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Niacin-ER and Lovastatin Treatment of Hypercholesterolemia and Mixed Dyslipidemia

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL; Clinical Adjunct Instructor, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL; Clinical Pharmacist, Department of Pharmacy, John H. Stroger Jr Hospital of Cook County, Chicago

Pang H Chong, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago; Clinical Adjunct Instructor, Chicago College of Pharmacy, Midwestern University; Clinical Pharmacist, Department of Pharmacy, John H. Stroger Jr Hospital of Cook County

Reprints: Pang H Chong PharmD, Department of Pharmacy, John H. Stroger Jr Hospital of Cook County, 1901 W. Harrison St., Chicago, IL, 60612-3736, FAX 312/864-9287, E-mail cpang{at}tigger.cc.uic.edu

OBJECTIVE: To review the currently available information on the once-daily combination of niacin extended-release (ER)/lovastatin in the treatment of patients with hypercholesterolemia and mixed dyslipidemia at high risk for cardiovascular events.

DATA SOURCES: MEDLINE (1966–July 2002) was searched for primary and review articles. Data from the manufacturer were also included.

STUDY SELECTION/DATA EXTRACTION:All articles and product labeling deemed relevant to the combination of niacin and statins (i.e., lovastatin) were included for review. English-language studies selected for inclusion were limited to those with human subjects.

DATA SYNTHESIS: The Food and Drug Administration approved a new fixed-dose combination of niacin-ER/lovastatin, which is administered once daily. The efficacy and safety of the combined agent have been proven to be similar to either component used alone or in combination for management of hyperlipidemia and mixed dyslipidemia.

CONCLUSIONS: Elevated low-density lipoprotein cholesterol (LDL-C) is independently associated with a higher risk for cardiovascular events. Lowering of elevated LDL-C concentrations with statin monotherapy may be insufficient in patients at high risk for cardiovascular events. In fact, consideration of elevated triglycerides (TGs) and/or low concentrations of high-density lipoprotein cholesterol (HDL-C) in patients with elevated LDL-C places them at greater risk. The addition of niacin may enhance or improve the lipid profile of those who require a further decrease of TGs and/or increase of HDL-C even after stable statin therapy. Niacin-ER offers efficacy similar to that of immediate-release niacin, but minimal myopathy and hepatotoxicity (compared with sustained-release niacin). Although no clinical outcomes are available, current evidence shows that the combination product offers adequate lowering of LDL-C and TGs and increasing HDL-C. The data suggest that therapy with the niacin-ER and lovastatin combination product is safe and does not increase the incidence of adverse effects.

Key Words: extended-release niacin, lovastatin

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ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-003-H01