niacin and lovastatin, Advicor

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is the dosage for niacin and lovastatin?

The recommended starting dose for Advicor is one tablet (500/20 mg). Doses can be increased by 500 mg of niacin every 4 weeks based on the response of the blood cholesterol level. Doses greater than 2000/40 mg are not recommended. Individuals already stabilized on niacin extended-release tablets can be directly switched to the niacin equivalent dose of Advicor. Individuals taking extended-release niacin and lovastatin separately can be switched to an equivalent dose of Advicor.

Other forms of niacin (for example, sustained-release, timed-release or immediate-release) are not equivalent to extended-release niacin in Advicor. Therefore, Advicor is not interchangeable with these niacin preparations, and patients taking these preparations should be switched and stabilized on extended-release niacin before switching to Advicor.

Advicor should be administered at bedtime with a low fat snack. Since there is evidence that at least some drugs in the same class as lovastatin lower cholesterol more when taken at night than in the morning. If Advicor is discontinued for longer than 7 days, therapy should be resumed at the lowest dose.

Which drugs or supplements interact with niacin and lovastatin?

Decreased elimination of lovastatin could increase the levels of lovastatin in the body and increase the risk of muscle toxicity from lovastatin. Examples of drugs that decrease elimination of lovastatin include erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune), nefazodone (Serzone), boceprevir (Victrelis), telaprevir (incivek), voriconazole (Vfend), and protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir). They should not be combined with lovastatin.

Large quantities of grape fruit juice (>1 quart daily) also will increase blood levels of lovastatin and should be avoided.

Amiodarone (Cordarone), verapamil (Calan, Verelan, Isoptin), diltiazem (Cardizem), danazol (Danocrine), niacin (Niacor, Niaspan, Slo-Niacin), colchicine, ranolazine (Ranexa), gemfibrozil (Lopid), and fenofibrate (Tricor) also may increase the risk of muscle toxicity when combined with lovastatin. Cyclosporine or gemfibrozil should not be combined with lovastatin. Patients taking amiodarone (Cordarone) should not exceed 40 mg daily of lovastatin. Patients taking verapamil, diltiazem, or danazol should start with 10 mg and should not exceed 20 mg of lovastatin daily. Patients taking niacin (greater than or equal to 1 g/day), fenofibrate (Tricor) or cyclosporine (Gengraf, Neoral) should not take more than 20 mg of lovastatin.

Lovastatin may increase the effect of warfarin (Coumadin), a blood thinner. Patients taking lovastatin and warfarin (Coumadin) should be monitored carefully for toxic effects of warfarin.

Niacin may increase blood glucose levels in individuals with diabetes. Therefore, medications for controlling blood glucose may need to be adjusted when niacin is taken by those with diabetes.

Bile acid sequestrants (for example, cholestyramine [Questran]) bind and prevent absorption of niacin. Administration of bile acid sequestrants and niacin should be separated by 4-6 hours. Alcohol or hot drinks may increase flushing and itching caused by niacin and should not be used when Advicor is ingested. Vitamins and nutritional supplements containing niacin or related compounds (for example, nicotinamide) will increase adverse effects of niacin and should not be combined with Advicor.

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