinical trial found little or no change in liver function tests, glucose, or uric acid levels following treatment with a combination of lovastatin 20 mg daily with niacin 1.5 grams daily. Thirty-two subjects with low-density lipoprotein (LDL) levels over 130 mg/deciliter were randomly assigned to six weeks of either monotherapy with 40 mg of lovastatin every evening, or combination therapy with lovastatin 20 mg daily and niacin 500 mg three times daily. One patient experienced joint discomfort and a rise in uric acid, and consequently was advised to discontinue the niacin. Otherwise, the regimen was well-tolerated. The authors caution that more side effects may occur with longer therapy .

Lovastatin Overview

• Lovastatin is used together with diet, weight-loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Lovastatin is also used to decrease the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Lovastatin is in a class of medications called HMG CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

• Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with lovastatin may help prevent heart disease, angina (chest pain), strokes, and heart attacks.

Niacin Overview

• Niacin is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol (a fat-like substance) and other fatty substances in your blood and to increase the amount of high density lipoprotein (HDL; ''good cholesterol''). Niacin can be used in a number of situations including the following:

  • alone or in combination with other medications, such as HMG-CoA inhibitors (statins) or bile acid-binding resins;

  • to decrease the risk of another heart attack in patients with high cholesterol who have had a heart attack;

  • to prevent worsening of atherosclerosis (buildup of cholesterol and fats along the walls of the blood vessels) in patients with high cholesterol and coronary artery disease;

  • to reduce the amount of triglycerides (other fatty substances) in the blood in patients with very high triglycerides who are at risk of pancreatic disease (conditions affecting the pancreas, a gland that produces fluid to break down food and hormones to control blood sugar).

• Niacin is also used to prevent and treat pellagra (niacin deficiency), a disease caused by inadequate diet and other medical problems. Niacin is a B-complex vitamin. At therapeutic doses, niacin is a cholesterol-lowering medication.

• Results of a clinical study in people with heart disease and well-controlled cholesterol levels that compared people who took niacin and simvastatin with people who took simvastatin alone and found similar results for the two groups in the rate of heart attacks or strokes. Taking niacin along with simvastatin or lovastatin also has not been shown to reduce the risk of heart disease or death compared with the use of niacin, simvastatin, or lovastatin alone. Talk to your doctor if you have questions about the risks and benefits of treating increased amounts of cholesterol in your blood with niacin and other medications.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.