Cardiac Medications

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 of treatment.

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 your meal.

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

Maintaining tolerance
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.

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