Drug & supplement interaction

Niacin + Cobicistat

Cobicistat brand name: Tybost.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Niacin and Cobicistat in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Cobicistat states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Niacin and Cobicistat

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Cobicistat and Niacin in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Niacin safety at a glance

Niacin overall Use caution Normal dietary amounts are safe, but high supplemental doses can cause flushing, liver problems, and other effects.
Pregnancy Likely Safe When used orally in amounts that do not exceed the tolerable upper intake level (UL). The UL of niacin during pregnancy and lactation is 30 mg daily for 14-18 y... Read the full pregnancy detail
Breastfeeding Likely Safe When used orally in amounts that do not exceed the tolerable upper intake level (UL). The UL of niacin during pregnancy and lactation is 30 mg daily for 14-18 y... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Cobicistat and Niacin? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Cobicistat

Interactions in our licensed database are recorded against drug classes, not just single drug names. Cobicistat is filed under 2 classifications — cytochrome p450 3a4 (cyp3a4) inhibitors, oral drugs. Niacin has documented interactions with 15 drug classes — the most serious being alcohol (ethanol) (moderate), allopurinol (zyloprim) (moderate) and anticoagulant/antiplatelet drugs (moderate) — and none of Cobicistat’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Niacin Does Interact With Other Medications

Niacin has 727 moderate known drug interactions in our database — Cobicistat isn’t one of them. If you take anything else, check it against the full list below.

Moderate 727 No known interaction 2,103 (incl. Cobicistat)
Taking anything else?

Check Another of Your Medications Against Niacin

Covers the 2,830 medications we’ve checked against Niacin. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Niacin and Cobicistat May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 3 of them are worth acting on rather than waiting out — marked below.

  • Severe muscle breakdown Worth acting on Additional detail

    Niacin

    “Orally, niacin has been associated with elevated creatine kinase levels. Also, several cases of niacin-induced myopathy have been reported. Concomitant administration of niacin and HMG-CoA reductase inhibitors may increase the risk of myopathy and rhabdomyolysis; patients should be monitored closely.”

    Niacin · Natural Medicines adverse-effect record, reported in muscle breakdown.

    6 sources cited
    1. 4818. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84. PubMed
    2. 4888. Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med 1994;154:73-82. DOI
    3. 26100. Gharavi AG, Diamond JA, Smith DA, Phillips RA. Niacin-induced myopathy. Am J Cardiol. 1994;74(8):841-2. PubMed
    4. 26111. Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
    5. 14508. Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8. PubMed
    6. 25918. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm. 1995;52(15):1639-45. PubMed

    Cobicistat

    Listed in the ADVERSE REACTIONS section of the FDA label for Cobicistat. Read the label on DailyMed ›

  • Yellowing of the skin or eyes Worth acting on Additional detail

    Niacin

    “Orally, niacin is associated with elevated liver function tests and jaundice, especially with doses of 3 grams/day or more, and when doses are rapidly increased. The risk of hepatotoxicity appears to be higher with slow-release and extended-release products. Niacin should be discontinued if liver function tests rise to three times the upper limit of normal.”

    Niacin · Natural Medicines adverse-effect record, reported in cirrhosis.

    6 sources cited
    1. 4458. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
    2. 4863. American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI
    3. 6243. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
    4. 4855. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8. PubMed
    5. 4856. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7. DOI
    6. 11691. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81. PubMed

    Cobicistat

    Listed in the ADVERSE REACTIONS section of the FDA label for Cobicistat. Read the label on DailyMed ›

  • Hives Worth acting on Additional detail

    Niacin

    “Orally, flushing is a common dose-related adverse reaction to niacin. A large meta-analysis of clinical studies shows that up to 70% of patients may experience flushing. Although flushing can occur with doses of niacin as low as 30 mg daily, it is more common with the larger doses used for treatment of dyslipidemia.”

    Niacin · Natural Medicines adverse-effect record, reported in arrhythmia.

    6 sources cited
    1. 96211. Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744. PubMed
    2. 4889. Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998;82:737-43.
    3. 26089. Andersson RG, Aberg G, Brattsand R, Ericsson E, Lundholm L. Studies on the mechanism of flush induced by nicotinic acid. Acta Pharmacol Toxicol (Copenh). 1977 Jul;41(1):1-10. PubMed
    4. 93341. Aramwit P, Srisawadwong R, Supasyndh O. Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. J Nephrol. 2012 May-Jun;25(3):354-62. PubMed
    5. 104933. Song S, Lee CJ, Oh J, Park S, Kang SM, Lee SH. Effect of Niacin on Carotid Atherosclerosis in Patients at Low-Density Lipoprotein-Cholesterol Goal but High Lipoprotein (a) Level: a 2-Year Follow-Up Study. J Lipid Atheroscler. 2019;8(1):58-66. PubMed
    6. 6243. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b

    Cobicistat

    Listed in the ADVERSE REACTIONS section of the FDA label for Cobicistat. Read the label on DailyMed ›

  • Itching / Headache Additional detail

    Niacin

    Recorded for Niacin in the same Natural Medicines adverse-effect record shown under Hives above.

