Drug treatments: Nicotinic acid (niacin)

Nicotinic acid, also called niacin, is a form of vitamin B. It is the first choice for patients with low HDL levels.


When used in high doses, nicotinic acid has the following benefits:

  • It raises HDL levels higher than any other cholesterol drug.
  • It is extremely effective in reducing triglyceride levels.
  • It lowers LDL-cholesterol.
  • It is the least expensive cholesterol drug.

Combining nicotinic acid with other cholesterol drugs, particularly statins, may add significant benefits.


Brands include Niaspan Extended Release and Slo-Niacin. The extended-release forms are generally administered at bedtime and may have fewer side effects, including headaches and flushing.

Although niacin is available over the counter as vitamin B3, the active form used for cholesterol is given in much higher doses and is available only by prescription. It is important to take this medication under a health care provider's direction to ensure its safety and effectiveness.

Side effects

Unfortunately, many patients find the side effects of nicotinic acid intolerable. About a quarter of patients who use rapid-acting forms of nicotinic acid stop taking them. The most common side effects are:

  • Flushing of the face and neck
  • Itching
  • Headache
  • Stomach and digestive problems, including bloating, gas, and nausea
  • Abnormal liver function which must be monitored by periodic blood tests
  • Blurred vision
  • Dizziness

Side effects occur between 5 minutes to hours after taking the drug and can last for minutes to hours. (Although longer periods of experiencing side effects are less common.) The body often becomes tolerant to these effects eventually, and the side effects generally subside.

You may be able to reduce flushing and itching with the following measures:

  • Start by taking low doses at mealtime, gradually working up to the prescribed dose.
  • Taking low-dose aspirin about 30 minutes before taking nicotinic acid may help prevent flushing. Discuss this option with your doctor.
  • Avoid hot drinks.
  • Choose an extended release form. (Even with this form, it is wise to gradually increase the bedtime dose over time and take a low-dose aspirin a half-hour beforehand.)

Potentially serious complications

  • About 3 - 5% of people taking nicotinic acid develop liver abnormalities, which disappear after the medication is discontinued. People who already have liver disease should not use nicotinic acid.
  • People with gout or gallbladder disease should avoid nicotinic acid, as should those who drink alcohol regularly (because of the potential effects on the liver).
  • The use of nicotinic acid in people with diabetes is less clear. Nicotinic acid can elevate blood glucose (sugar) levels. While one study found that people with diabetes who used nicotinic acid had little trouble with blood sugar control, at this time most physicians avoid prescribing it to this population.


Main Menu

Review Date: 10/31/2006

Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.


Related Links

Find a Cardiac Specialist:





Request an Appointment Online or call
1-800-789-PENN (7366)
Penn Heart and Vascular
Encyclopedia Articles about the Heart




About Penn Medicine   Contact Us   Site Map   Privacy Statement   Legal Disclaimer   Terms of Use

Penn Medicine, Philadelphia, PA 800-789-PENN © 2015, The Trustees of the University of Pennsylvania space