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.
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
- Stomach and digestive problems, including bloating, gas, and nausea
- Abnormal liver function which must be monitored by periodic blood tests
- Blurred vision
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
- Start by taking low doses at mealtime, gradually working up to the
- 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
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.
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