- What is niacin and lovastatin, and how does it work (mechanism of action)?
- What brand names are available for niacin and lovastatin?
- Is niacin and lovastatin available as a generic drug?
- Do I need a prescription for niacin and lovastatin?
- What are the side effects of niacin and lovastatin?
- What is the dosage for niacin and lovastatin?
- Which drugs or supplements interact with niacin and lovastatin?
- Is niacin and lovastatin safe to take if I'm pregnant or breastfeeding?
- What else should I know about niacin and lovastatin?
What is niacin and lovastatin, and how does it work (mechanism of action)?
Advicor is an oral drug that is used for lowering cholesterol levels in the blood. It is a combination of extended-release niacin and lovastatin. It reduces blood levels of total cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides and increases blood levels of high density lipoprotein (HDL) cholesterol.
Niacin (nicotinic acid, vitamin B3) is a part of the normal diet that is essential for various chemical reactions in the body. Doses of niacin larger than normal dietary needs reduce cholesterol and triglyceride levels in the blood. Niacin reduces bad cholesterol (LDL cholesterol) and increases good cholesterol (HDL cholesterol). It is not clear how niacin causes its effects on cholesterol and triglyceride levels, but it may be by reducing the production of proteins that transport cholesterol and triglycerides in the blood.
Lovastatin belongs to a class of cholesterol-lowering drugs called HMG-CoA reductase inhibitors, or, more commonly, "statins." Other statins include simvastatin (Zocor), atorvastatin (Lipitor), fluvastatin (Lescol), and rosuvastatin (Crestor). Statins reduce cholesterol by inhibiting an enzyme in the liver (HMG-CoA reductase) that is necessary for the production of cholesterol. In the blood, statins lower LDL cholesterol and triglycerides. LDL cholesterol is believed to be an important cause of coronary artery disease. Lowering LDL cholesterol levels slows and may even reverse coronary artery disease. Statins also increase HDL cholesterol. Raising HDL cholesterol levels, like lowering LDL cholesterol may slow coronary artery disease.The combination of niacin and lovastatin is better than either drug alone in reducing cholesterol, reducing triglycerides and increasing HDL. The FDA approved Advicor in December 2001.
What are the side effects of niacin and lovastatin?
The most common side effects are:
- warm sensation,
- stomach upset,
- muscle pain, and
- tingling in extremities.
Flushing may be reduced by taking 325 mg of aspirin 30 minutes before the niacin and by increasing the dose of niacin slowly.
Drinking hot liquids or alcohol shortly before or after niacin is taken may increase the occurrence of flushing.
Other important side effects include:
- liver test abnormalities,
- kidney failure,
- muscle pain,
- muscle tenderness,
- increases in HbA1c and fasting serum glucose
- memory loss,
- confusion, and
- memory impairment
Lovastatin shares side effects, such as liver and muscle damage associated with all statins. Serious liver damage caused by statins is rare. More often, statins cause abnormalities of liver tests. Abnormal tests usually return to normal even if a statin is continued, but if the abnormal test value is greater than three times the upper limit of normal, the statin usually is stopped. Liver function tests should be performed at the beginning of treatment then as needed thereafter.
Inflammation of the muscles caused by statins can lead to a serious breakdown of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood. Myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than one percent of patients. To prevent the development of rhabdomyolysis, patients taking lovastatin should contact their health care professional immediately if they develop unexplained muscle pain, weakness, or muscle tenderness.
Statins have been associated with increases in HbA1c and fasting serum glucose levels as are seen in diabetes.
There are also post-marketing reports of memory loss, forgetfulness, amnesia, confusion, and memory impairment. Symptoms may start 1 day to years after starting treatment and resolve within a median of 3 weeks after stopping the statin.
Quick GuideLower Your Cholesterol, Save Your Heart
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.
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.
Is niacin and lovastatin safe to take if I'm pregnant or breastfeeding?
Advicor should not be administered to pregnant women because lovastatin can be harmful to the fetus. Niacin has not been evaluated in pregnant women at doses used for treating levels of cholesterol and triglycerides.
Niacin in Advicor is excreted in breast milk and may cause side effects if ingested by the infant.
What else should I know about niacin and lovastatin?
What preparations of niacin and lovastatin are available?
Tablets (niacin/lovastatin): 500/20, 750/20, 1000/20, 1000/40 mg
How should I keep niacin and lovastatin stored?
