Niacin

Niacin is a prescription medication used to lower cholesterol and fats (triglycerides) in the blood. It can also help raise the amount of HDL ("good") cholesterol in the blood. Niacin should be used in conjuction with a low-fat and low-cholesterol diet. Sometimes, niacin is taken with other cholesterol-lowering medications.

Niacin is a B-complex vitamin, which may work by increasing the breakdown and removal of certain fats in the blood by increasing the activity of a certain enzyme.

Niacin is available in immediate-release tablet and extended-release tablet and capsule forms. The immediate-release form is usually taken 2 or 3 times a day. The extended-release form is usually taken once daily at night. Swallow niacin tablets whole. Take niacin with food.

Common side effects of niacin include warmth and redness of the face (flushing), itching, rash, diarrhea, nausea, vomiting, and cough.

Niacin may cause dizziness and blurred vision. Do not drive or operate heavy machinery until you know how niacin affects you.

Niacin is a prescription medicine used with diet and exercise to increase the good cholesterol (HDL) and lower the bad cholesterol (LDL) and fats (triglycerides) in your blood. Niacin can be used by itself or with other cholesterol-lowering medicines. Niacin is also used to lower the risk of heart attack in people who have had a heart attack and have high cholesterol.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Niacin may be found in some form under the following brand names:

• Advicor

• B-3-50

• B3-500-Gr

• Concept OB

• Folivan-F

• Irospan Tablet

• MVC-Fluoride

• Nephrocaps

• Nephrocaps QT

• Niacor

• Niacor B3

• Niaspan

• Nico-400

• Nicobid Tempules

• Nicolar

• Nicotinex

• Poly-Vi-Sol

• Poly-Vi-Sol with Iron

• Simcor

• Slo-Niacin

• Vitafol-One

Serious side effects have been reported with niacin. See the "Niacin Precautions" section.

Common side effects of niacin include:

• flushing
• rash
• diarrhea
• nausea
• vomiting
• increased cough

Flushing is the most common side effect of niacin. Flushing happens when tiny blood vessels near the surface of the skin (especially on the face, neck, chest and/or back) open wider. Symptoms of flushing may include any or all of the following:

• warmth
• redness
• itching
• tingling of the skin

Flushing does not always happen. If it does, it is usually within 2 to 4 hours after taking a dose of niacin. Flushing may last for a few hours. Flushing is more likely to happen when you first start taking niacin or when your dose of niacin is increased. Flushing may get better after several weeks.

If you wake up at night because of flushing, get up slowly, especially if you:

• feel dizzy or faint
• take blood pressure medicines

To lower your chance of flushing:

• Ask your doctor if you can take aspirin to help lower the flushing side effect from niacin. You can take aspirin (up to the recommended dose of 325 mg) about 30 minutes before you take niacin to help lower the flushing side effect.
• Do not drink hot beverages (including coffee), alcohol, or eat spicy foods around the time you take niacin.
• Take niacin with a low-fat snack to lessen upset stomach.

Tell your doctor if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of niacin. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, herbal supplements or other nutritional supplements.

Especially tell your doctor if you take:

• supplements or medications containing niacin or nicotinamide
• other medicines to lower cholesterol or triglycerides
• aspirin
• insulin or medications for diabetes
• blood pressure medicines
• anticoagulants ("blood thinners") such as warfarin (Coumadin, Jantoven)
• bile acid-binding resins such as colestipol (Colestid) or cholestyramine (Questran)
• large amounts of alcohol

This is not a complete list of niacin drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with niacin, including:

• dizziness
• feeling faint
• hast heartbeat
• nausea
• vomiting
• extreme tiredness
• dark colored urine
• light colored stools
• unusual bleeding or bruising
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• flu-like symptoms
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• unexplained muscle pain, tenderness, or weakness

Niacin can cause dizziness and blurred vision. Do not drive or operate heavy machinery until you know how niacin affects you.

Do not take niacin if you:

• are allergic to niacin or to any of its ingredients
• have liver problems
• have a stomach ulcer
• have bleeding problems

Avoid ingestion of alcohol, hot beverages, and spicy foods around the time you take niacin to minimize flushing.

Before taking niacin, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to niacin or to any of its ingredients.
• have diabetes. Tell your doctor if your blood sugar levels change after you take niacin.
• have gout
• have ulcers
• have liver disease
• have jaundice
• have kidney disease
• have heart diseases
• have gallbladder disease
• have bleeding problems
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X - are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Niacin falls into category C. No reproduction studies have been done in animals and no well-controlled studies have been done in pregnant women. Niacin should only be given to a pregnant woman if clearly needed.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Niacin is excreted into human breast milk. Because of the potential for serious adverse reactions in nursing infants from this medication, a decision should be made whether to stop nursing or stop taking niacin, taking into account the importance of the drug to the mother.

Take niacin exactly as prescribed.

Niacin is available in immediate-release tablet and extended-release tablet and capsule forms. The immediate-release form is usually taken 2 or 3 times a day. The extended-release form is usually taken once daily at night. Swallow niacin tablets whole. Take niacin with food.

Several forms of niacin are available, but they are not all interchangeable. Do not switch brands or formulations without speaking to your doctor or pharmacist.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take 2 doses of niacin at the same time.

Medicines used to lower your cholesterol called bile acid resins, such as colestipol (Colestid) and cholestyramine (Questran), should not be taken at the same time of day as niacin. You should take niacin and the bile acid resin medicine at least 4 to 6 hours apart.

Your doctor may do blood tests before you start taking niacin and during your treatment. You should see your doctor regularly to check your cholesterol and triglyceride levels and to check for side effects.

Take niacin exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication

The recommeded dose range of niacin for the treatment of high cholesterol is 500 mg to 2000 mg daily. The maximum recommended dose of niacin is 2000 mg daily.

If you take too much niacin, call your healthcare provider or local Poison Control Center or seek emergency medical attention right away.

If niacin is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store niacin at room temperature (68ºF to 77ºF or 20ºC to 25ºC).
• Keep this and all medicines out of the reach of children.