Possible Interaction: Niacin and Pravastatin

“The addition of low-dose niacin to pravastatin therapy resulted in a significant lowering of LDL cholesterol compared with pravastatin monotherapy.”

“Adding nicotinic acid to pravastatin produced LDL cholesterol levels of 2.6 mmol/L or less in 15 more of these 35 patients, so that 94% (n = 33) of the patients receiving these two drugs reached this goal.”

“Thus, in this group of patients with clustered risk factors, the combination of pravastatin and niacin resulted in significant improvements in HDL and triglyceride levels, total cholesterol to HDL ratio, small dense LDL levels, and postprandial lipemia.”

“… pravastatin … nicotinic acid in reducing levels of total cholesterol (−24.9 versus −9.8%, P <0.001) and LDL cholesterol (−32.1 versus −16.9%, P <… −31.8%, NS) and tended to be less effective in elevating levels of HDL cholesterol (+16.4 versus +30.8%, P = 0.06).”

“However, as with any HMG-CoA reductase inhibitor, caution should be exercised when pravastatin is given with nicotinic acid (niacin), gemfibrozil or cyclosporin, because of increased risk for myopathy in patients receiving combination therapy.”

“In the presence of a proton gradient (pHin/out = 7.5/5.5), the initial uptake of pravastatin … ± 3.2 mM and Jmax of 10.6 ± 1.21 nmol/mg protein/10 sec. The uptake of pravastatin was significantly … and nicotinic acid in a competitive manner … acidic amino acid.”