Interaction between Niacin and Rosuvastatin
Major
Synergy
| ID | DDInter1286 and DDInter1622 |
| Interaction |
Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is unknown; however, the development of myopathy has been associated with both the administration of statins alone and lipid-modifying dosages of niacin (1 g/day or more) alone. Certain populations may be more susceptible to the interaction.
acute pancreatitis
adenocarcinoma
als
aneurysm
Arrhythmia
Aching joints
arthritis
ascites
asthenia
Ataxia
More
|
| Management | Concomitant use of statins with lipid-modifying dosages of niacin (1 g/day or more) should be approached cautiously and only if the benefit of further alterations in lipid levels is anticipated to outweigh the potential risks. Addition of niacin to statin therapy typically provides little additional reduction in LDL cholesterol, but further reductions of triglycerides and increases in HDL cholesterol may be attained. If the combination is prescribed, lower dosages of the statin should be considered. Coadministration of simvastatin with high doses of niacin (1 g/day or more) is not recommended in Chinese patients due to an increased risk of myopathy. Lovastatin labeling recommends that the dosage not exceed 20 mg daily when prescribed with lipid-modifying dosages of niacin. All patients should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed. |
| References | |
| Alternative for Niacin |
C10A
C10B C04A
More
|
| Alternative for Rosuvastatin |
C10B
C10A
More
|
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.