    Cobicistat

    Listed in the ADVERSE REACTIONS section of the FDA label for Cobicistat. Read the label on DailyMed ›

  • Stomach pain / Diarrhea / Vomiting / Nausea Additional detail

    Niacin

    “Orally, large doses of niacin can cause gastrointestinal disturbances including nausea, vomiting, bloating, heartburn, abdominal pain, anorexia, diarrhea, constipation, and activation of peptic ulcers. These effects may be reduced by taking the drug with meals or antacid, and usually disappear within two weeks of continued therapy. Gastrointestinal effects may be more common with time-release preparations of niacin.”

    Niacin · Natural Medicines adverse-effect record, reported in anorexia.

    6 sources cited
    1. 4458. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
    2. 4863. American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI
    3. 12033. McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705. PubMed
    4. 26083. Aronov DM, Keenan JM, Akhmedzhanov NM, et al. Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia. Arch Fam Med. 1996;5(10):567-75. PubMed
    5. 93341. Aramwit P, Srisawadwong R, Supasyndh O. Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. J Nephrol. 2012 May-Jun;25(3):354-62. PubMed
    6. 96211. Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744. PubMed

    Cobicistat

    Listed in the ADVERSE REACTIONS section of the FDA label for Cobicistat. Read the label on DailyMed ›

Reported for Niacin but not commonly for Cobicistat: stomach upset, liver problems, a low platelet count and a stroke or mini-stroke.

Effects for Cobicistat come from the ADVERSE REACTIONS section of its FDA label; effects for Niacin come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 20,779 voluntary FDA FAERS reports for Cobicistat that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Niacin in Pregnancy & Breastfeeding

Pregnancy And Lactation Likely Safe

When used orally in amounts that do not exceed the tolerable upper intake level (UL). The UL of niacin during pregnancy and lactation is 30 mg daily for 14-18 years of age and 35 mg daily for 19 years and older. There is insufficient reliable information available about the safety of larger oral doses of niacin during pregnancy or lactation; avoid using.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Cobicistat Products Have a Food Rule — Niacin Should Not Break It

At least one FDA label for a product containing Cobicistat says to take it with food. If you take Niacin on an empty stomach out of habit, keep them separate — and take Cobicistat with a meal where the label says to.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Cobicistat products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

2 DOSAGE AND ADMINISTRATION TYBOST must be coadministered with atazanavir or darunavir at the same time, with food, and in combination with other HIV-1 antiretroviral agents.

From the Dosage and Administration section of the FDA label we read for Cobicistat — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

Everything else you take

See Every Supplement That Interacts With Cobicistat

This page covers Niacin only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Cobicistat page lists 30 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Adrafinil (moderate), Cannabidiol (cbd) (moderate), Cannabinol (cbn) (moderate) and Cannabis (moderate).

By severity: 1 major · 19 moderate · 10 minor.

From our pharmacist’s overview on the Cobicistat page

“Activated charcoal is the one entry to understand first if you take cobicistat (Tybost). Charcoal soaks up drugs in the gut, and since cobicistat's entire job is boosting an HIV medicine to protective levels, blunting its absorption can put the whole regimen at risk.”

Reviewed by 2 · Jul 18, 2026

Open the Cobicistat interaction page

One more smart check

Taking Niacin as Part of a Dietary Supplement Product? Check It for Interactions

We hold 933 real supplement products containing Niacin, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Niacin. Even though Niacin itself has no known interaction with Cobicistat, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Niacin and Cobicistat Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Niacin
Top 25%

#232 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Cobicistat
Steady interest

#1,547 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Niacin reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Niacin and Cobicistat records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Niacin

What is Niacin?

Niacin
  • High cholesterol
  • Vitamin B3 deficiency (pellagra)
  • Heart health support
  • General energy and metabolism

Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to adjust cholesterol levels, but high doses can cause flushing and other side effects and should only be taken under medical supervision. Always talk with a pharmacist or doctor before using high-dose niacin supplements.

Not applicable (a vitamin, not a plant part) · Tablets, extended-release tablets, capsules; also found in multivitamins and food

An interaction check asks whether these two react with each other — it does not ask whether Niacin is a good idea for someone in your situation. Here is what our Niacin record says about it on its own.

