Nicotinic acid for high cholesterol

Examples

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Immediate-release form

Brand Name	Chemical Name
Nicolar	nicotinic acid or niacin

Sustained-release form

Brand Name	Chemical Name
Slo-Niacin	nicotinic acid or niacin

Extended-release form

Brand Name	Chemical Name
Advicor	niacin with lovastatin

Brand Name	Chemical Name
Niaspan	nicotinic acid or niacin

How It Works

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Nicotinic acid reduces the production of triglycerides and VLDL (very low-density lipoprotein, which is converted to LDL in the blood). This leads to decreased LDL ("bad") cholesterol, increased HDL ("good") cholesterol, and lowered triglycerides. Nicotinic acid raises HDL cholesterol more than other lipid-lowering medicines.

Why It Is Used

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Nicotinic acid is especially useful in people who have low HDL levels and high triglyceride levels because it raises HDL and lowers triglycerides. Niacin may not be appropriate for some people who have:

• Gout.
• Active stomach ulcer.
• Oversensitivity to niacin.
• Glaucoma.
• Type 2 diabetes and do not have their blood sugar levels controlled.
• Clotting disorders, such as hemophilia.
• Active liver disease.
• Alcoholism.

How Well It Works

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• LDL can be reduced by 5% to 25%.¹
• HDL can be increased by 15% to 35%.¹
• Triglycerides can be reduced by 20% to 50%.¹

Side Effects

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The immediate-release form is safe for long-term use. However, nicotinic acid has frequent side effects, including:

• Sudden blushing or redness of the face (flushing), which is more common with the immediate-release forms of nicotinic acid.
• Itching.
• Liver problems (hepatotoxicity), especially with the sustained-release form.
• High blood sugar (hyperglycemia).
• Too much uric acid in the blood (hyperuricemia). Excess uric acid in the blood can lead to gout.
• Gastrointestinal problems such as upset stomach, gas, nausea, vomiting, and diarrhea.
• Dizziness, lightheadedness, or a fast or slow heartbeat.

These side effects are more severe when higher doses are used.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Nicotinic acid is a B vitamin that is available without a prescription as a vitamin supplement (niacin). The vitamin supplement may cost less, but large doses are needed to be effective. Because taking large doses of niacin can damage your liver, it is not wise to take this drug unless a doctor is monitoring your liver function. Niaspan is a newer form of niacin that does not appear to cause the liver problems associated with the older sustained-release preparations.

Nicotinamide is another form of the B vitamin, but it doesn't lower cholesterol.

All people who are taking nicotinic acid should be closely monitored for signs of liver problems by measuring the level of liver enzymes with blood tests.

In most people, facial flushing and itching gradually diminish over time. Starting with a low dose and gradually increasing the dose may help. Work with your doctor to find what works best for you.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.

Credits

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Author	Ralph Poore
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology
Last Updated	July 20, 2006