Statins vs. Niacin
- Statins and niacin (nicotinic acid, or vitamin B3) are medications used to treat high cholesterol. Both medications lower LDL (bad) cholesterol in the blood and triglycerides (fats), and raise HDL (good) cholesterol.
- Statins and niacin work by blocking the enzyme in the liver responsible for making cholesterol, and helping the liver remove the cholesterol already circulating in the blood.
- The difference is that statins do a better job than niacin of reducing LDL (bad) cholesterol in the blood, while niacin raises HDL (good) cholesterol more than statins.
- Examples of statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin calcium (Crestor), and simvastatin (Zocor).
- Common side effects of statins include:
- Side effects of niacin include:
- Stomach upset
- Dietary supplements containing niacin should not be used as prescription medications. Nonprescription forms of niacin are often immediate-release and have the potential for serious side effects, particularly at the higher doses required to treat high cholesterol.
What are statins and niacin?
Statins are used to lower cholesterol in the blood. They work by reducing the amount of cholesterol made by the liver and by helping the liver remove cholesterol circulating in the blood. Statins help lower LDL (bad) cholesterol and triglycerides (blood fats), while raising HDL (good) cholesterol. Statins can lower LDL cholesterol better than niacin can.
Niacin (nicotinic acid, or vitamin B3) is a vitamin that, when taken in high doses, can help lower LDL cholesterol and triglycerides while raising HDL cholesterol. Niacin can raise HDL levels more than statins can.
What are the side effects of statins and niacin?
The most common side effects are:
The most serious side effects are liver failure and rhabdomyolysis (injury or death of muscle tissue). 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 tests should be measured before statins are started and if there is a medical concern about liver damage thereafter.
Rhabdomyolysis is a rare serious side effect which involves damage to muscles. Rhabdomyolysis often begins as muscle pain and can progress to loss of muscle cells, kidney failure, and death. It occurs more often when statins are used in combination with other drugs that themselves cause rhabdomyolysis or with drugs that prevent the elimination of statins and raise the levels of statins in the blood. Since rhabdomyolysis may be fatal, unexplained joint or muscle pain that occurs while taking statins should be brought to the attention of a health care professional for evaluation. Statins must not be used during pregnancy because of the risk of serious adverse effects to the developing fetus.
Statins have been associated with increases in HbA1c and fasting serum glucose levels that are seen in diabetes.
There are also post-marketing reports of memory loss, forgetfulness, amnesia, confusion, and memory impairment. Symptoms may start one day to years after starting treatment and resolve within a median of three weeks after stopping the statin.
The most common side effects of niacin are:
- stomach upset,
- reduced blood pressure upon standing (orthostatic hypotension),
- itching and
- tingling sensations of the 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. Extended release formulations of niacin may cause flushing less frequently than immediate release formulations.
Rare cases of liver failure or muscle injury have occurred from the use of niacin. Blood tests to monitor for liver injury should be performed before niacin therapy begins, every 6-12 weeks for the first year, and then occasionally thereafter. Niacin should be discontinued if liver tests are greater than three times the upper limit of normal, are persistently elevated, or are accompanied by nausea, vomiting, or weakness.
What drugs interact with statins and niacin?
Statins have some important drug interactions. The first type of interaction involves the enzymes responsible for the elimination of statins by the liver. Liver enzymes (specifically, the cytochrome P-450 liver enzymes) are responsible for eliminating all statins from the body with the exception of pravastatin and rosuvastatin. Therefore, drugs that block the action of these liver enzymes increase the levels of simvastatin, lovastatin, fluvastatin, and atorvastatin (but not pravastatin or rosuvastatin) in the blood and can lead to the development of rhabdomyolysis.
Drugs or agents that block these enzymes include:
- protease inhibitors, for example, indinavir (Crixivan), ritonavir (Norvir) used in treating AIDS)
- erythromycin (E-Mycin)
- itraconazole, (Sporanox)
- clarithromycin, (Biaxin)
- telithromycin (Ketek)
- cyclosporine (Sandimmune)
- boceprevir (Victrelis)
- telaprevir (Incivek)
- voriconazole (Vfend)
- diltiazem, (Cardizem, Dilacor, Tiazac)
- verapamil (Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS)
- ombitasvir/paritaprevir/ritonavir and dasabuvir (Viekira Pak)
- grapefruit juice (> one quart daily)
Lovastatin and simvastatin should not be combined with the following drugs:
- ketoconazole (Nizoral, Extina, Xolegel, Kuric)
- danazol (Danocrine)
- protease inhibitors
- amiodarone (Cordarone)
- amlodipine (Norvasc)
- ranolazine (Ranexa)
Another important drug interaction occurs between statins and niacin and fibric acids, for example, gemfibrozil (Lopid), clofibrate (Atromid-S), and fenofibrate (Tricor). Niacin and the fibric acid drugs (lipid-lowering agents) can cause rhabdomyolysis or liver failure when used alone, and combining them with statins increases the likelihood of rhabdomyolysis or liver failure. Gemfibrozil should not be combined with statins. Other fibric acids and niacin are used, with caution, in combination with statins.
Cholestyramine (Questran) as well as colestipol (Colestid) bind statins in the intestine and reduce their absorption into the body. To prevent this binding within the intestine, statins should be taken one hour before or four hours after cholestyramine or colestipol.
Statins should not be combined with red yeast rice because red yeast rice contains a chemical that is similar to statins. Combining red yeast rice with statins can lead to serious side effects such as muscle breakdown (myopathy).
Use of niacin with drugs that cause liver or muscle injury, for example, lovastatin (Mevacor) or simvastatin (Zocor) may increase the occurrence of liver or muscle injury.
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.
