Drug Interaction Report

Niacin and Atorvastatin: Interaction Details

A pharmacist-reviewed analysis of the Niacin and Atorvastatin interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Atorvastatin

Atorvaliq Lipitor Lipitor®
+

Niacin

Endur-Acin Endur-Amide Niacor Niacor® Niaspan Niaspan® Nicolar® Slo-Niacin
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 24 documented Niacin interactions, 14 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
probable
Severity
Major

What happens

Increased atorvastatin exposure and an increased risk of myopathy and rhabdomyolysis

Interaction Deep Dive

Concomitant use of atorvastatin and niacin may increase the risk of myopathy and rhabdomyolysis during treatment. Cases of myopathy/rhabdomyolysis have been reported with atorvastatin coadministered with lipid modifying doses (1 g/day or greater) of niacin. Consider if the benefit of using lipid modifying dosages of niacin concomitantly with atorvastatin outweighs the increased risk of myopathy and rhabdomyolysis12.

Why it happens (mechanism)

Unknown

Literature reports

1 report — tap to read

a) Cases of myopathy/rhabdomyolysis have been reported with atorvastatin coadministered with lipid modifying doses (1 g/day or greater) of niacin 12.

Common questions

Can I take Niacin and Atorvastatin together?

Increased atorvastatin exposure and an increased risk of myopathy and rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.

How serious is the Niacin and Atorvastatin interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Niacin or Atorvastatin need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (2)

  1. Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Viatris Specialty LLC (per FDA), Morgantown, WV, 2022. DailyMed
  2. Product Information: ATORVALIQ(R) oral suspension, atorvastatin calcium oral suspension. CMP Pharma Inc (per FDA), Farmville, NC, 2023. DailyMed
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Atorvastatin

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All Atorvastatin interactions (159) Atorvastatin drug information
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Niacin

Keep reading about Niacin

All Niacin interactions (24) Niacin drug information
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Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Atorvastatin + Activated Charcoal Apple Beer Grapefruit Green Tea Siberian Cocklebur St. John's Wort Sweet Orange + 173 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.