NutriStack
Pravastatin and Vitamin B3, a caution.
High-dose Vitamin B3 as niacin can increase adverse effects when added to statin therapy, even though pravastatin has fewer CYP3A4 interaction concerns. Large trials of niacin added to statins did not show cardiovascular benefit and did show more adverse events, including glucose and liver-related problems. Ordinary dietary-dose niacin is not the concern.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Pravastatin and Vitamin B3
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. High-dose Vitamin B3 as niacin can increase adverse effects when added to statin therapy, even though pravastatin has fewer CYP3A4 interaction concerns. Large trials of niacin added to statins did not show cardiovascular benefit and did show more adverse events, including glucose and liver-related problems. Ordinary dietary-dose niacin is not the concern.
Mechanism. Pharmacologic niacin can cause hepatotoxicity, worsen glycemic control, and contribute to myopathy. These risks can stack with statin-associated muscle and liver monitoring concerns even when the statin is not CYP3A4-metabolized.
Recommendation. Do not add high-dose niacin to pravastatin unless your prescriber has a specific reason and monitoring plan. If used, monitor liver enzymes, blood sugar, and any muscle pain or weakness.
Sources (3)
- Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255-2267. PMID 22085343
- Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, et al. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med. 2014;371(3):203-212. PMID 25014686
- Haynes R, Valdes-Marquez E, Hopewell JC, Chen F, Li J, Parish S, et al. Serious Adverse Effects of Extended-release Niacin/Laropiprant: Results From the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) Trial. Clin Ther. 2019;41(9):1767-1777. PMID 31447131
Stack Score
How this pair moves the number.
Effect on the composite score
If both Pravastatin and Vitamin B3 are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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