Niacin and Fluvastatin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Niacin
Fluvastatin
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.
What happens
An increased risk of myopathy or rhabdomyolysis
Interaction Deep Dive
concurrent administration of fluvastatin and lipid-lowering doses (1 g/day or more) of niacin may increase the risk of myopathy and rhabdomyolysis. Consider reducing the fluvastatin dosage1. Carefully weigh risks and benefits of combination therapy prior to initiation. Monitor patients for signs and symptoms of skeletal muscle adverse effects, particularly during first few months and with upward dosage titrations 23. Consider periodic measurements of serum CPK 3. Results from a short-term clinical trial involving 74 patients indicated that combination therapy with fluvastatin and niacin may be safe, although careful monitoring of patients is still advised 8.
Why it happens (mechanism)
Unknown
Literature reports
3 reports — tap to read
a) In several case reports, the concurrent use of lovastatin, another HMG-CoA reductase inhibitor, and niacin has resulted in reversible myopathy and rhabdomyolysis 456.
b) A single dose of fluvastatin 20 mg in capsule form was administered to 21 healthy men two hours after the evening meal, and blood was drawn for baseline values. The next day the subjects began taking an immediate-release form of niacin on a schedule that resulted in a dosage of 1 gram three times daily by day 11. On day 16, they received single-dose fluvastatin 20 mg two hours after the evening meal and niacin 1 gram. The mean fluvastatin AUC, Cmax, and Tmax for baseline and day 16 were compared; the differences for all parameters were not statistically significant 7.
c) A double-blind clinical trial comparing the combination therapy of fluvastatin plus niacin versus fluvastatin monotherapy found both to be safe. Seventy-four hypercholesterolemic patients participated in the trial, which consisted of six weeks of monotherapy with either 20 mg fluvastatin or placebo, followed by nine weeks of the same plus the addition of immediate-release niacin titrated to 3 grams daily. There were no serious adverse events reported; most adverse events were associated with the niacin (rash, itching, flushing), which resulted in nine withdrawals from the study. Two patients withdrew due to transient myalgias, which were considered clinically insignificant since the creatine phosphokinase levels were less than 10 times the upper limit normal. No myositis or rhabdomyolysis was reported. The researchers considered both combination and monotherapy safe in the short-term, but recommended continued patient monitoring with longer term use 8.
Common questions
Can I take Niacin and Fluvastatin together?
An increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Niacin and Fluvastatin interaction?
It is rated moderate. Can be significant — usually manageable with 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Niacin or Fluvastatin 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 anything you'd monitor while I'm on both?
References (8)
- Product Information: LESCOL(R) oral capsules, fluvastatin sodium oral capsules. Novartis Pharmaceuticals Corporation (Per FDA), East Hanover, NJ, 2012. DailyMed
- Product Information: Lescol(R) XL oral extended release tablets, fluvastatin sodium oral extended release tablets. Sandoz, Inc.(per FDA), Princeton, NJ, 2023. DailyMed
- Product Information: NIASPAN(R) extended-release film coated oral tablets, niacin extended-release film coated oral tablets. Abbott Laboratories, North Chicago, IL, 2010. DailyMed
- Malloy MJ, Kane JP, Kunitake ST, et al: Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med 1987; 107(5):616-623. PubMed
- Reaven P & Witztum JL: Lovastatin, nicotinic acid, and rhabdomyolysis (letter). Ann Intern Med 1988; 109:597-598. DOI
- Norman DJ, Illingworth DR, Munson J, et al: Myolysis and acute renal failure in heart-transplant recipient receiving lovastatin (letter). N Engl J Med 1988; 318:46.
- Smith HT, Jokubaitis LA, Troendle AJ, et al: Pharmacokinetics of fluvastatin and specific drug interactions. Am J Hypertens 1993; 6:375S-382S. PubMed
- Jacobson TA, Chin MM, Fromell GJ, et al: Fluvastatin with and without niacin for hypercholesterolemia. Am J Cardiol 1994; 74:149-154. DOI
Keep reading about Niacin
Keep reading about Fluvastatin
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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