Alirocumab
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Drug reference
niacin
Water-soluble B-complex vitamin · Antihyperlipidemic
Water-soluble B-complex vitaminAntihyperlipidemic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AlirocumabSevereTextbookG&G 14e · p736
- Atorvastatin + AspirinSevereTextbookG&G 14e · p736
- EvolocumabSevereTextbookG&G 14e · p736
- EzetimibeSevereTextbookG&G 14e · p736
Mechanism
Niacin inhibits triglyceride lipolysis by hormone-sensitive lipase in adipose tissue, reducing free fatty acid transport to the liver and decreasing hepatic triglyceride synthesis. It also reduces hepatic VLDL production, which accounts for reduced LDL levels. Niacin increases HDL-C by decreasing the fractional clearance of apo A-I in HDL.
Indications
HypertriglyceridemiaElevated LDL-CIncreasing HDL-C
Dosing
- Adult
- ER: Start 500 mg at bedtime, increase by 500 mg every 4 weeks to a maximum of 2000 mg/day. IR: Start 250 mg every evening, increase every 4 to 7 days to a maximum of 1500 to 2000 mg/day. May be further titrated every 2 to 4 weeks to a maximum of 6000 mg/day (for marked lipid abnormalities, but risk of adverse effects increases above 2000 mg/day).
Pharmacokinetics
Onset
Peak serum concentrations within 30 to 60 min (crystalline niacin), 4 to 5 h (time-release ER niacin)
Half-life
Approximately 20 to 48 min (crystalline niacin)
Contraindications
- Pregnancy
- Peptic ulcer disease
- Liver disease
- Substantial alcohol consumption
- Concurrent use of statins (FDA withdrew approval for this indication)
- History of gout (relative contraindication)
Side effects
Common
FlushingPruritus (face and upper trunk)Skin rashesAcanthosis nigricansDyspepsiaNauseaVomitingDiarrheaDry skin
Serious
- Hepatotoxicity (elevated serum transaminases, more likely with time-release and doses >2 g/day)
- Hyperglycemia (niacin-induced insulin resistance, severe in diabetes)
- Elevated uric acid levels (may reactivate gout)
- Toxic amblyopia (rarer, reversible)
- Toxic maculopathy (rarer, reversible)
- Atrial tachyarrhythmias
- Atrial fibrillation (more common in elderly patients)
Drug interactions
Atorvastatin + Aspirin
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Evolocumab
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Ezetimibe
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Mevastatin
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Nicotinic Acid
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Orlistat
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Rosuvastatin + Aspirin
Severe
Textbook
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: G&G 14e · p736
Atorvastatin
Severe
Database
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: DDInter
Cerivastatin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Leflunomide
Severe
Database
Clinical effect not specified
Source: DDInter
Lomitapide
Severe
Database
Increased risk of myopathy.
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing niacin in 2016.
Source: DDInter
Related guidelines
Ask House about niacin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team