HMG-CoA reductase inhibitors,antihypertensive therapy, aspirin, concomittant alcohol, hot drinks, digoxin, erythromycin, oral contraceptives

Vitamin or other nutrional supplements containing large doses of niacin or related compounds such as nicotinamide may potentiate the adverse effects of niacin

Elevated serum triglyceridess

Low HDL cholesterol

Diabetic dyslipemics

Gastrointestinal discomfort.

headaches, skin rashes,

muscle aches, liver inflammation, drowsiness,

dizziness, flushing, pruritis,

hyperurimia, and glucose intolerance

Hypersensitrivity

Active peptic ulcer disease

Artrial bleeding

Pregnancy and lactation

Special precautions-

The combination should be used with caution in patients with renal insuficiency

Indication-

Elevated serum triglycerides

Low HDL cholesterol

Diabetic dyslipemics

Dosage-

to be initiated with 1 tablet of Atorvastatin -Niacin combination at bed time.

The dose of Atorvatatin and /or Niacin may be titrated upwards depending on the response of the patient.

Pharmacology-

Atorvastatin belongs to the group HMG-CoA reductase inhibitor thsat inhibits cholesterol synthesis in the liver by inhibiting the rate-inhibiting enzyme HMG-CoA reductase. Consequently there is a ncrease in the number of LDL receptors onthe liver surface, that take up the excess circulating LDL-C (rich with cholesterol ) in the blood.

This leads to decreased levels of LDL-C in blood Niacin has diverse actions affecting lipid metabolism. It however does not cholesterol synthesis. Primary effects is to decrease production of VLDL by inhibiting liupolysis. This inhibits the delivery of fatty acids to liver and consequently there is a decreased triglyceride and VLDL synthesis.

The decrease in LDL levels is primarily due to decreased VLDL production and also by improving the activity of lipoprotein lipase. It also elevates HDL by promoting synthesis of apolipoprotein precursors that produce HDL particles.Of the entire lipid lowering agents, niacin is the most effective agent in elevating HDL levels.

Contraindicated in pregnancy and lactation.