Niacin

  I am a 38 yr old woman with high cholesterol.  I am on 20 mg of lipitor which seems to contol it to raesonable number. My lipoprotein a is exteremly high (90) so for that raeson I was given niacin. (the night satrter pack) where you gradually increase your dose to  tolerate it.  After moving to the 2nd level  on the second night (500mg)  I had a reaction of flushing,tingling and tremors of my legs that I could not control.  Due to very high anxiety aboout what was going on my blood pressure (which is alwyas fine) went up to 179/90.  The episode lasted about 1/2 hr.  The next day I felt better but the flushing and tingling in one arm remained.(it is time release)  Both Drs told me it was result of niacin.  My blood pressure was normal the next day when I saw my GP.  I am trying  to weigh the benefit of taking Niacin and putting up with this as a possible side effect.  Whta info do yo have on benefits?  Thank you

[Cleveland Clinic, MD]

_

Dear cd,
Thank you for your question. Niacin (also called nicotinic acid) is a vitamin that taken in large doses has a therapeutic effects on cholesterol and on reducing heart disease.  Niacin taken in doses of 1 to 3 grams a day lowers total and LDL cholesterol and triglycerides.  In addition it is the only medication that reduces Lp(a).  The main side effects of niacin are flushing and GI intolerance.  These symptoms may be decreased by staring at very low doses (50 mg three times daily) and increasing slowly every 5 days to the target dosage.  There are several long-acting preparations that are in use but there is a risk of liver toxicity and blood levels must be monitored.  The new Niaspan is also a once daily preparation and has low risk and side effect profile.  It comes in a "starter kit" that gradually uptiters the dosage to the target dose.  Another way to reduce the flushing effect is to take an aspirin 30 minutes prior to taking the niacin.
Here is an article that goes more in-depth on the effect of niacin and heart disease.
Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease.  American Journal of Cardiology. 82(12A):18U-23U; discussion 39U-41U, 1998 Dec 17
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.