The combination of a statin and
nicotinic acid has been implicated in cases of rhabdomyolysis.
If the decision is made to use
nicotinic acid with a statin the outcome should be very well monitored. All patients should be warned to report promptly any unexplained muscle aches, tenderness, cramps, stiffness or weakness. The manu- facturers of
simvastatin say that the dose should not exceed 10 mg daily in patients taking
nicotinic acid in doses of at least 1 g daily.