Niacin And Cholesterol Treatment
Niacin for Heart Disease
It's a good choice for some people who have low levels of good cholesterol, but it's not for everyone. Learn more about the benefits and side effects of this heart medication.
By Beth W. Orenstein
Medically Reviewed by Pat F. Bass III, MD, MPH
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Niacin or nicotinic acid is a member of the complex B-vitamin family. Most people get the daily recommended allowance (14 to 16 milligrams, or mg, for women, 16 to 20 mg for men) from their diet — especially if they eat fortified cereals, lean red meats, poultry, eggs, milk and other dairy products, nuts and seeds, and green leafy vegetables.
Your doctor also may prescribe niacin in higher doses (50 to 1,000 mg) to treat heart disease, says Christopher P. Cannon, MD, associate professor of medicine at Harvard Medical School.
How Does Niacin Work to Treat Heart Disease?
Prescription niacin works in the liver by slowing the breakdown of triglycerides, a type of fat particle found in the blood. By slowing the breakdown, niacin prevents fat storage and decreases the production of low-density lipoprotein (LDL), the bad cholesterol, Dr. Cannon explains.
“Niacin decreases triglycerides by 30 to 60 percent. It also decreases LDL by 15 to 20 percent,” he says. However, to lower cholesterol, you need to take at least 1,000 mg and ideally as much as 2,000 mg. “That’s why you should use niacin only under your physician’s supervision,” Cannon says.
Who Is Prescribed Niacin?
Niacin is given to lower cholesterol. “Niacin is a good medication for patients who have low levels of high-density lipoprotein (HDL), the good cholesterol,” Cannon says. However, you should not take niacin if you have:
- Chronic liver disease
- Peptic ulcer
Common brand names of prescription niacin and dosage are:
- Niacor (niacin tablet): 50 mg, 100 mg, 250 mg, 500 mg
- Niaspan (niacin extended-release): 500 mg, 750 mg, 1000 mg
Pros and Cons of Niacin as a Heart Medication
One benefit of niacin is that it is one of the only heart medications to increase good cholesterol (or HDL), which may be protective against cardiovascular disease, Cannon says.
Other advantages to niacin include:
- It is relatively mild.
- Generally, side effects are mild.
As for the drawbacks, some people find the side effects intolerable, especially flushing, Cannon says.
Other disadvantages to niacin include:
- While side effects are rare, they can be serious (for example, liver failure).
- Niacin can interfere with medications you are taking for diabetes or ulcers. Because niacin can affect the liver, it is not for people who have chronic liver disease.
Side Effects of Niacin
In addition to flushing there a number of other side effects, Cannon says, including:
- Skin rash
- Abdominal pain or upset stomach
However, he says, extended-release niacin (Niaspan) can significantly reduce these effects. In rare cases, niacin can cause liver failure.
How Should You Take Niacin?
Take niacin with food to avoid an upset stomach, Cannon says. Don’t crush or chew niacin. You may be able to reduce flushing by taking the dose at bedtime, or by using extended release or slow-release formulations, and by increasing the dose slowly over time, Cannon says. Also, you can take aspirin or another non-steroidal anti-inflammatory drug 30 minutes before the dose. Avoid drinking alcohol while taking niacin.
The U.S. Food and Drug Administration does not regulate niacin as a dietary supplement the same way that it regulates prescription niacin. Niacin sold over-the-counter as a dietary supplement may contain variable amounts of niacin — each capsule may have far less or more than the label suggests. Even if you buy the same brand, you can have some tablets with more and some with less niacin. You should never substitute dietary niacin for prescription niacin.
Niacin is a commonly prescribed heart medication, but like any medication, niacin is not for everyone. You and your doctor must decide whether niacin is the right medicine for you.
Video: Niacin and Heart Disease
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