Nicotinic acid, also called niacin, is a form of vitamin B. It is the first choice for patients with low HDL levels.
Benefits
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
Brands include Niacor, Nicolar, Slo-Niacin, Niacin SR, and Niaspan. The extended-release forms (including Niacin SR, Niaspan, and Slo-Niacin) 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 physician's direction in order
to ensure its safety and effectiveness.
Side effects
Unfortunately, many patients find the side effects of nicotinic acid intolerable. About a quarter of patients taking
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 five minutes to hours after taking the drug and can last for minutes to hours. (Although longer times are less common.) The body often becomes tolerant to these effects eventually, and the side effects generally subside.
Flushing and itching may be reduced with the following measures: |
- Start with low doses taken at mealtime and gradually work up to the
prescribed dose.
- Take low-dose aspirin about 30 minutes before taking nicotinic
acid, which appears to 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% to 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.
Review Date: August 24, 2004
Reviewed By: Jacqueline A. Hart, M.D., Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor,
A.D.A.M., Inc.
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