Niacin/lovastatin

Advicor niacin, lovastatin Aldoril hydrochlorothiazide, methyldopa... 

Some combinations of lipid-altering drugs are currently available such as extended-release niacin/lovastatin and ezetimibe/simvastatin, which are more promising for lipid-lowering therapy with stronger effects and decreased adverse reactions. 

Extended-release niacin + Kos Niacin/lovastatin 500-mg/20-mg Niacin/lovastatin Niacin/lovastatin... 

Clofibrate (Atromid-S) Wyeth-Ayerst Niacin/lovastatin 750-mg/20-mg tablets Niacin/lovastatin 10OO-mg/20-mg tablets 500-mg capsules 1 g bid 2g... 

Kashjfap ML, McGovern ME, Berra K, Guyton JR, Kwiterovich PO, Harper WL, Toth PD, Favrot LK, Kerzner B, Nash SD, Bays HE, Simmons PD. Long-term safety and efficacy of a once-daily niacin/lovastatin formulation for patients witii cfysl idaemia. Am J Cardiol (2002) 89, 672-8. 

Brown, B.G., Bardsley, J., Poulin, D., Hillger, L.A., Dowdy, A., Maher, V.M., Zhao, X.Q., Albers, J.J., and Knopp, R.H., 1997. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol < 100 mg/dl in patients with hyperlipidemia and coronary artery disease. American Journal of Cardiology. 80 111-115. 

Acetaminophen, bosentan, diclofenac, isoniazid, lovastatin, methyldopa, niacin, nefazodone, phenytoin, propylthiouracil, rifampin, trazodone, valproic acid, and venlafaxine... 

Some patients, in particular those with genetic forms of hypercholesterolemia (Table 9-2), will require three or more drugs to manage their disorder. Regimens using a statin, resin, and niacin were found to reduce LDL cholesterol up to 75%.42 These early studies were conducted with lovastatin, so larger reductions would be expected with the more potent statins available today. 

Niaspan) Extended-release niacin + tablets N iaci n/lovastatin 500mg/20 500 mjy20 mg 1,000 mg/... 

Niacin ER/ lovastatin [19] 25 5 16-42 30-41 Flushing, pruritis, gastro-intestinal symptoms... 

In clinical trials, the combination of niacin with lovastatin (14) afforded significant HDL elevation (30%) and reduced LDL-C (47%) and TG (41%) after 16 weeks of treatment [19]. At 52 weeks of treatment, HDL increased by 41% with this combination therapy [19]. 

Crestor Astra-Zeneca) and lovastatin + niacin (Advicor Kos Pharmaceutical) — that can also cause rhabdomyolysis remain on the market. Although scientists agree that the other statins "seem to have essentially identical safety profiles and benefif-risk rafios," FDA said the ADRs associated with Baycol "have been reported significantly more frequently than for other approved statins." ... 

HMG-CoA reductase inhibitors Coadministration of niacin and HMG-CoA reductase inhibitors (eg, lovastatin) may result in myopathy and rhabdomyolysis. 

Concomitant lipid-lowering therapy - Generally avoid use of lovastatin with fibrates or niacin. If lovastatin is used in combination with gemfibrozil, other fibrates, or lipid-lowering doses (1 g/day or more) of niacin, the dose of lovastatin should not exceed 20 mg/day. 

Primary hypercholesterolemia/mixed dyslipidemia For the treatment of primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Frederickson Types lla and Mb) in the following Patients treated with lovastatin who require further TG-lowering or FIDL-raising who may benefit from having niacin added to their regimen patients treated with niacin who require further... 

The usual recommended starting dose for extended-release niacin tablets is 500 mg at bedtime. Niacin extended-release tablets must be titrated and the dose should not be increased by more than 500 mg every 4 weeks up to a maximum dose of 2000 mg/day, to reduce the incidence and severity of side effects. Patients already receiving a stable dose of niacin extended-release tablets may be switched directly to a niacin-eguivalent dose of niacin extended-release/lovastatin tablets. 

Take niacin extended-release/lovastatin tablets at bedtime, with a low-fat snack, and individualize dose according to patient response. 

Take whole do not break, chew, or crush before swallowing. Do not increase the dose by more than 500 mg/day (based on the niacin extended release component) every 4 weeks. The lowest dose of niacin extended-release/lovastatin tablets is 500/20 mg. Doses greater than 2000/40 mg/day are not recommended. If therapy is discontinued for an extended period (greater than 7 days), begin reinstitution of therapy with the lowest dose. 

Lovastatin (Mevacor/ Altocor) [Antilipemic/HMG-CoA Reductase Inhibitor] Uses Hypercholesterolemia Action HMG-CoA reductase inhibitor Dose 20 mg/d PO w/ PM meal may T at 4-wk intervals to 80 mg/d max or 60 mg ER tab take w/ meals Caution [X, -] Avoid w/ grapefruit juice, gemfibrozil. Contra Active liver Dz Disp Tabs SE HA GI intolerance common promptly report any unexplained muscle pain, tenderness, or weakness (myopathy) Interactions T Effects W/ grapefruit juice T risk of severe myopathy W/ azole antifungals, cyclosporine, erythromycin, gemfibrozil, HMG-CoA inhibitors, niacin T effects OF warfarin >1 effects W/ isradipine, pectin EMS t Risk of photosensitivity Rxns T effects of warfarin concurrent EtOH use t risk of liver tox diltiazem and verapamil can T risk of lovastatin tox OD Unlikely to cause life-threatening Sxs... 

The medication costs in this study are for branded Lovastatin and generic niacin. For niacin, the cost was taken to be Medicaid s reimbursement for multiple-source drugs. The actual measure was slightly below the average wholesale price but was above the lowest wholesale prices quoted. For Lovastatin, costs were estimated using the 1994 average wholesale price. 

ADVICOR (Kos) (niacin extended-release/lovastatin tablets) November 2003 labeling... 

It is clear from Equation (19.4) that saturated fat, not cholesterol, is the single most important factor that raises serum cholesterol. Some cases of hyperlipoproteinemia type IV (high VLDL) respond to low-carbohydrate diets, because the excess of VLDL comes from intestinal cells, where it is produced from dietary carbohydrate. Resins, such as cholestyramine and cholestipol, bind and cause the excretion of bile salts, forcing the organism to use more cholesterol. Lovastatin decreases endogenous cholesterol biosynthesis (see later), and niacin (nicotinic acid) apparently decreases the production of VLDL and, consequently, LDL. It also results in an HDL increase. Antioxidants that inhibit the conversion of LDL to oxidized LDL have also been used with some success. These are high doses of vitamin E and the drug probucol. 

Treatment Low cholesterol and low saturated fat in the diet. Heterozygotes Cholestyramine or colestipol, and/or lovastatin or mevastatin. Homozygotes As above, plus niacin. 

Treatment Weight reduction (if necessary) is of primary Importance. Dietary restriction of controlled carbohydrate, modified fat, low alcohol consumption. If necessary, drug therapy includes niacin and/or gemfibrozil (or clofibrate), or lovastatin (or mevastatin). 

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