Drug interactions
Simvastatin + Vitamin b3
Severity: Major
Simvastatin and Vitamin b3: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Niacin at lipid-lowering doses with simvastatin increases the risk of myopathy and rhabdomyolysis. Risk is particularly notable in Chinese patients, for whom labeling advises against the combination.
What this interaction means in plain words
Simvastatin and Vitamin b3 can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Simvastatin belongs to Cardiovascular; Vitamin b3 belongs to Gastrointestinal Tract.
Why it happens
Additive myotoxicity, with the mechanism not fully established.
What to do
Avoid simvastatin with lipid-modifying niacin doses in Chinese patients and use the lowest effective doses in others. Monitor for muscle symptoms and check CK if they occur.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Vitamin b3
- Lovastatin + Vitamin b3 Major
- Atorvastatin + Vitamin b3 Moderate
- Cholestyramine + Vitamin b3 Moderate
- Colestipol + Vitamin b3 Moderate
- Fluvastatin + Vitamin b3 Moderate
- Insulin aspart protamine / insulin aspart + Vitamin b3 Moderate
Other interactions of Simvastatin
- Atazanavir + Simvastatin Contraindicated
- Clarithromycin + Simvastatin Contraindicated
- Cobicistat + Simvastatin Contraindicated
- Cyclosporine + Simvastatin Contraindicated
- Cyclosporin + Simvastatin Contraindicated
- Danazol + Simvastatin Contraindicated
Frequently asked questions
Can I take Simvastatin with Vitamin b3?
MediHelp rates the interaction as major. Simvastatin and Vitamin b3 can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Niacin at lipid-lowering doses with simvastatin increases the risk of myopathy and rhabdomyolysis. Risk is particularly notable in Chinese patients, for whom labeling advises against the combination.
How serious is the interaction between Simvastatin and Vitamin b3?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid simvastatin with lipid-modifying niacin doses in Chinese patients and use the lowest effective doses in others. Monitor for muscle symptoms and check CK if they occur.
What other medicines interact with Vitamin b3?
MediHelp also lists interactions of Vitamin b3 with, for example, Lovastatin, Atorvastatin, Cholestyramine. The full list is on the Vitamin b3 page.
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