What is Niacin?

Prescription niacin, also known as nicotinic acid, is a form of Vitamin B3 specifically formulated for medical use. Unlike over-the-counter niacin supplements, prescription niacin is used to treat specific health conditions under the guidance of a healthcare provider. It comes in different formulations, including immediate-release, extended-release, and sustained-release forms, which vary in how quickly they release niacin into the bloodstream. Prescription niacin is commonly used to manage high cholesterol and other lipid disorders.

Generic: Niacin (oral tablet and oral extended-release tablets)

Brand names: Niacor (oral tablet), Niaspan (oral extended-release tablet)

Why is it used?

It is primarily prescribed to manage dyslipidemia, a condition characterized by abnormal lipids (fats) levels in the blood. It is particularly effective in lowering levels of "bad" LDL cholesterol and triglycerides while raising "good" HDL cholesterol. This dual action makes prescription niacin valuable in reducing the risk of heart disease, especially in patients who cannot tolerate other lipid-lowering medications like statins. Additionally, prescription niacin is sometimes used in combination with other medications to achieve better cholesterol control.

How does Niacin work?

Niacin inhibits the liver's triglyceride production enzyme, reducing VLDL production and LDL (low-density lipoprotein) cholesterol levels. It also increases HDL cholesterol levels, transporting excess cholesterol to the liver for metabolism and excretion, reducing the risk of atherosclerosis.

Dosage

For adults (18-64):

Extended-release tablet – 500 mg is the starting dosage and a 500 mg increase after 4 weeks. The standard dosage is 1000-2000 mg once daily at bedtime.

Oral tablet – starting from 250 mg to a gradual increase of 6 g per day. The standard dosage is 1-2 grams 2-3 times a day.

For children (16-17):

Extended-release tablet - 500 mg is the starting dosage and a 500 mg increase after 4 weeks. The standard dosage is 1000-2000 mg once daily at bedtime.

Oral tablet – starting from 250 mg to a gradual increase of 6 g per day. The standard dosage is 1-2 grams 2-3 times a day.

• To reduce side effects, take the extended-release niacin at bedtime.
• Strictly follow your doctor

What are the known side effects of Niacin?

• Nausea
• Flushing (reddening of face)
• Diarrhea
• Vomiting
• Itching
• Increased cough

Serious side effects (should be consulted immediately);

• Muscle issues
• Liver problems

Health Warnings

• Cholesterol drugs called statins may cause trouble while used with niacin
• May cause certain allergies (breathing troubles, swellings on the body, itching, skin rashes)
• Avoid consumption of alcohol
• For patients with liver disease, kidney disease, diabetes, gout, ulcers, and women with pregnancy, breastfeeding would cause certain problems. Consult your doctor before taking niacin.

Things to remember

• Always take niacin with food
• Don’t crush or cut the medicine
• Be aware of the signs of liver toxicity, such as dark urine, jaundice (yellowing of the skin or eyes), and severe fatigue.
• Store it at room temperature (20°C – 25°C)
• Keep the container closed, and tight and protect it from sunlight

FAQ

Q1: How does prescription niacin differ from over-the-counter niacin? 

A: Prescription niacin is specifically formulated for medical use, often in higher doses and different formulations, while over-the-counter niacin is typically used as a general supplement.

Q2: Can I switch from prescription niacin to an over-the-counter version? 

A: No, switching from prescription to over-the-counter niacin should only be done under the guidance of your healthcare provider, as the doses and formulations are different.

Q3: Is it safe to drink alcohol while taking prescription niacin? 

A: Alcohol can increase the risk of liver damage and exacerbate flushing, so it's advisable to limit or avoid alcohol consumption while taking niacin.

Q4: What should I do if I experience severe flushing with niacin? 

A: Contact your healthcare provider if you experience severe flushing. They may adjust your dosage or recommend taking an aspirin before your niacin dose to minimize this effect.

Q5: Can prescription niacin be taken with other cholesterol-lowering medications? 

A: Yes, niacin is often used with other lipid-lowering agents, but this should be done under medical supervision to avoid interactions and enhance efficacy.

Q6: How long does it take for niacin to start lowering cholesterol? 

A: It may take several weeks to months to see a significant reduction in cholesterol levels, with full effects usually observed after 4-6 weeks of consistent use.

Q7: What happens if I miss a dose of niacin? 

A: If you miss a dose, take it as soon as you remember, unless your next dose is almost due. Don't take two doses.

Q8: Can I take niacin if I have diabetes? 

A: Niacin can raise blood sugar levels, so if you have diabetes, you need to monitor your blood glucose closely and consult your healthcare provider.

Q9: What are the signs of liver damage I should watch for while on niacin? 

A: Symptoms of liver damage include dark urine, jaundice, fatigue, and upper abdominal pain. Get in touch with your doctor right away if you observe any of these symptoms.

Q10: Should I stop taking niacin if I feel fine? 

A: No, even if you feel well, you should continue taking niacin as prescribed, as discontinuing it without your doctor’s approval could lead to a return of high cholesterol levels.