Cholesterol and Lipid Lowering Drugs: Niacin
Niacin is a B-vitamin (no relationship to nicotine) and is one of the
best medication available for patients with elevated levels of both
triglycerides and cholesterol and low levels of HDL cholesterol. In
well-controlled studies, niacin has been shown to reduce heart attacks
and death from heart disease. It has also been shown to be effective in
reducing the size of cholesterol deposits in the arteries of the heart.
Niacin is also available as a long acting preparation Niaspan®.Niaspan® is an extended release form of niacin intended for once daily dosisng.Niaspan® may have less side effects and be better tolerated than short acting niacin. The starting dose is 500 mg and the dosing is not directly interchangable with short acting niacin. Dose adjustments should be made at four weekly intervals. The maximum dose is 2000mg.Take Niaspan® only as directed. Do not chew the tablet.Take in the evening with a fatty snack.
Niacin is quite a safe medication. There is a risk of an increase in blood
sugar levels in patients with diabetes but this can usually be controlled
with diet. Uric acid levels in the blood tend to rise and, rarely, this
may result in gout. In a few patients, small changes may occur in liver
function tests. Patients with a history of duodenal ulcers may experience
an increase in ulcer symptoms and should avoid this medication until the
ulcer is well healed. You will be checked each time that you have a blood
test for each of these possible complications and if you do experience
any side-effects, they tend to resolve quickly once the niacin is stopped.
The most common side-effects with niacin are not serious ones but can
make it difficult to adjust to the medication. When patients first start
to take niacin, they will experience symptoms such as flushing, itching
or tingling of the skin and slight lightheartedness. These side-effects
are due to opening up of small blood vessels in the skin. Fortunately
these symptoms tend to disappear as the body adjusts to the medication
and are not usually a significant problem after the first month or two
One to three coated aspirin per day will help to reduce flushing during
the first few weeks of treatment. Take the coated aspirin approximately
I hour before each meal or just before breakfast and take the niacin after
Start therapy as follows: 500 mg tablets
1/4 tablet after each meal for 2 weeks-then
1/2 tablet after each meal for 2-4 weeks-then
1 tablet after each meal for 2-4 weeks-then, if directed
2 tablets after each meal thereafter
If you experience excessiveness of flushing, increase the dose more slowly.
Avoid taking niacin with a hot beverage or on an empty stomach. It is
important to follow a regular pattern and take the niacin 2 or 3 times
per day after meals. Usually, in a few weeks, flushing and itching disappear.
However, if you miss taking the medication for even a day or two, these
symptoms tend to return.