Drug & supplement interaction

Niacin + Ticagrelor

Ticagrelor brand name: Brilinta.

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

Niacin has a moderate interaction with Ticagrelor. Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.

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

Niacin and Ticagrelor

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

Why this applies to Ticagrelor

Ticagrelor falls under ANTICOAGULANT/ANTIPLATELET DRUGS — the group Niacin interacts with.

Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
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: Ticagrelor (Brilinta) is a blood thinner that keeps your platelets from clumping, so it already raises your bleeding risk a bit on its own. High-dose niacin has, in a handful of reports, been linked to lower platelets and trouble making clotting factors. Stack those two together and the worry is simply more bleeding or bruising, not a change in how Ticagrelor works.

I'll be honest, this one is theoretical and based on how the two behave on paper, not strong proof. Everyday food amounts of B3 won't matter. The concern is really concentrated, drug-level niacin doses. If you bruise easily, see nosebleeds, or notice bleeding gums, loop in your pharmacist or doctor before changing anything.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Dearing BD, Lavie CJ, Lohmann TP, Genton E. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152(4):861-3. DOI
  2. O'Brien T, Silverberg JD, Nguyen TT. Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin. Mayo Clin Proc. 1992;67(5):465-8. 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 728 moderate known drug interactions in our database — the Ticagrelor one above is one of them. If you take anything else, check it against the full list below.

Moderate 728 No known interaction 2,102 (incl. Ticagrelor)
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 Ticagrelor

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 Ticagrelor, 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 Ticagrelor

This page covers Niacin only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ticagrelor page lists 286 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 241 moderate · 40 minor.

From our pharmacist’s overview on the Ticagrelor page

“Grapefruit sits at the top of this list for good reason. Ticagrelor (Brilinta) is cleared by the CYP3A4 enzyme, and grapefruit blocks that enzyme, so drug levels can climb and bleeding becomes more likely.”

Reviewed by 2 · Jul 18, 2026

Open the Ticagrelor 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 Ticagrelor 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 Ticagrelor 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%

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

29 days ago today
Medication Ticagrelor
Top half

#1,381 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 Ticagrelor

What Is Ticagrelor Used For?

Brand name: Brilinta

Ticagrelor tablets are used to lower the risk of cardiovascular death, heart attack (myocardial infarction), and stroke in adults who have had acute coronary syndrome (ACS) — a group of conditions including unstable angina and heart attack — or who have a history of heart attack. It also reduces the risk of stent thrombosis (a blood clot forming in a coronary stent) in people who have been stented for ACS treatment.

Ticagrelor tablets are also used in people with coronary artery disease (CAD) who are at high risk for a first heart attack or stroke, particularly those with type 2 diabetes. Additionally, Brilinta is approved to reduce the risk of stroke in adults with a mild acute ischemic stroke or a high-risk transient ischemic attack (TIA, or "mini-stroke").

See full Ticagrelor 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
728Moderate
0Minor
2,101No known interaction
728 Moderate 2,101 No interaction
Moderate

728 interactions

Showing 60 of 728 moderate interactions — see all 728 on the Niacin page.

No interaction 2,101 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 2,101 medications checked with no known interaction — see the full Niacin list.

See the full Niacin interactions page
See every supplement checked against Ticagrelor, 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 Ticagrelor supplement interactions › Every supplement checked against Ticagrelor, ranked by severity Ticagrelor 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 Ticagrelor Together: Common Questions

Can you take Niacin with Ticagrelor?
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.
How serious is the Niacin and Ticagrelor 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 Ticagrelor 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.