Advicor should be stored at room temperature, between 20 C - 25 C (68 F - 77 F).
Niacin and lovastatin (Advicor) is a drug prescribed for treating elevated blood levels of total cholesterol, LDL cholesterol, triglycerides, and for raising low levels of HDL cholesterol. Side effects, drug interactions, and warnings and precautions should be reviewed prior to taking this medication.
Multimedia: Slideshows, Images & Quizzes
Picture of Cholesterol
Cholesterol carried in particles of low density (LDL cholesterol) is referred to as the "bad" cholesterol because elevated levels...
Cholesterol Drugs: What to Expect With Heart Medication
When diet and exercise aren't enough, should you turn to drugs? Learn cholesterol basics, drug classes, and available drugs along...
Related Disease Conditions
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as: gallstones, high...
Stroke (Signs, Symptoms, Warning Signs)
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding...
Cholesterol (Lowering Your Cholesterol)
High cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride...
How to Lower Triglycerides Naturally
Trigylcerides are fatty molecules that travel in the bloodstream. Excess sugar and fat can increase triglyceride levels....
Heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack...
High Cholesterol: Frequently Asked Questions
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease,...
How to Lower Your Cholesterol
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein...
Heart Attack Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management....
Treatment & Diagnosis
Medications & Supplements
Prevention & Wellness
Daily Health News
Subscribe to MedicineNet's Heart Health Newsletter
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Top niacin and lovastatin Related Articles
atorvastatin lipitor vs simvastatin zocorAtorvastatin (Lipitor) and simvastatin (Zocor) are both statins that lower cholesterol levels in the bloodstream. These drugs, part of a family called statins, are prescribed to treat a large number of cardiovascular disease, including to prevent heart failure. Learn dosage, side effects, and pregnancy safety information before taking this drug.
Cholesterol Drugs SlidesWhen diet and exercise aren't enough, should you turn to drugs? Learn cholesterol basics, drug classes, and available drugs along with their benefits and side effects.
Cholesterol ManagementHigh cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride levels in an optimal range will help protect your heart and blood vessels. Cholesterol management may include lifestyle interventions (diet and exercise) as well as medications to get your total cholesterol, LDL, HDL, and triglycerides in an optimal range.
Cholesterol PictureCholesterol carried in particles of low density (LDL cholesterol) is referred to as the "bad" cholesterol because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. See a picture of Cholesterol and learn more about the health topic.
Heart AttackHeart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Heart Attack and Atherosclerosis Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back. Women experience the same symptoms as men; however, they also may experience:
- Extreme fatigue
- Pain in the upper abdomen
Leading a healthy lifestyle with a heart healthy low-fat diet, and exercise can help prevent heart disease and heart attack.
High Cholesterol: Frequently Asked QuestionsCholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
How to Lower Triglycerides NaturallyTrigylcerides are fatty molecules that travel in the bloodstream. Excess sugar and fat can increase triglyceride levels. Triglycerides are also manufactured in the liver. The body uses triglycerides for energy, but excess triglycerides are a risk factor for heart attack, stroke, and obesity. Many lifestyle factors can influence triglyceride levels.
Liver DiseaseLiver disease can be cause by a variety of things including infection (hepatitis), diseases such as:
- high cholesterol or triglycerides,
- blood flow obstruction to the liver, and
- toxins (medications and chemicals).
- upper right abdominal pain, and
Lower Cholesterol Levels with Diet and Medication
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, and high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High levels of LDL and low levels of HDL cholesterol put a person at risk for heart attack, stroke, transient ischemic attack (TIA or mini stroke), and peripheral artery disease. High cholesterol can be lowered by eating foods that lower cholesterol, for example:
- Eat more high soluble fiber foods (oatmeal, oat bran, vegetables, and certain fruits)
- Use olive oil
- Eat foods fortified with plant sterols and stanols
- Omega-3 fatty acids
Foods that raise LDL or bad cholesterol include:
- Foods high in saturated and trans fats
- Fatty meats
- Limit egg yolks
- Limit milk products
- Limit crackers, muffins, and snacks
- Avoid unhealthy fast foods that are high in fat and sugar
High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Stroke Symptoms and Treatment
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic). Symptoms of a stroke may include
- double vision or vision loss,
- vertigo, and
- difficulty speaking or understanding speech.
A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.