Priacin Dosage/Direction for Use

Dosage Range: 5-80 mg/day, given as a single dose in the evening. Adjustments of dosage, if required, should be made at intervals of not <4 weeks, to a maximum of 80 mg/day given as a single dose in the evening.
Due to the increased risk of myopathy, including rhabdomyolysis, particularly during the 1st year of treatment, use of the 80-mg dose of simvastatin should be restricted to patients who have been taking simvastatin 80 mg chronically (eg, for ≥12 months) without evidence of muscle toxicity. Patients unable to achieve their LDL-C goal utilizing the 40-mg dose of simvastatin should not be titrated to the 80-mg dose, but should be placed on alternative LDL-C-lowering treatment(s) that provides greater LDL-C lowering.
Patients with High Risk or Existing Coronary Heart Disease (CHD): Patients with CHD can be treated with a starting dose of 20 mg/day given as a single dose in the evening. Patients at high risk for a CHD event due to existing CHD, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular disease have been shown to benefit from 40 mg/day and can be started at this dose.
Patients with Hyperlipidemia (Who are Not in the Risk Categories Previously Specified): The patient should be placed on a standard cholesterol-lowering diet before receiving Priacin and should continue on this diet during treatment with Priacin.
The usual starting dose is 10 mg/day given as a single dose in the evening. Patients who require a reduction in LDL-C (>45%) may be started at 40 mg/day given as a single dose in the evening. Adjustments of dosage, if required, should be made as specified previously.
Patients with Homozygous Familial Hypercholesterolemia: Based on the results of a controlled clinical study, the recommended dosage is 40 mg/day in the evening or 80 mg/day in 3 divided doses of 20 mg, 20 mg and an evening dose of 40 mg. Priacin should be used as an adjunct to other lipid-lowering treatments (eg, LDL apheresis) in these patients or if such treatments are unavailable.
Concomitant Therapy: Priacin is effective alone or in combination with bile acid sequestrants.
In patients taking cyclosporine, danazol, gemfibrozil, other fibrates (except fenofibrate) concomitantly with Priacin, the dose of Priacin should not exceed 10 mg/day. In patients taking amiodarone or verapamil concomitantly with Priacin, the dose of Priacin should not exceed 20 mg/day. In patients taking diltiazem concomitantly with Priacin, the dose of Priacin should not exceed 40 mg/day. (See Precautions and Interactions.)
Renal Insufficiency: Because Priacin does not undergo significant renal excretion, modification of dosage should not be necessary in patients with moderate renal insufficiency.
In patients with severe renal insufficiency (creatinine clearance <30 mL/min), dosages >10 mg/day should be carefully considered and, if deemed necessary, implemented cautiously.