Drug Interaction Report

MONITOR: Severe myopathy and rhabdomyolysis have been reported with concomitant use of lovastatin and niacin, and may be possible with other HMG-CoA inhibitors such as fluvastatin. The mechanism is unknown.

MANAGEMENT: Patients should be instructed to report symptoms of muscular pain, weakness, or tenderness. If such symptoms occur, creatine kinase should be measured. Fluvastatin and niacin should be discontinued if creatine kinase is elevated or if myopathy is suspected.

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.

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.