Increased risk of myopathy with some other lipid-lowering therapies (fibrates or niacin), gemfibrozil, cyclosporine, lopinavir/ritonavir, atazanavir/ritonavir, organic anion transporting polyprotein 1B1 inhibitors, or breast cancer resistance protein inhibitors. Avoid with gemfibrozil. Caution with coumarin anticoagulants; determine INR before initiation and frequently during early therapy. May enhance the risk of skeletal muscle effects with ≥1 g/day of niacin. Caution with drugs that may decrease levels or activity of endogenous steroid hormones (ex, ketoconazole, spironolactone, cimetidine), fenofibrates, or protease inhibitors in combination with ritonavir. Cyclosporine may increase levels. Caution with colchicine; cases of myopathy, including rhabdomyolysis, reported.
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