Examples

Immediate-release form

Sustained-release form

Extended-release form

The nicotinic acid form of niacin lowers cholesterol, but other forms of niacin do not. These other forms that do not lower cholesterol include nicotinamide and inositol nicotinate (also called no-flush niacin). Niacin is also known as a B vitamin.

How It Works

Nicotinic acid reduces the production of triglycerides and VLDL (very low-density lipoprotein, which is converted to LDL in the blood). This leads to decreased LDL ("bad") cholesterol, increased HDL ("good") cholesterol, and lowered triglycerides. Nicotinic acid raises HDL cholesterol more than other lipid-lowering medicines.

Why It Is Used

Nicotinic acid is especially useful in people who have low HDL levels and high triglyceride levels because it raises HDL and lowers triglycerides. Niacin may not be appropriate for some people who have:

• Gout.
• Active stomach ulcer.
• Oversensitivity to niacin.
• Glaucoma.
• Type 2 diabetes and do not have their blood sugar levels controlled.
• Clotting disorders, such as hemophilia.
• Active liver disease.
• Alcoholism.

How Well It Works

• LDL can be reduced by 5% to 25%. ¹
• HDL can be increased by 15% to 35%. ¹
• Triglycerides can be reduced by 20% to 50%. ¹

Side Effects

The immediate-release form is safe for long-term use. But nicotinic acid has frequent side effects, including:

• Sudden blushing or redness of the face (flushing), which is more common with the immediate-release forms of nicotinic acid.
• Itching.
• Liver problems (hepatotoxicity), especially with the sustained-release form.
• High blood sugar (hyperglycemia).
• Too much uric acid in the blood (hyperuricemia). Excess uric acid in the blood can lead to gout.
• Gastrointestinal problems such as upset stomach, gas, nausea, vomiting, and diarrhea.
• Dizziness, lightheadedness, or a fast or slow heartbeat.

These side effects are more severe when higher doses are used.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

All people who are taking nicotinic acid should be closely monitored for signs of liver problems by measuring the level of liver enzymes with blood tests.

Nicotinic acid is a B vitamin that is available without a prescription as a vitamin supplement (niacin). Talk to your doctor before you start taking nonprescription niacin. If you choose to take nonprescription niacin, ask your doctor to help you figure out the dose that will be effective. You do not want to take more niacin than you need. Larger doses of niacin can be dangerous because they can damage your liver. So if you take nonprescription niacin, watch for symptoms of liver problems such as stomach pain, bloody stools, or yellow skin (jaundice). Your doctor will also want to check your liver function on a regular basis.

The extended release form of niacin, such as Niaspan, is a newer form of niacin that does not appear to cause the liver problems associated with sustained-release niacin. Extended release niacin is a prescription medicine.

Facial flushing and itching gradually diminish over time for most people. Starting with a low dose and gradually increasing the dose may reduce the flushing and itching. You can also try taking an aspirin 30 to 60 minutes before taking your niacin. Or you can try taking niacin with a snack. Work with your doctor to find what works best for you to relieve flushing or itching.

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Citations

1. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.