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Niacin to Treat High Cholesterol
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By Katie Orton, Pharm. D. Student
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December, 2007
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High cholesterol levels play a significant role in the progression of heart disease, which is the leading cause of death in the United States. Extra cholesterol in your blood can build up in your arteries causing them to narrow and harden which may lead to a heart attack or stroke. Weight loss, diet, and exercise are recommended for all patients with abnormal cholesterol levels but are often not enough to help a patient reach their cholesterol level goals.
You may have heard of people taking niacin, a B vitamin, to treat high cholesterol. When given in appropriate doses, niacin lowers triglycerides and LDL and increases HDL. Triglycerides are a form of fat carried through the bloodstream. LDL is often called the bad or Lousy cholesterol as it leads to the buildup of cholesterol in arteries. HDL is also known as the good or Healthy cholesterol because it removes cholesterol from the bloodstream. Niacin is actually the most effective drug for raising HDL and may be used in combination with other drugs. A high level of HDL, along with low levels of LDL and triglycerides, are linked to a healthy heart and blood vessels.
Niacin is available both as a prescription and over the counter (OTC) as a dietary supplement in several different formulations. It is important to know that dietary supplements have not been evaluated by the FDA for safety or effectiveness, therefore, it is important to talk to your doctor or pharmacist before taking niacin on your own.
One form of niacin available as both a prescription and OTC is the immediate-release niacin. Although a safer product, it can cause some side effects. One of these is flushing (an uncomfortable feeling of warmth, reddening, itching, and/or tingling in the face, neck, chest, and/or back) which occurs in 80% of patients. To reduce the frequency and severity of flushing, aspirin or ibuprofen may be taken about 30 minutes prior to taking niacin (with approval of your health care provider). You should also take niacin at bedtime so that if you experience flushing, you’ll be asleep. It may be beneficial to take niacin with a low-fat snack. Avoid alcoholic drinks, hot drinks, and spicy foods near the time of taking niacin.
Note that products labeled as “flush-free” or “no flush” do not contain niacin and will not work for cholesterol-lowering.
Other side effects associated with niacin include rashes, nausea, indigestion, and diarrhea. If any of these symptoms occur, be aware that most will subside within a few days or weeks of starting niacin or increasing the dose. Treatment with niacin should be started at a low dose and gradually increased to a dose of 1.5 to 4.5 grams per day in most people.
Long-acting niacin is available OTC and may also be called controlled-release, timed-release, extended-release, or sustained-release. These formulations were designed to minimize flushing by releasing niacin slower. Although the incidence of flushing is reduced, the risk of liver damage is substantially increased which is why these products should be avoided.
Extended-release niacin is available only by prescription as Niaspan®. The way it is released into the body minimizes the risk of both flushing and liver problems.
Anyone taking niacin should undergo regular monitoring of their liver function. Niacin may also increase glucose levels which might limit its use in diabetics. It should be avoided in patients with a history of gout or certain types of heart disease.
Niacin can be extremely effective for lowering your cholesterol. Also, because it is available over the counter and therefore is inexpensive, it is a desirable medication for people to use. However, niacin does not come without risks, so it is important to talk to your health care provider to see if niacin is right for you.
References:
American Pharmacists Association. The appropriate use of niacin to treat dyslipidemias. Pharmacy Today. 2004;suppl:1-11.
Rosenson RS. Lipid lowering drugs other than statins and fibrates. In: UpToDate, Rose BD (Ed), UpToDate, Waltham, MA, 2007.
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