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Niacin/simvastatin Disease Interactions

There are 11 disease interactions with niacin / simvastatin.

Major

HMG-CoA reductase inhibitors (applies to niacin/simvastatin) liver disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism

The use of most HMG-CoA reductase inhibitors is contraindicated in patients with active liver disease, decompensated cirrhosis, or unexplained persistent elevations of serum transaminases. HMG-CoA reductase inhibitors are extensively metabolized by the liver. Decreased drug metabolism may lead to accumulation and increased risk of toxicity, including biochemical abnormalities of liver function and, rarely, jaundice, hepatitis, cirrhosis, fatty change in the liver, and fulminant hepatic necrosis. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. A lower initial dosage may be appropriate, and clinical monitoring of liver transaminase levels according to the individual manufacturer product information is recommended. Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, consideration should be given to a reduction in dosage or withdrawal of therapy.

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Major

Niacin/niacinamide (applies to niacin/simvastatin) liver disease/hepatotoxicity

Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism, Gallbladder Disease

The use of nicotinic acid and its derivatives is contraindicated in patients with significant or unexplained liver disease. Hepatotoxicity, including biochemical abnormalities of liver function, cholestatic jaundice, increased prothrombin time, and fulminant hepatic necrosis and failure, has been reported during therapy with niacin and niacinamide (nicotinamide), particularly in patients who have substituted sustained-release nicotinic acid products for immediate-release preparations at equivalent dosages. Treatment using pharmacologic dosages (e.g., lipid-lowering dosages) of these agents should be administered cautiously in patients with gallbladder disease or a history of jaundice, liver disease and/or heavy alcohol use. Liver transaminase levels should be evaluated prior to initiation of therapy, every 6 to 12 weeks for the first year, and periodically thereafter (e.g., semiannually). Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, therapy should be withdrawn. Liver biopsy should be considered in patients with elevations that persist beyond cessation of therapy.

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Major

Niacin/niacinamide (applies to niacin/simvastatin) peptic ulcer disease

Major Potential Hazard, High plausibility. Applicable conditions: History - Peptic Ulcer

The use of niacin and niacinamide (nicotinamide) is contraindicated in patients with active peptic ulcer disease. These agents have been reported to activate peptic ulcer. Treatment should be administered cautiously in patients with a history of peptic ulcer disease. Close observation is advised.

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Major

Simvastatin (applies to niacin/simvastatin) renal dysfunction

Major Potential Hazard, High plausibility.

Although simvastatin itself is not eliminated by the kidney, the plasma concentrations of total HMG-CoA reductase inhibitors after a single dose of simvastatin may be increased in patients with significant renal impairment, presumably due to the accumulation of active metabolites. Increased HMG-CoA reductase inhibitory activity may be associated with a greater risk of adverse effects, including hepatic and musculoskeletal toxicities. Therapy with simvastatin should be administered cautiously at a reduced dosage in patients with severe renal impairment. Close clinical monitoring is recommended.

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Moderate

HMG-CoA reductase inhibitors (applies to niacin/simvastatin) cognitive impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder

Cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) have been observed in patients receiving statins. The reports are usually not serious, and reversible upon statin discontinuation. Caution is recommended when using these agents in patients with cognitive impairment.

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Moderate

HMG-CoA reductase inhibitors (applies to niacin/simvastatin) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Increases in hemoglobin A1c and fasting serum glucose levels have been reported with the use of certain HMG-CoA reductase inhibitors. Caution should be exercised when using these agents in diabetic patients and close monitoring is recommended.

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Moderate

HMG-CoA reductase inhibitors (applies to niacin/simvastatin) renal disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Some HMG-CoA reductase inhibitors (e.g., fluvastatin) have not been studied in patients with severe renal dysfunction or end-stage renal disease. Some others (e.g., pitavastatin, simvastatin) require a dose reduction when used in this group of patients. Caution and close monitoring are advised when using these drugs in patients with renal dysfunction.

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Moderate

HMG-CoA reductase inhibitors (applies to niacin/simvastatin) rhabdomyolysis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Myopathy, Myoneural Disorder, Hypothyroidism, Renal Dysfunction

HMG-CoA reductase inhibitors may cause myopathy and rhabdomyolysis; acute renal failure secondary to myoglobinuria and rare fatalities have occurred due to rhabdomyolysis in patients treated with statins. The myopathy may be dose-related and is characterized by unexplained muscle weakness, pain, or tenderness accompanied by increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy, or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.

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Moderate

Niacin/niacinamide (applies to niacin/simvastatin) hyperglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Elevated fasting blood sugars and decreased glucose tolerance have been reported during niacin and niacinamide (nicotinamide) therapy. Patients with diabetes mellitus should be monitored closely during therapy with these agents, and adjustments made accordingly in their antidiabetic regimen.

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Moderate

Niacin/niacinamide (applies to niacin/simvastatin) hyperuricemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Gout

Niacin and niacinamide (nicotinamide) can compete with uric acid for excretion by the kidney. Hyperuricemia and precipitation of gout have been reported during long-term therapy. Treatment using pharmacologic dosages (e.g., lipid-lowering dosages) of these agents should be administered cautiously in patients with or predisposed to gout.

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Moderate

Niacin/niacinamide (applies to niacin/simvastatin) unstable angina

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Angina Pectoris

Caution is advised when niacin is used in patients with unstable angina or in the acute phase of myocardial infarction, especially when the patients are also receiving vasoactive drugs such as nitrates, calcium channel blockers, or adrenergic blocking agents.

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Niacin/simvastatin drug interactions

There are 371 drug interactions with niacin / simvastatin.

Niacin/simvastatin alcohol/food interactions

There are 3 alcohol/food interactions with niacin / simvastatin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.