Niacin/simvastatin | Side Effects, Dosage, Uses & More
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Generic Name:

niacin-simvastatin, Oral tablet

All Brands

  • Simcor
SECTION 1 of 4

Highlights for niacin-simvastatin

Oral tablet
1

Niacin/simvastatin is used to reduce cholesterol and triglyceride levels. It’s used when diet changes and treatment with simvastatin or niacin therapy alone haven’t worked.

2

Niacin/simvastatin is available as a brand-name drug called Simcor. It’s not available as a generic drug.

3

This medication is a combination product that contains two drugs: niacin and simvastatin. The niacin in this medication is an extended-release version. That means it’s slowly released into your bloodstream over time.

4

This drug comes in the form of a tablet you take by mouth.

5

The more common side effects can include flushing (sudden reddening of the skin), headache, back pain, diarrhea, nausea, or itching.

IMPORTANT INFORMATION

Muscle pain, tenderness, or weakness

Niacin/simvastatin raises your risk of muscle pain or serious damage. Muscle tissue is broken down and released into your bloodstream. This can lead to kidney problems, and even death. Call your doctor right away if you have any unexplained muscle pain, tenderness, or weakness. This is especially important if you also have a fever and feel tired. You should also tell your doctor if you have these symptoms after stopping niacin/simvastatin.

Flushing

Flushing is a common side effect of niacin/simvastatin. With flushing, your skin suddenly becomes red, warm, and tingly. It occurs more often when therapy is started and during dose increases. It may stop after several weeks of treatment.

Drug features

Niacin/simvastatin is a prescription drug. It comes in the form of a tablet you take by mouth.

Niacin/simvastatin is available as a brand-name drug called Simcor. It’s not available as a generic drug.

Niacin/simvastatin is a combination drug. It contains two drugs: niacin and simvastatin. The niacin in this medication is an extended-release version. That means it’s slowly released into your bloodstream over time. It’s important to know about both drugs in this combination because each drug may affect you in a different way.

Niacin/simvastatin may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Niacin/simvastatin is used along with diet and exercise to lower cholesterol levels. It’s also used to lower levels of triglycerides (other fats in your blood). If you have high cholesterol and triglycerides, you are at higher risk of heart disease, heart attack, or stroke.

How it works

Niacin/simvastatin is a combination of two drugs. Niacin belongs to a class of drugs called nicotinic acids. Simvastatin belongs to a class of drugs called statins. A class of drugs is a group of medications that work in a similar way.

More Details

How it works

Niacin/simvastatin is a combination of two drugs. Niacin belongs to a class of drugs called nicotinic acids. Simvastatin belongs to a class of drugs called statins. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions.

Niacin may improve cholesterol levels by stopping the release of fat from fat tissue into the bloodstream. It may also slow down your body’s production of triglycerides (fats). Simvastatin works by stopping your body from making cholesterol. 

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SECTION 2 of 4

niacin-simvastatin Side Effects

Oral tablet

More Common Side Effects

The more common side effects that can occur with niacin/simvastatin include:

  • flushing (redness, warmth, itching, or tingling in the skin)

  • headache

  • back pain

  • diarrhea

  • nausea

  • itching

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Muscle problems. This is a very serious side effect. Muscle tissue is broken down and released into your bloodstream. This can lead to kidney problems, and even death. Symptoms can include unexplained:

    • muscle weakness
    • muscle tenderness
    • muscle pain
  • Liver problems. Symptoms can include:

    • tiredness
    • loss of appetite
    • pain in the upper abdomen (stomach area)
    • dark-colored urine
    • yellowing of the skin or whites of the eyes
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Niacin/simvastatin does not cause drowsiness. However, flushing is a common side effect of niacin therapy. Symptoms can include warmth, redness, itching, or tingling of the skin. A few ways to help reduce flushing include:

  • Take aspirin about 30 minutes before taking niacin/simvastatin.
  • Take this drug at night. This can help prevent flushing during the day. However, in some cases the flushing can wake you up at night. If it does and you decide to get up, you should move slowly. Be especially careful if you feel dizzy or faint, or if you take blood pressure medications.
  • Avoid having spicy foods or hot drinks for 30–60 minutes before or after you take this drug.
  • Avoid drinking alcohol for 1 hour before or after you take this drug.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

niacin-simvastatin May Interact with Other Medications

Oral tablet

Niacin/simvastatin can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Food interactions

Eating grapefruit or drinking grapefruit juice can increase the level of simvastatin in your body. This raises your risk of serious muscle pain or damage. Avoid drinking grapefruit juice or eating grapefruit while taking niacin/simvastatin.

Alcohol interaction

The use of drinks that contain alcohol raises your risk of liver injury from niacin/simvastatin. If you drink alcohol, talk to your doctor. You may need to be monitored for signs of liver damage.

Alcohol can increase the amount of flushing you have from this drug. To help avoid this, don’t drink alcohol for 1 hour before or after you take this drug.

