Supplement · Considered, not recommended

Niacin and medications.

Why it sits outside our recommendations, and what to consider instead.

Niacin is not in the Distil recommendation database. We surface it here deliberately, because why a compound is left out is as useful as what we recommend.

Niacin (nicotinic acid) does lower LDL and raise HDL, and it was once a mainstay of lipid treatment. The reason it is no longer recommended for most people, and why it is outside the Distil database, is what happened when it was tested properly. The large outcome trials that added niacin on top of a statin (AIM-HIGH in 2011 and HPS2-THRIVE in 2014, the latter in over 25,000 people) found no reduction in heart attacks or strokes, and a clear signal of harm: more new-onset diabetes, more infection, and more bleeding.

At the doses used for cholesterol it also causes flushing, and the slow-release forms can stress the liver. Taken with a statin it adds to the risk of muscle injury. The benefit did not hold up. The risks did. For lipids, the options below have a better balance, though none replaces a statin where one is indicated.

What to consider instead. Every option below is in the Distil database, so you can check each against your own medications:

Bergamot Extract (BPF / Bergavit40): standardised bergamot has trial evidence for LDL and triglycerides
Berberine: lowers LDL and fasting glucose; watch for additive effects with diabetes medicines
Omega-3 EPA: mainly a triglyceride lever

We still hold the documented interactions for Niacin, which is why it stays in the interactions checker even though we do not recommend it. Below are the 2 documented pairs we have explicitly assessed: 1 red and 1 amber. Every call is cited to a clinical reference (PMID) or the British National Formulary.

Documented interactions

Additive muscle toxicity

Red Simvastatin

High-dose niacin combined with simvastatin raises the risk of severe muscle breakdown (rhabdomyolysis). The FDA has a class warning on this combination. Do not combine.

PMID 25014686 · BNF: Simvastatin

Amber Atorvastatin

High-dose niacin combined with atorvastatin raises myopathy risk, though less than with simvastatin. If you take both, watch for unexplained muscle pain and tell your GP.

BNF: Atorvastatin

What this page does not say. Leaving a compound out of our recommendations is not a verdict that it is useless for everyone. It is a statement about safety, evidence, or interaction load in the context Distil screens for. Discuss any supplement decision with whoever manages your prescriptions.

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.

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How we decide

How we grade severity, choose what's in scope, and what we exclude.

Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.

Read the full methodology

Your whole stack

Want this checked across everything you take?

This page checks the pairs you enter. The personalised Distil report goes further:

the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
where your current routine may be leaving you short of your goals
the evidence-backed compounds worth adding, and the ones worth dropping

It's a paid report: £79, or £49 for the first 25 customers. The interactions check is one section of it, and you can read a real one in full before you buy.

See a real sample report

Something missing?

If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.

Thanks, that's logged. We go through flagged items every week.

Distil's interactions database is reviewed and updated every quarter. We grade evidence transparently and publish our methodology, including every database change, at /about/methodology. This tool is information, not a substitute for clinical judgement. If you take medication and supplements together, your GP or pharmacist can review your full regimen against your medical history. If you want a full personalised stack reasoned against this same database, the Distil report is the next step up.