Drug & supplement interaction

Niacin + Rosuvastatin

Rosuvastatin brand names: Crestor, Ezallor.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Rosuvastatin falls into 2 drug categories that Niacin can interact with; the most serious is rated moderate. Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Niacin and Rosuvastatin

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Niacin interacts with whole categories of medication. Rosuvastatin falls into 2 of those categories, so it can interact with Niacin in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

HEPATOTOXIC DRUGS

1 of 2

Why this applies to Rosuvastatin

Rosuvastatin falls under HEPATOTOXIC DRUGS — the group Niacin interacts with.

Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with rosuvastatin (Crestor, Ezallor) and niacin: both can occasionally be tough on the liver, so taking them together theoretically adds up that small risk. This isn't about niacin changing how rosuvastatin works in your blood. It's simply two products that each, on rare occasions, can irritate the liver doing it at the same time.

I want to be honest that this concern is based on pharmacology, not strong real-world data, so please don't panic. The risk mainly ties to high, drug-like niacin doses (especially sustained-release versions), not the small amounts in a regular multivitamin. Signs to watch for would be unusual fatigue, belly pain, dark urine, or yellowing of the skin or eyes. Before adding high-dose niacin, check with your pharmacist or doctor so they can monitor your liver labs.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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
  2. Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71. PubMed
  3. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81. PubMed
  4. Etchason JA, Miller TD, Squires RW, et al. Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin. Mayo Clin Proc. 1991;66(1):23-8. PubMed
  5. Henkin Y, Johnson KC, Segrest JP. Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin. JAMA. 1990;264(2):241-3. DOI
  6. Henkin Y, Oberman A, Hurst DC, Segrest JP. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991;91(3):239-46. PubMed
  7. Bassan M. A case for immediate-release niacin. Heart Lung. 2012 Jan-Feb;41(1):95-8. PubMed
  8. Nawaz N, Mistretta T, Karime C, Lewis J, Wolf E. Cholestatic Drug-Induced Liver Injury in a Patient Taking High-Dose Niacin for Hyperlipidemia. J Investig Med High Impact Case Rep 2024;12:23247096231224349. PubMed
Moderate

HMG-CoA REDUCTASE INHIBITORS ("Statins")

2 of 2

Rosuvastatin also falls under HMG-CoA REDUCTASE INHIBITORS ("Statins").

Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the short version on pairing high-dose niacin with rosuvastatin (Crestor, Ezallor). Both can, on their own, occasionally stress muscle tissue, so the worry is that taking them together might bump up the chance of muscle problems. The classic warning signs would be unusual muscle aches, soreness, weakness, or tenderness, and in very rare cases dark or tea-colored urine, which can signal a serious muscle breakdown called rhabdomyolysis.

That said, I want to keep this in perspective. This concern comes mostly from a handful of old case reports, and large studies (including an approved niacin-statin combo product) didn't show a clear jump in muscle risk. So it's something to be aware of, not alarmed by. Everyday food amounts of B3 are not an issue. If you're considering high-dose niacin, please run it by your pharmacist or doctor first, and report any new muscle pain right away.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-93. DOI
  2. Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71. PubMed
  3. McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705. PubMed
  4. Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8. PubMed
  5. Ito MK. Advances in the understanding and management of dyslipidemia: using niacin-based therapies. Am J Health-Syst Pharm 2003;60(suppl 2):s15-21. PubMed
  6. Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm. 1995;52(15):1639-45. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Niacin Also Interacts With Other Medications

Niacin has 726 moderate known drug interactions in our database — the Rosuvastatin one above is among them. If you take anything else, check it against the full list below.

Moderate 726 No known interaction 2,104 (incl. Rosuvastatin)
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.

From our Q&A

Questions About Niacin or Rosuvastatin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Niacin or Rosuvastatin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Rosuvastatin

This page covers Niacin only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Rosuvastatin page lists 63 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and Wine (major).

By severity: 5 major · 48 moderate · 10 minor.

From our pharmacist’s overview on the Rosuvastatin page

“Rosuvastatin (Crestor, Ezallor) is a statin taken daily for years to lower cholesterol, and its supplement list deserves real scrutiny, not a quick skim. Five of the 63 ingredients on file carry a major rating, headed by grapefruit, which can raise statin blood levels, and by heavy drinking, since beer and wine compound the strain this…”

Reviewed by 2 · Jul 18, 2026

Open the Rosuvastatin 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. Your product may carry other ingredients that interact with Rosuvastatin too, on top of Niacin — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Niacin and Rosuvastatin 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%

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

29 days ago today
Medication Rosuvastatin
Top 1%

#11 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.

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.

Read the full Niacin monograph & all interactions
Medication

About Rosuvastatin

What Is Rosuvastatin Used For?

Brand names: Crestor, Ezallor

Rosuvastatin tablets are used alongside diet changes to lower LDL-C ("bad" cholesterol), total cholesterol, and triglycerides (blood fats), and to raise HDL-C ("good" cholesterol) in adults with high cholesterol or mixed cholesterol problems. They are also used in adults with very high triglycerides, a condition called primary dysbetalipoproteinemia (Type III, a genetic fat-metabolism disorder), and to slow the buildup of plaque in arteries (atherosclerosis).

In people without established heart disease but with multiple risk factors, rosuvastatin tablets can reduce the risk of heart attack, stroke, and procedures to open blocked arteries. For children and teens aged 8 and older with heterozygous familial hypercholesterolemia (HeFH, an inherited high-cholesterol condition), the tablet form is used to lower LDL-C after diet alone has not worked. Crestor tablets are also approved to treat homozygous familial hypercholesterolemia (HoFH, a more severe inherited form) in adults and in children aged 7 and older.

See full Rosuvastatin 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
726Moderate
0Minor
2,103No known interaction
726 Moderate 2,103 No interaction
Moderate

726 interactions

Showing 60 of 726 moderate interactions — see all 726 on the Niacin page.

No interaction 2,103 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 2,103 medications checked with no known interaction — see the full Niacin list.

See the full Niacin interactions page
See every supplement checked against Rosuvastatin, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Niacin monograph › Uses, safety, and every drug interaction in one place Rosuvastatin supplement interactions › Every supplement checked against Rosuvastatin, ranked by severity Rosuvastatin drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Niacin and Rosuvastatin Together: Common Questions

Can you take Niacin with Rosuvastatin?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Niacin and Rosuvastatin?
Rosuvastatin belongs to more than one drug category, and Niacin interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Niacin and Rosuvastatin interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

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

Still Have a Question About Rosuvastatin 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.