Significant Interactions

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STATIN DRUGS (HMG-CoA REDUCTASE INHIBITORS)

The combined use of niacin and statins, including atorvastatin (lipitor), fluvastatin (lescol), lovastatin (mevacor), pravastatin (pravachol), simvastatin (zocor), has been found to provide added therapeutic effects and reduce requirements for statin medications (Gardner et al 1996, 1997, Jacobson et al 1994, Yim & Chong 2003). A review of the combination of once daily, extended-release niacin and lovastatin therapy found that the addition of niacin may enhance or improve the lipid profile of those who require a further decrease of triglycerides, LDL-cholesterol and/or increase of HDL-cholesterol, even after stable statin therapy. The combination has been found to be safe with no increase in adverse reactions (Yim & Chong 2003) — beneficial interaction possible.

As early studies using the sustained-release form of niacin in combination with lovastatin indicated a potential for myopathy, rhabdomyolysis and hepatotoxicity, use of this form is controversial. Liver function should be monitored and patients observed for symptoms of myopathy (Guyton & Capuzzi 1998) — use sustained-

release niacin with caution. n

Vitamin B3 — Niacin 1232

^pv HYPOLIPIDAEMIC AGENTS

Vi/ Several clinical studies confirm the lipid-lowering effects of vitamin B3. Although a beneficial interaction has been shown in clinical trials with statin drugs, similar additive effects are theoretically possible with other hypolipidaemic drugs — beneficial interaction possible.

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