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Is Niacin Safe For Everyone to Take to Lower Their Lipids?

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Updated September 15, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Question: Is Niacin Safe For Everyone to Take to Lower Their Lipids?
Niacin (nicotinic acid), or vitamin B3, is a cholesterol-lowering medication that affects all aspects of your lipid profile, by increasing HDL levels more than any other cholesterol-lowering drug on the market and lowering LDL cholesterol and triglycerides. Many formulations of niacin are available without a prescription and relatively inexpensive.
Answer: Even though niacin is a vitamin and may not require a visit to your healthcare provider for a prescription, this doesn’t mean that it is 100% safe for everyone. In fact, taking niacin may worsen certain conditions. Therefore, before adding over-the-counter niacin to your cholesterol-lowering regimen, you should discuss this with your healthcare provider.

The following medical conditions may place you at risk for experiencing complications if not properly monitored:

  • Gout – Niacin could increase your uric acid levels, increasing your chances of experiencing a gouty attack.

  • Gallbladder disease – Taking niacin with gallbladder disease could increase the formation of gallstones, or worsen your gallbladder disease.

  • Diabetes – Diabetics taking niacin could note an increase in fasting blood sugar levels. Although this is usually modest (about 5%), it may be noticeable in cases of where blood sugar levels are well controlled.

  • Liver disease – Taking niacin could increase liver enzyme levels, which could be even higher in individuals already diagnosed with liver disease.

  • Kidney disease - Having poor kidney function may cause niacin to accumulate in your blood, possibly toxic effects.

  • Pregnancy – There have not been enough studies to adequately assess the safety of niacin on your baby. Therefore, you should consult your healthcare provider if you are pregnant, or planning to become pregnant.

  • Breast feeding – Studies have shown that niacin is excreted in breast milk, however, it is not fully known if doses given to lower cholesterol could also harm the baby. Therefore, you should consult your healthcare provider before taking niacin.

  • Cardiovascular disease – Taking niacin could worsen certain cardiovascular conditions, such as unstable angina.

  • Taking multiple medications – just because it’s over-the-counter, it doesn’t mean that it’s completely safe. Certain medications could also interact with niacin, either decreasing the effectiveness of certain medications, or increasing toxic effects of other drugs.

If you have any of the above conditions, you should talk to your healthcare provider before starting niacin on your own. Having one or more of these conditions won’t necessarily prevent you from taking niacin, however, your healthcare provider may want to assess your condition before initiating it, and monitor for any complications after you've started taking niacin.

Sources:

Micromedex Healthcare Series [Internet database].Greenwood Village, CO: Thomson Reuters (Healthcare) Inc. Updated periodically.

Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 7th ed 2008.

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