According to "Goodman & Gilman's The Pharmacological Basis of Therapeutics," niacin is the "best agent available for increasing HDL-C" levels. HDL is a form of cholesterol that helps lower total body cholesterol by scavenging it from tissues and bringing it to the liver for disposal. Niacin also lowers triglycerides and LDL levels directly. Niacin is not a synthetic medication. It is simply vitamin B3, which we can get from such sources as chicken, tuna and salmon. However, the prescription form of niacin, effective against hypercholesterolemia, is given in much higher doses than we would normally get from our diets.
As with all medications, there is a risk of side effects. Even the slow-release form of niacin specifically designed to avoid some of these side effects is not without its share of problems. Thankfully, the vast majority of the adverse effects associated with niacin use are minor and can be managed to reduce their impact.
Flushing and Itching
The skin flushing and itching often encountered with niacin is not a result of the drug itself. Large doses of niacin seem to promote the release of a type of molecule called a prostaglandin. This is one of the same molecules released during an allergic reaction, and it serves to increase capillary permeability and dilate blood vessels in order to bring your body's immune system cells to the site. The slow release form of niacin was designed specifically to minimize flushing, but it can still occur. To alleviate this side effect, take an aspirin every day (consult your doctor for the proper dosage), take your niacin after breakfast or supper, and avoid taking the medication with hot beverages or with alcohol. Most patients experience spontaneous relief after one to two weeks on a stable dose.
Stomach Upset
Niacin can affect the gastrointestinal systems of some people. This may manifest as nausea, vomiting, diarrhea or dyspepsia (general stomach upset and bloating). As with flushing, if you take niacin directly after a meal, you should be able to minimize this effect. Your doctor may be able to prescribe a separate medication to decrease your stomach's acid secretion. Let your doctor know if you have a history of peptic ulcer disease,as niacin may aggravate this.
Insulin Resistance
Diabetics or people who are pre-diabetic may want to avoid niacin due to the possibility of increased insulin resistance. Insulin is the hormone that moves glucose out of your blood and into your cells. If your body becomes resistant to this hormone, your blood glucose levels will rise. Diabetics currently on insulin therapy who start taking niacin will probably need to adjust their insulin dosages to offset this effect.
Elevated Levels of Uric Acid
Niacin has a tendency to raise uric acid levels in the blood. High levels of uric acid can cause gout. Your doctor can prescribe allopurinol to decrease the risk of a gout attack.
Birth Defects
High doses of niacin given to experimental animals have been shown to cause birth defects. Pregnant women should not take niacin, and all women should be careful to use some form of birth control while on the medication.
References
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th Ed.; Laurence L. Brunton, John S. Lazo, Keith L. Parker; 2006
- Basic and Clinical Pharmacology, 11th Ed.; Bertram G. Katzung, Susan B. Masters, Anthony J. Trevor; 2009
Member Comments