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How Can I Prevent Niacin Side Effects?

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Updated September 15, 2013

Question: How Can I Prevent Niacin Side Effects?
Answer: If you’ve ever taken nicotinic acid, a form of niacin, you might be familiar with its side effects, such as flushing, itching, and hot flashes. Although these side effects are pretty common, they can be intolerable to the point that some people stop taking nicotinic acid. The side effects usually subside over a couple of weeks, but in the meantime, they might be very bothersome.

These are some simple tips that might help reduce the side effects experienced by taking nicotinic acid:

  • If you are taking an immediate-release form of nicotinic acid, you may want to gradually increase your dose. For instance, if you are supposed to take 500 mg of nicotinic acid a day, take 250 mg the first few days until you are able to tolerate the side effects and gradually increase your dose until you reach the recommended dose each day. This only works for immediate-release products (never cut sustained or extended-release pills in half). Also, you might try to divide your dose throughout the day. In this case, you would take 250 mg twice a day, instead of 500 mg once a day.
  • If you are having trouble with side effects, such as flushing or itching, you may take a 325 mg aspirin dose at least 15 to 30 minutes before your nicotinic acid dose. Studies have shown that taking aspirin before your nicotinic acid dose can decrease the flushing and itching associated with nicotinic acid.
  • Don’t drink hot beverages (such as coffee and hot tea) or alcohol around the time you take your niacin dose, since these drinks may increase the likelihood of flushing.
  • If you are still having trouble tolerating the immediate-release form of niacin, you might want to ask your health care provider about a sustained-release or extended-release form of niacin. These forms of niacin release nicotinic acid into the body gradually and somewhat reduce side effects. There are sustained-release forms available over-the-counter, however, in some cases, they have caused hepatitis. Niaspan is the only extended-release form of nicotinic acid and it is only available by prescription.
  • There are also other forms of niacin, such as nicotinamide and inositol hexaniacinate, that are designated as ”flush-free” forms of niacin. Although they may not produce the side effects that nicotinic acid can cause, some studies have shown that these forms of niacin may not be effective in lowering cholesterol.
Before trying any of these tips, make sure your health care provider is aware that you are taking a nicotinic acid product, since some individuals may need to be monitored more closely due to health conditions they may have or medications they are taking.

Sources:

Cefali EA, Simmons PD, Stanek EJ, et al. Aspirin reduces cutaneous flushing after administration of an optimized extended-release niacin formulation. Int J Clin Pharmacol Ther. 2007; 45(2):78-88.

Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 6th ed 2005.

Lai E, De Lepeleire I, Crumley TM, et al. Suppression of niacin-induced vasodilation with an antagonist to prostaglandin D2 receptor subtype 1. Clin Pharmacol Ther. 2007; 81(6):849-57.

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