Niacin : Uses, Side Effects, Interactions & More
Why is this medication prescribed?
Niacin is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol (a fat-like substance) and other fatty substances in your blood and to increase the amount of high density lipoprotein (HDL; ”good cholesterol”). Niacin can be used in a number of situations including the following:
- Alone or in combination with other medications, such as HMG-CoA inhibitors (statins) or bile acid binding resins;
- To lower the risk of another heart attack in patients with high cholesterol who have had a heart attack;
- To prevent the worsening of atherosclerosis (accumulation of cholesterol and fats along the walls of the blood vessels) in patients with high cholesterol and coronary heart disease;
- To reduce the amount of triglycerides (other fatty substances) in the blood in patients with very high triglycerides who are at risk for pancreatic disease (conditions that affect the pancreas, a gland that produces fluid to break down food, and hormones to control sugar in the blood).
Niacin is also used to prevent and treat pellagra (niacin deficiency), a disease caused by improper diet and other medical problems. Niacin is a vitamin B complex. At therapeutic doses, niacin is a cholesterol-lowering medication.
Results of a clinical study in people with heart disease and well-controlled cholesterol levels that compared people who took niacin and simvastatin with people who took simvastatin alone and found similar results for the two groups in the rate of heart attacks or strokes . Taking niacin together with simvastatin or lovastatin has also not been shown to reduce the risk of heart disease or death compared to using niacin, simvastatin, or lovastatin alone. Talk to your doctor if you have questions about the risks and benefits of treating increased amounts of cholesterol in the blood with niacin and other medications.
How should this medicine be used?
Niacin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is usually taken two to three times a day with meals, and the extended-release tablet is taken once a day at bedtime after a low-fat snack. Follow the directions on your prescription label or package label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take niacin exactly as directed. Do not take more or less or take it more often than prescribed by your doctor.
Swallow the extended-release tablets whole; do not split, chew, or crush them.
Your doctor will probably start with a low dose of niacin and gradually increase it.
Keep taking niacin even if you feel fine. Do not stop taking niacin without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Other uses for this medicine
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking niacin,
- Tell your doctor and pharmacist if you are allergic to niacin, any other medications, or any of the ingredients in niacin tablets. Ask your pharmacist or check the manufacturer’s patient information for a list of ingredients.
- Tell your doctor and pharmacist what prescription and over-the-counter medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: blood thinners (‘blood thinners’) such as warfarin (Coumadin); aspirin; insulin or oral diabetes medications; medications for high blood pressure; nutritional supplements or other products containing niacin; or other medications to lower cholesterol or triglycerides. If you take insulin or diabetes medicine by mouth, your dose may need to be changed because niacin can increase the amount of sugar in your blood and urine.
- If you are taking a bile acid binding resin such as colestipol (Colestid) or cholestyramine (Questran), take it at least 4 to 6 hours before or 4 to 6 hours after niacin.
- Tell your doctor if you drink large amounts of alcohol and if you have or have ever had diabetes; gout; ulcers; allergies jaundice (yellowing of the skin or eyes); bleeding problems or disease of the gallbladder, heart, kidney or liver.
- Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking niacin, stop taking niacin and call your doctor.
- If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking niacin.
- Ask your doctor about the safe use of alcoholic beverages while taking niacin. Alcohol can worsen the side effects of niacin.
- You should know that niacin causes redness (redness, warmth, itching, tingling) on the face, neck, chest, or back. This side effect usually goes away after taking the medicine for several weeks. Avoid drinking alcohol or hot drinks or eating spicy foods when taking niacin. Taking aspirin or other non-steroidal anti-inflammatory medication such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) 30 minutes before niacin can reduce redness. If you take niacin extended-release at bedtime, the redness is likely to occur while you are asleep. If you wake up and feel flushed, get up slowly, especially if you feel dizzy or light-headed.
What special dietary instructions should I follow?
Eat a diet low in fat and cholesterol. Be sure to follow all diet and exercise recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.
What should I do if I forget a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
If you stop taking niacin for a long period of time, call your doctor before you start taking it again.
What side effects can this medication cause?
Niacin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- increased cough
If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:
- fast heartbeat
- extreme tiredness
- dark colored urine
- light colored stools
- unusual bleeding or bruising
- lack of energy
- 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
- unexplained muscle pain, tenderness, or weakness
If you experience a serious side effect, you or your doctor can submit an online report to the Food and Drug Administration (FDA) MedWatch Adverse Event Reporting Program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medicine in its container, tightly closed and out of the reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unnecessary medications must be disposed of in special ways to ensure that pets, children, and others cannot consume them. However, you should not flush this medicine down the toilet. Instead, the best way to dispose of your medication is through a medication take-back program. Talk to your pharmacist or contact your local recycling / trash department to find out about return programs in your community. Check out the FDA drug safe disposal website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medicines out of the sight and reach of children, as many containers (such as those for weekly pills and those for eye drops, creams, patches and inhalers) are not resistant to children and young children can easily open them. To protect young children from poisoning, always close the safety caps and immediately put the medicine in a safe place, one that is up and away and out of their sight and reach. http://www.upandaway.org
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, is having trouble breathing, or is unable to wake up, immediately call 911 emergency services.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain laboratory tests to verify your response to niacin.
Before having a laboratory test, tell your doctor and the laboratory personnel that you are taking niacin.
Only use the brand and type of niacin that your doctor has prescribed. Do not use another brand of niacin or change products without talking to your doctor. If you switch to a different brand or type of niacin, your dose may need to be changed.
Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.
It is important to keep a written list of all prescription and over-the-counter (non-prescription) medications that you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should carry this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Brand names of combination products
- Advicor® (containing Lovastatin, Niacin)
- Simcor® (containing Niacin, Simvastatin)
- Nicotinic acid
Disclaimer: We have made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.