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Drug Interactions between niacin and pravastatin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

niacin pravastatin

Applies to: niacin and pravastatin

ADJUST DOSE: The concomitant use of pravastatin and niacin may increase the risk of severe myopathy and rhabdomyolysis. Although this reaction has not been reported in clinical trials where pravastatin and niacin were used in combination, the manufacturer warns of an increased risk of myopathy when HMG-CoA reductase inhibitors are used concurrently with niacin.

MANAGEMENT: The concurrent use of niacin and pravastatin should be avoided unless the benefit outweighs risk. Some authorities suggest that a dose reduction for pravastatin should be considered if concomitant therapy is required. It should also be noted that the risk of adverse effects is increased with niacin doses greater than 1 gram per day. In addition, if patients do receive this combination, they should be instructed to promptly report symptoms of muscular pain, weakness, or tenderness. Creatine kinase should be measured if such symptoms appear. If creatine kinase is elevated or if myopathy is suspected, the drugs should be discontinued.

References

  1. McTavish D, Sorkin EM (1991) "Pravastatin. A review of its pharmacological properties and therapeutic potential in hypercholesterolaemia [published erratum appears in Drugs 1991 Dec;42(6):944]." Drugs, 42, p. 65-89
  2. Pan HY (1991) "Clinical pharmacology of pravastatin, a selective inhibitor of HMG- CoA reductase." Eur J Clin Pharmacol, 40, s15-8
  3. McGovern ME, Mellies MJ (1993) "Long-term experience with pravastatin in clinical research trials." Clin Ther, 15, p. 57-64
  4. Reaven P, Witztum JL (1988) "Lovastatin, nicotinic acid, and rhabdomyolysis." Ann Intern Med, 109, p. 597-8
  5. (2001) "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb
  6. Quion JAV, Jones PH (1994) "Clinical pharmacokinetics of pravastatin." Clin Pharmacokinet, 27, p. 94-103
  7. Davignon J, Roederer G, Montigny M, Hayden MR, Tan MH, Connelly PW, Hegele R, McPherson R, Lupien PJ, Gagne C, et al. (1994) "Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia." Am J Cardiol, 73, p. 339-45
  8. Okeefe JH, Harris WS, Nelson J, Windsor SL (1995) "Effects of pravastatin with niacin or magnesium on lipid levels and postprandial lipemia." Am J Cardiol, 76, p. 480-4
  9. Pasternak RC, Brown LE, Stone PH, Silverman DI, Gibson CM, Sacks FM (1996) "Effect of combination therapy with lipid-reducing drugs in patients with coronary heart disease and "normal" cholesterol levels: a randomized, placebo-controlled trial." Ann Intern Med, 125, p. 529-40
  10. Gardner SF, Marx MA, White LM, Granberry MC, Skelton DR, Fonseca VA (1997) "Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control." Ann Pharmacother, 31, p. 677-82
  11. Haria M, McTavish D (1997) "Pravastatin. A reappraisal of its pharmacological properties and clinical effectiveness in the management of coronary heart disease." Drugs, 53, p. 299-336
  12. Arntz HR, Agrawal R, Wunderlich W, Schnitzer L, Stern R, Fischer F, Schultheiss HP (2000) "Beneficial effects of Pravastatin (+/- colestyramine/niacin) initiated immediately after a coronary event (The randomized lipid-coronary artery disease [L-CAD] study)." Am J Cardiol, 86, p. 1293-8
  13. Hatanaka T (2000) "Clinical pharmacokinetics of pravastatin - Mechanisms of pharmacokinetic events." Clin Pharmacokinet, 39, p. 397-412
  14. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  15. Cerner Multum, Inc. "Australian Product Information."
View all 15 references

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Drug and food interactions

Moderate

niacin food

Applies to: niacin

GENERALLY AVOID: Ethanol can exacerbate the cutaneous flushing that is a common side effect of niacin. At least one case of delirium and lactic acidosis has been reported with coadministration of these drugs, although data are limited.

MANAGEMENT: Coadministration should probably be discouraged, particularly since chronic consumption of large amounts of alcohol is associated with hyperlipidemia.

References

  1. Schwab RA, Bachhuber BH (1991) "Delirium and lactic acidosis caused by ethanol and niacin coingestion." Am J Emerg Med, 9, p. 363-5

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Moderate

pravastatin food

Applies to: pravastatin

MONITOR: Concomitant use of statin medication with substantial quantities of alcohol may increase the risk of hepatic injury. Transient increases in serum transaminases have been reported with statin use and while these increases generally resolve or improve with continued therapy or a brief interruption in therapy, there have been rare postmarketing reports of fatal and non-fatal hepatic failure in patients taking statins. Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury. Active liver disease or unexplained transaminase elevations are contraindications to statin use.

MANAGEMENT: Patients should be counseled to avoid substantial quantities of alcohol in combination with statin medications and clinicians should be aware of the increased risk for hepatotoxicity in these patients.

References

  1. (2001) "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb
  2. (2001) "Product Information. Zocor (simvastatin)." Merck & Co., Inc
  3. (2001) "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals
  4. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  5. (2002) "Product Information. Altocor (lovastatin)." Andrx Pharmaceuticals
  6. (2003) "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
  9. (2010) "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic)
View all 9 references

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Minor

niacin food

Applies to: niacin

A single case has been reported in which cutaneous flushing and tremors were noted in a woman who was taking niacin while wearing a nicotine patch. The mechanism is suspected to be synergistic cutaneous vasodilatory effects. The clinical significance of this possible interaction is not known.

References

  1. Rockwell KA Jr (1993) "Potential interaction between niacin and transdermal nicotine." Ann Pharmacother, 27, p. 1283-8

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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.

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