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CARDIOVASCULAR SYSTEM › LIPID MODIFYING AGENTS › LIPID MODIFYING AGENTS, COMBINATIONS › Combinations of various lipid modifying agents
lovastatin and nicotinic acid
C10BA01
Forms & Strengths
- Extended-release niacin / lovastatin 500 mg / 20 mg tablet
- Extended-release niacin / lovastatin 750 mg / 20 mg tablet
- Extended-release niacin / lovastatin 1000 mg / 20 mg tablet
Adult Dosing
- Initial: One tablet (niacin 500 mg/lovastatin 20 mg) taken once daily at bedtime with a low-fat snack
- Titration: Increase every 4 weeks or more to maximum dose of niacin 2000 mg/lovastatin 40 mg daily
- Maximum dose: Niacin 2000 mg/lovastatin 40 mg once daily
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment of primary hypercholesterolemia and mixed dyslipidemia when treatment with niacin or lovastatin monotherapy is inadequate
- Reduction of elevated total cholesterol, LDL-C, Apo B, and triglycerides, and to increase HDL-C
Mechanism of Action
- Lovastatin inhibits HMG-CoA reductase, decreasing hepatic cholesterol synthesis and upregulating LDL receptors
- Nicotinic acid inhibits hepatic synthesis of VLDL and LDL, decreases free fatty acid release from adipose tissue, and raises HDL-C
Contraindications
- Active liver disease or unexplained persistent elevations of serum transaminases
- Active peptic ulcer disease
- Arterial bleeding
- Hypersensitivity to niacin, lovastatin, or any component
- Pregnancy and lactation
Adverse Reactions
- Flushing and pruritus (most common)
- Gastrointestinal upset, nausea, dyspepsia, and diarrhea
- Myopathy, rhabdomyolysis, and myalgia
- Elevated hepatic transaminases and hyperuricemia
- New-onset or worsening hyperglycemia
Drug Interactions
- Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) increase lovastatin exposure and myopathy risk
- Coumarin anticoagulants: Niacin and statins may potentiate bleeding risk
- Bile acid sequestrants reduce absorption of niacin and statins (administer at least 4-6 hours apart)
- Alcohol and other hepatotoxic drugs increase risk of severe hepatic injury
- Colchicine increases risk of myopathy and rhabdomyolysis
Curated Content: Needs Vetting Before Put to Clinical Use