Niacin and Zocor

In people who take both Zocor and the cholesterol medication niacin, there is an increased risk of developing serious muscle problems. Each medicine by itself can increase the chances of developing two serious muscle conditions called myopathy and rhabdomyolysis. Therefore, it is believed that the risk of these conditions occurring is even greater when niacin and Zocor are taken together.

 

Niacin and Zocor: An Overview

There are a number of possible drug interactions with Zocor® (simvastatin). One of these drug interactions is with niacin, a medicine used to lower total cholesterol, LDL cholesterol, and triglyceride levels, while raising HDL cholesterol levels.
 
When the two medicines are used together, there is an increased risk of developing serious muscle problems.
 

The Niacin-Zocor Warning: Serious Muscle Problems

Muscle pain, weakness, and muscle aches are among the more common side effects of Zocor, affecting up to 1.2 percent of people who take the drug. For most people, this muscle pain does not indicate a serious problem. However, in rare cases (less than 0.1 percent), people can develop a serious problem with their muscles while on Zocor. Two serious muscle problems are myopathy and rhabdomyolysis. Rhabdomyolysis is very serious because it can cause muscles to break down, which can cause the kidneys to stop working properly (acute kidney failure), and in some cases, lead to loss of life.
 
Niacin used alone also increases a person's chances of developing myopathy or rhabdomyolysis. Therefore, it is believed that people taking both niacin and Zocor are at increased risk of developing these serious muscle problems because of the combined effect of the two medicines.
 

Niacin and Zocor: Recommendations

In most cases, taking niacin and Zocor together is not recommended.
 If you are taking niacin and Zocor or a supplement with niacin in it, let your healthcare provider know.
 
However, there may be some situations in which your healthcare provider may recommend both niacin and Zocor. This is most often the case when taking either Zocor or niacin alone is not able to lower cholesterol to "normal" levels. For some people, a combination of the two drugs is needed to reach healthy cholesterol levels. Your healthcare provider may feel that the risk of a niacin and Zocor interaction is less than the risk of high cholesterol.
 
If you develop muscle pain, tenderness, or weakness while taking Zocor (especially if you also have a fever or feel ill), call your healthcare provider immediately. This could be a sign that you have a serious condition that needs treatment right away (see Zocor and Muscle Pain).
 
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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;