Medications that might interact with this drug

Antibiotics

Taking certain antibiotics along with niacin/simvastatin can cause high levels of niacin/simvastatin to build up in your body. This raises your risk of side effects from niacin/simvastatin, including muscle pain, weakness, and breakdown. Examples of these drugs include: 

  • clarithromycin
  • erythromycin
  • telithromycin

Antifungals

Taking certain antifungal drugs along with niacin/simvastatin can cause high levels of niacin/simvastatin to build up in your body. This raises your risk of side effects from niacin/simvastatin, including muscle pain, weakness, and breakdown. Examples of these drugs include:

  • itraconazole
  • ketoconazole
  • posaconazole

Blood thinners

Warfarin is used to thin the blood. When this drug and niacin/simvastatin are taken together, it can increase the effects of warfarin. This raises your risk of bleeding. Your doctor should closely monitor your INR (a blood test) if you take warfarin along with niacin/simvastatin.

Cholesterol drugs

Taking certain drugs used to lower cholesterol levels along with niacin/simvastatin raises your risk of severe muscle problems. Some of these drugs should be avoided if you are taking niacin/simvastatin. Others may be used with careful monitoring. Talk to your doctor to find out if taking these drugs is safe for you. Examples of these drugs include: 

  • gemfibrozil
  • fibrates, such as:
    • fenofibrate
    • fenofibric acid 

Also, taking other cholesterol drugs along with niacin/simvastatin can prevent them from working well. To avoid these problems, you should take these medications at least 4–6 hours before or after taking niacin/simvastatin. Examples of these drugs include: 

  • cholestyramine
  • colestipol

Gout drugs

Colchicine is used to treat gout. Taking this drug along with niacin/simvastatin raises your risk of serious muscle problems. These include muscle pain, weakness, and breakdown.

Heart drugs

Taking certain blood pressure and heart drugs along with niacin/simvastatin raises your risk of serious muscle problems. These include muscle pain, weakness, and breakdown. If you take these drugs together, your doctor may lower your dosage of niacin/simvastatin. Your doctor may also take you off of this drug. Examples of these drugs include: 

  • amlodipine
  • amiodarone
  • diltiazem
  • ranolazine
  • verapamil 

Taking certain blood pressure drugs with niacin/simvastatin can increase their effects. This could cause very low blood pressure. Examples of these drugs include: 

  • clonidine
  • epoprostenol
  • isosorbide dinitrate
  • isosorbide mononitrate

Digoxin is used to treat heart rhythm problems. Taking this drug with niacin/simvastatin can raise the levels of digoxin in your body. This raises your risk of side effects from digoxin. Your doctor should monitor you carefully when you start taking niacin/simvastatin along with this drug. 

Hormone therapy

Danazol is a hormone drug used to treat endometriosis, breast disease, or angioedema. Taking this drug with niacin/simvastatin raises the risk of severe muscle problems. These problems include muscle pain, weakness, and breakdown. You should avoid taking danazol with niacin/simvastatin.

Nutritional supplements

Talk to your doctor before taking niacin/simvastatin along with nutritional supplements that contain niacin. Using these drugs together can raise your risk of side effects from niacin. These side effects include flushing (sudden reddening of the skin).

Other drugs

Cyclosporine is used to suppress the immune system. It may be used to treat conditions such as rheumatoid arthritis or psoriasis. It may also be used after solid organ transplant. Taking this drug with niacin/simvastatin raises the risk of serious muscle problems, such as muscle pain, weakness, or breakdown. You should avoid taking cyclosporine with niacin/simvastatin.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with kidney problems

Talk to your doctor about whether taking niacin/simvastatin is safe for you. If you take it, your doctor should monitor you closely throughout treatment. If you have severe kidney problems, you shouldn’t take this drug until you have taken simvastatin at doses of 10 mg or higher without problems. 

People with liver disease

If you have liver disease or have had a recent blood test with abnormal liver function results, you should not take niacin/simvastatin. If you have a past history of liver disease or drink a lot of alcohol, talk to your doctor about whether taking niacin/simvastatin is safe for you.

People with active peptic ulcer disease

You should not take niacin/simvastatin. It can worsen your condition.

People with active bleeding

If you have any type of active bleeding, you should not take niacin/simvastatin. Niacin/simvastatin can lower your platelet count. This will make your blood take longer to clot. If you have an active bleed and take this drug, you are at risk of increased bleeding.

People with diabetes

If you have diabetes or borderline diabetes, talk to your doctor to find out if taking this drug is safe for you. Niacin/simvastatin can raise fasting blood sugar. If you take this drug, you should be closely monitored, especially during the first few months of treatment. To manage your blood sugar, you may need to adjust your diet, or your doctor may need to change your doses of diabetes medications.

People with gout

Talk to your doctor to find out if taking this drug is safe for you. Niacin/simvastatin can increase uric acid levels in your body. This can cause a flare-up of your gout.

Pregnant women

Niacin/simvastatin is a category X pregnancy drug. Category X drugs should never be used during pregnancy. Women of childbearing age should use reliable birth control while taking this drug.

Talk with your doctor if you’re pregnant or planning to become pregnant. 

Women who are breast-feeding

Niacin passes into breast milk and may cause side effects in a child who is breast-fed. It is not known if simvastatin passes into breast milk.

