Treatment of hyperlipidemia with combined niacin-statin regimens

Combined use of niacin with a statin is an attractive option, since these t ypes of medication have the best records in clinical trials for reduction i n cardiovascular events and improvement in progression/regression of corona ry lesions. In early use, the niacin-statin combination generated a few cas e reports documenting severe myopathy and rhabdomyolysis. Subsequent prospe ctive trials in >400 patients, however, have not encountered myopathy. This experience includes 165 patients who took a statin in combination with Nia span, a new, extended-release niacin administered once nightly. Hepatic tox icity with immediate-release niacin and with Niaspan used in combination wi th statins has been minimal. However, substantial transaminase elevations o ccurred with the use of a sustained-release niacin (Nicobid) given twice da ily. The niacin-statin treatment regimens gave augmented low-density lipopr otein (LDL)-cholesterol reduction along with favorable changes in high-dens ity lipoprotein (HDL) cholesterol, lipoprotein(a), and triglycerides. This combination therapy can be used safely as long as (1) careful attention is given to niacin formulation and dosing; (2) liver functions are monitored; and (3) patients are educated to recognize symptoms of myopathy. However, s pecial caution should apply to use of niacin in combination with high doses of statins, or with statins introduced into clinical practice in 1997 or l ater, since little experience has accumulated in these circumstances. (C) 1 998 by Excerpta Medica, Inc.