FDA Prescribing information
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Medications & Supplements
- Zocor (simvastatin)
- rosuvastatin, Crestor
- Zocor (simvastatin) vs. Crestor (rosuvastatin)
- lovastatin, Mevacor, Altoprev
- pravastatin, Pravigard PAC (discontinued)
- niacin, Niacor, Niaspan, Slo-Niacin, Nicolar (discontinued)
- fluvastatin, Lescol, Lescol XL
- folic acid/niacinamide (nicotinamide)/copper/zinc - oral, Nicomide
- lovastatin vs. simvastatin
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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.
fluvastatinFluvastatin (Lescol, Lescol XL) is a drug belonging to the drug class "statins." Fluvastatin is prescribed for reducing total blood cholesterol, LDL cholesterol, triglycerides, and increasing HDL cholesterol levels in conjunction with a healthy diet. Fluvastatin is also prescribed to reduce the risks of coronary revascularization procedures and slows the progression of coronary heart disease. Side effects, drug interactions, and patient safety information should be reviewed prior to taking this medication.
HDL vs. LDL Cholesterol Differences
HDL (high-density lipoprotein), or the "good" cholesterol, and LDL (low-density lipoprotein), or the "bad" cholesterol, are lipoproteins that carry cholesterol through the veins and arteries of the body. HDL and LDL combined, is your "total" blood cholesterol. The difference between the two are that high levels of the "good," or HDL cholesterol, may protect against narrowing of the blood vessels in the body, which protects you against heart attack, stroke, and other cardiovascular diseases. But high levels of LDL, or the "bad" cholesterol, may worsen the narrowing of the blood vessels in the body, which puts you at a greater risk of stroke, heart attack, and cardiovascular diseases, some of which are life threatening.
Triglycerides are found in body fat and from the fats you eat. Triglycerides levels in the blood reflect what you have eaten recently. HDL and LDL cholesterol levels show what you have been eating over a long period of time. If you eat a fatty meal your triglyceride levels will be elevated for a short period of time. If you continue to eat a diet high in fat your triglyceride levels will continue to rise. The liver transfers the triglycerides into body fat, or cholesterol, which raises LDL and lowers HDL levels in the blood.
Healthy (normal) total blood cholesterol levels are determined by the levels of HDL, LDL, and triglycerides in the blood. Talk with your doctor or other health care professional if you are concerned about your cholesterol levels, which can easily be determined with a simple blood test.
VLDL, or very-low- lipoproteins, is a third type of cholesterol. VLDL is another type of "bad" cholesterol that the liver produces, which contains a high amount of triglycerides.
REFERENCE: American Heart Association. "HDL (Good), LDL (Bad) Cholesterol and Triglycerides." Updated: Jul 05, 2017.
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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
lovastatinLovastatin (Mevacor, Altoprev) is in the drug class of statins. Lovastatin (Mevacor, Altoprev) is prescribed for reducing total cholesterol and triglycerides in patients with elevated cholesterol levels. Side effects, drug interactions, and pregnancy safety should be reviewed prior to taking this medication.
lovastatin vs simvastatinLovastatin (Mevacor) and simvastatin (Zocor) are both members of the cholesterol-lowering class of drugs called statins. Statins work by causing the liver to absorb cholesterol in the form of LDL from the bloodstream so it does not add to plaque deposits, which are implicated in heart attacks and strokes. Lovastatin tends to be less potent than simvastatin. Doctors often keep lovastatin in reserve for use in drug combinations or if people have adverse reactions to a stronger statin like simvastatin.
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.
Lower Cholesterol TipsNeed to lower your cholesterol levels? Use these smart diet tips to quickly and easily lower your blood cholesterol levels. Choose heart-healthy foods to lower cholesterol and improve your heart health.
niacinNiacin, nicotinic acid, vitamin B3 Niacor, Niaspan, Slo-Niacin, Nicolar (discontinued) is used medically to treat people with niacin deficiency. Advanced deficiency of niacin can lead to pellagra. Niacin is also prescribed for the treatment of high cholesterol and triglyceride levels in the blood. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
pravastatinPravastatin (Pravachol, Pravigard PAC [discontinued]) is a drug that belongs to the drug class of statins and is prescribed for the treating individuals at risk of the consequences of arteriosclerotic vascular disease, strokes, transient ischemic attacks (TIAs or mini-strokes), and heart attacks. Side effects, dosing, drug interactions, and warnings and precautions should be reviewed prior to taking any medication.
rosuvastatinRosuvastatin (Crestor) is a drug belonging to the drug class of statins. Rosuvastatin (Crestor) is prescribed to reduce total blood cholesterol and triglycerides. Rosuvastatin is also prescribed for reducing the risk of heart attacks, strokes, and arterial revascularization procedures in individuals without clinical heart disease. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
simvastatinZocor (simvastatin) belongs to the drug class of statins and is prescribed for lowering cholesterol and triglyceride levels. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
simvastatin zocor vs crestor rosuvastatinSimvastatin (Zocor) and Crestor (rosuvastatin) are both statins that lower bloodstream cholesterol to manage heart disease and various other cardiovascular conditions. Learn about side effects, dosage, pregnancy safety and other facts about simvastatin and Crestor.
Statins is a class of drugs prescribed to lower blood cholesterol. Statins also are prescribed for preventing and treating atherosclerosis. Common side effects of statins are
- constipation, and
Serious side effects can occur.
Examples of statins available in the US are
- atorvastatin (Lipitor),
- fluvastatin (Lescol, Lescol XL),
- lovastatin (Mevacor, Altoprev),
- pravastatin (Pravachol),
- rosuvastatin (Crestor),
- simvastatin (Zocor), and
- pitavastatin (Livalo).
Drug interactions, dosing, storage, and pregnancy safety should be reviewed prior to taking this medication.