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USING NIACIN AND AVOIDING
SIDE EFFECTS
The vitamin Niacin (B-3) given in pharmacologic amounts is a very effective medication to combat atherosclerosis and reduce the risk of heart attack and stroke. It has been used for decades but eclipsed in recent years by statin drugs (Lipitor, Zocor, etc.) which are more potent in lowering the LDL so called "bad" cholesterol. However, it is a very good second line drug in this regard and useful in people who have side effects from statins. It also has unique effectiveness in reducing high triglycerides and raising low HDL "good" cholesterol, particularly in pre-diabetics and diabetics. The science supporting niacin as a primary agent for protecting patients against the complications of atherosclerosis is extensive and well validated 1-7. Recent controversy regarding its use has centered on its limited added benefit when used with a statin drug. It also slightly increased conversion to full blown diabetes in pre-diabetic patients. It should be prescribed and supervised by a physician familiar with its use and lipid (cholesterol) disorders. MONEY SAVING TIP
Your out of pocket cost will depend on whether or not you have insurance for drug coverage, the amount of your co-pay for the niacin product prescribed, or the retail cost of a prescribed or OTC non-prescription brand. By far the most economical OTC brand and the only one we recommend is Slo-Niacin. It is taken twice a day. The prescription brand is Niaspan, designed to be taken at bedtime. OTC Retail Cost 90404 Zip Code for 2000 mg/day If you are insured and your co-pay for Niaspan is more than $20, it is less expensive to pay out of pocket for Slo-Niacin. If you have no drug coverage, Slo-Niacin is very affordable. HOW TO TAKE NIACIN PRODUCTS AND MINIMIZE SIDE EFFECTS
The most common side effect of any niacin product is flushing and itching. So called "non-flush niacin" is a misnomer. This product is niacinamide, also called nicotinamide, and does not lower cholesterol. Some people do not flush at all. Others have severe problems. Most flush once in awhile. You can try the following strategies to minimize the problem.
1. Avoid alcohol for 3 hours before taking any niacin product.
2. Use a regular, non-coated, full strength 325mg Aspirin one hour before a dose.
The aspirin interferes with the mechanism of flushing.
3. Take Slo-Niacin with food. Usually the two largest meals of your day.
4 .Take Niaspan at bedtime with chunky applesauce. The pectin in the apple
product slows absorption effectively.
Other side effects are much less common or rare. You should always consult with your doctor before starting niacin or any new drug. Caution should be used in prescribing niacin if you have a history of gout, peptic ulcer, liver disease, kidney disease or diabetes. Muscle symptoms are rarely seen with the lower doses now used. Liver function abnormalities are sometimes seen but very uncommon. REFERENCES
1. Canner, et.al. Fifteen Year Mortality in Coronary Drug Project patients: long term benefit with niacin. J.Am.Coll.Cardiol. 1986; 8: 1245. 2. Brown, et.al. Regression of coronary artery disease as a result of intensive lipid lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990; 323: 1289 3. Brown, et.al. Types of change in coronary stenosis severity and their relative importance in overall progression and regression of coronary disease. Observations from the FATS trial. Anny NY Acad Sci 1995; 748: 407. 4. Brown, et.al. HDL-Atherosclerosis Treatment Study (HATS Trial) NEJM 2001; 345:1583. 5.Taylor et.al. Arterial Biology for the investigation of the treatment effects of reducing cholesterol (ARBITER 3) Circulation 2004; 110: 3512. 6. Lee et. al. Effects of high dose modified release nicotinic acid on atherosclerosis and vascular function. J Am Coll Cardiol 2009; 54:1787. 7. Zhao et.al. Effects of combination lipid therapy on coronary stenosis progression and clinical cardiovascular events in coronary disease patients with metabolic syndrome: a combined analysis of the Familial Atherosclerosis Treatment Study (FATS), the HDL-Atherosclerosis Treatment Study (HATS), and the Armed Forces Regression Study (AFREGS) Am J Cardiol 2009; 104:1457.

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