Niacin: dosing

There is no single "best" supplement dose that fits everyone, and needs vary by age, sex, and health status. For preventing deficiency, the amounts in a normal diet or a standard multivitamin are usually enough for most people.High-dose niacin used for cholesterol is a different situation and is dosed much higher than nutritional amounts—this should only be done with a prescription and medical monitoring. They can help you choose the right form and dose and watch for side effects.

From our Niacin monograph — the full record covers uses, side effects and every documented interaction.

Read the full Niacin monograph & all interactions
Medication

About Cobicistat

What Is Cobicistat Used For?

Brand name: Tybost

Tybost (cobicistat) is not itself an HIV treatment — it works by slowing the breakdown of certain HIV medicines so they stay active in your body long enough to work. Specifically, Tybost is used to boost the HIV medicines atazanavir or darunavir (once-daily dosing) as part of a complete HIV-1 treatment regimen in adults and in children weighing at least 14 kg (about 31 lbs).

Tybost is not interchangeable with ritonavir (another booster) for all HIV medicines. It is not recommended with darunavir twice-daily, fosamprenavir, saquinavir, or tipranavir.

Most-Reported Side Effects for Cobicistat

From FAERS, the FDA’s public side-effect reporting system (20,779 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Bone density decreased 8,112 reports
Chronic kidney disease 4,754 reports
Renal injury 4,577 reports
Tooth loss 4,186 reports
Bone loss 4,107 reports
See full Cobicistat drug information
Keep checking

Other Drugs & Niacin

Browse every other medication we’ve checked against Niacin — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
727Moderate
0Minor
2,102No known interaction
727 Moderate 2,102 No interaction
Moderate

727 interactions

Showing 60 of 727 moderate interactions — see all 727 on the Niacin page.

No interaction 2,102 drugs checked — show the list

We also checked Niacin against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,102 medications checked with no known interaction — see the full Niacin list.

See the full Niacin interactions page
See every supplement checked against Cobicistat, ranked by severity
Evidence & sources

Niacin References

The 66 references that drive our Niacin monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Garg R, Malinow MR, Pettinger M, et al. Niacin treatment increases plasma homocysteine levels. Am Heart J 1999;138:1082-7.
  2. Anon. Inositol hexaniacinate. Altern Med Rev 1998;3:222-3.
  3. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
  4. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84. PubMed
  5. Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85. PubMed
  6. Whelan AM, Price SO, Fowler SF, Hainer BL. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract 1992;34:165-8.
  7. Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 1997;12:591-6. PubMed
  8. Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74-81;disc. 85U-6U. PubMed
  9. Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8. PubMed
  10. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7. DOI
  11. Knopp RH, Alagona P, Davidson M, et al. Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998;47:1097-104. PubMed
  12. Knopp RH. Clinical profiles of plain versus sustained-release niacin (Niaspan) and the physiologic rationale for nighttime dosing. Am J Cardiol 1998;82:24U-28U;discussion 39U-41U. PubMed
  13. Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990;264:723-6. DOI
  14. Leighton RF, Gordon NF, Small GS, et al. Dental and gingival pain as side effects of niacin therapy. Chest 1998;114:1472-4. PubMed
  15. American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Niacin and Cobicistat Together: Common Questions

Is it safe to take Niacin with Cobicistat?
We do not list a known interaction between Niacin and Cobicistat. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Niacin and Cobicistat have any of the same side effects?
Yes — our sources link each of them separately to 9 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take Niacin and Cobicistat at the same time of day?
At least one FDA label for a product containing Cobicistat says to take it with food. If you take Niacin on an empty stomach out of habit, keep them separate and take Cobicistat with a meal where the label says to. Food instructions belong to the product rather than the ingredient — two Cobicistat products can differ — so check the directions on your own box. This is about absorption, not an interaction.
How was the Niacin and Cobicistat combination checked?
Interactions in our licensed database are recorded against drug classes. Cobicistat is filed under 2 classifications, and Niacin has documented interactions with 15 drug classes — none of Cobicistat's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Niacin interact with any other medications?
Yes. Niacin has 727 documented drug interactions in our database — Cobicistat is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Cobicistat interact with any supplements?
Yes. Cobicistat has documented interactions with 30 supplements in our database — Niacin is not one of them. The Cobicistat interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Niacin monograph Uses, safety profile, and every drug interaction in one place Cobicistat drug information The full plain-English guide to this medication Cobicistat supplement interactions Every supplement checked against Cobicistat, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 66 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Cobicistat and Niacin?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.