Niacin for cholesterol control

Only the “flushing” type of niacin is effective for cholesterol control.  Flushing is a harmless, but unpleasant, potential side effect which happens shortly after taking niacin, and may include a prickly warm “flush” sensation.

Ways to avoid and minimize flushing include:

  • Take niacin at bedtime
  • Take aspirin 325mg 30 minutes prior to taking niacin
  • Take niacin with a snack, especially fat containing
  • Start low and go slow increasing the niacin dose

There are many different kinds of “niacin”.  The nicotinic acid is the only type that controls cholesterol.  Other types include niacinamide,

Brands of Niacin (nicotinic acid):

  • Rx “Niaspan” (expensive)
  • OTC “Slo-Niacin” 250mg, 500mg, 750mg

Dosing of Niacin:

  • Start with 250-500mg at bedtime
  • Wait 1-2 weeks
  • Increase dose by 250-500mg
  • Wait another 1-2 weeks
  • Repeat dose increases to achieve a total dose of 1000mg to 2000mg nightly
  • The maximum dose is 2000mg nightly

The good news is that niacin works to raise HDL better than other drugs, and it lowers LDL, increases LDL particle size, and lowers Lp(a).  Niacin also works in synergy with the statin drugs.  The bad news is that niacin and statin drugs can tax the liver and the liver function needs to be watched carefully, especially when the two drugs are combined.  Blood tests should be done every few months when starting niacin or statin drugs.

When starting niacin, it is recommended that the statin drugs:

  • Be stopped altogether and measure the effect of niacin alone
  • Be lowered to a very very low dose and measure the effect of adding niacin
  • Be restarted at a very very low dose if niacin alone does not work
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