There is a risk of serious side effects in children who are breast-fed, so do not take this drug while breast-feeding. You’ll need to decide whether to stop breast-feeding or stop taking this medication.

For seniors

Patients 65 years of age and older are already at risk of muscle pain or damage. This risk is increased with use of niacin/simvastatin. Talk to your doctor to find out if taking this drug is safe for you. 

For children

This medication has not been studied in children. It should not be used in people younger than 18 years.

When to call the doctor

Call your doctor if you are having symptoms of a heart attack or stroke.

Symptoms of heart attack can include:

  • chest pain
  • pain in your arms, back, shoulders, neck, jaw or upper stomach
  • shortness of breath
  • lightheadedness
  • nausea or vomiting

Symptoms of a stroke can include:

  • sudden weakness or numbness on one side of your body
  • sudden vision loss
  • slurred speech
  • loss of balance or ability to walk
  • loss of consciousness

Also call your doctor if you become pregnant while taking this drug.

Allergies

Niacin/simvastatin can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • flushing (sudden reddening of the skin)
  • shortness of breath

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you have ever had an allergic reaction to it before. Taking it again could be fatal (cause death).

SECTION 4 of 4

How to Take niacin-simvastatin (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Hypercholesterolemia (high cholesterol levels) with hypertriglyceridemia (high triglyceride levels)

Brand: Simcor

Form: Oral extended-release tablet
Strengths:
  • 500 mg niacin/20 mg simvastatin
  • 500 mg niacin/40 mg simvastatin
  • 750 mg niacin/20 mg simvastatin
  • 1,000 mg niacin/20 mg simvastatin
  • 1,000 mg niacin/40 mg simvastatin
Adult dosage (ages 18 years and older)
  • Initial dose
    • If you are currently not taking niacin/simvastatin or any other products that contain niacin:
      • 500 mg niacin/20 mg simvastatin once per day at bedtime
    • If you are currently on 20–40 mg of simvastatin only each day and need more help managing your cholesterol:
      • 500 mg niacin/40 mg simvastatin once per day at bedtime
  • Maintenance dose
    • From 1,000 mg niacin/20 mg simvastatin to 2,000 mg niacin/40 mg simvastatin once per day
  • Maximum dose
    • Two doses of 1,000 mg niacin/40 mg simvastatin once per day at bedtime
    • Niacin/simvastatin shouldn’t be increased by more than 500 mg per day of niacin every 4 weeks. 
Child dosage (ages 0–17 years)

This medication has not been studied in children. It should not be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with Chinese heritage: Your doctor should carefully monitor you if take doses above 1,000 mg niacin/20 mg simvastatin per day. This is due to an increased risk of muscle pain. It’s not known if this risk applies to other Asian people.

Warnings

Switching niacin drugs: If you’re switching from niacin/simvastatin to another niacin product, you should only switch to equal doses of niacin extended-release capsules. This is because if you switch to immediate-release niacin or other types of modified-release niacin, you’re at increased risk of severe liver damage.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Niacin/simvastatin comes with serious risks if you don't take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your cholesterol will not be controlled. This can lead to serious health problems such as a heart attack or stroke.

If you stop taking niacin/simvastatin for any length of time, contact your doctor before restarting it. You will need to restart the drug at a lower dose.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

f you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • flushing (sudden reddening of the skin)
  • dizziness
  • fast heart rate
  • shortness of breath
  • fainting
  • muscle pain

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

Your cholesterol levels should improve. You won’t be able to feel this. Your doctor will do blood tests to check your cholesterol. Test results should show a decrease in triglycerides, LDL (bad) cholesterol, and total cholesterol. They should also show an increase in HDL (good) cholesterol.

Niacin/simvastatin is used for long-term treatment.

Take this drug after eating a low-fat snack

Taking niacin/simvastatin on an empty stomach is not recommended.

Store niacin/simvastatin carefully

  • Keep this drug at room temperature between 68°F and 77°F (20°C and 25°C).
  • Keep it away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Do not put this medicine in your glove compartment or leave it in the car, especially when the temperature is hot or freezing.

Clinical monitoring

Your doctor will do blood tests during your treatment with niacin/simvastatin. These tests will help make sure the medication is safely helping to control your cholesterol levels. These tests may include:

  • Periodic fasting cholesterol check. This test checks your cholesterol levels. It will be done from time to time during your treatment with this drug.
  • Liver function test. This test checks for any signs of liver injury. It’s done before and during your treatment with niacin/simvastatin.
  • Creatinine kinase. This test checks for increased levels of this enzyme. Higher levels can be a sign of muscle pain or damage.
  • Blood sugar/A1c. This test checks blood sugar levels. It’s done for people with diabetes during the first few months of treatment with this drug.

Your diet

To help manage your cholesterol levels, your diet should be low on saturated fat and cholesterol. Ask your doctor to suggest an eating plan that’s right for you.

Hidden costs

You will need to have blood tests during your treatment with niacin/simvastatin. The cost of these tests will depend on your insurance coverage.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other options that may work for you.

What does the pill look like?

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on October 13, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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