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April 27, 2010 | Comments: 2

When Niacin Is a Drug

The B vitamin niacin can improve blood cholesterol and triglyceride levels dramatically. Statins are usually the first choice, but niacin is also worth considering, especially if your HDL is low.

If you have high cholesterol, and dietary changes and exercise don’t lower it enough, your doctor will probably prescribe a statin drug. But there is also a vitamin, niacin—known as B3 or nicotinic acid—that in large doses can improve cholesterol levels. Niacin’s beneficial effect on blood cholesterol has been recognized for at least half a century.

The niacin we commonly consume is found chiefly in meats, beans, and whole grains. At high doses of 1 to 3 grams daily—70 to 200 times the recommended dietary intake—niacin becomes a drug. There are prescription versions, such as Niaspan (for extended release), but you can buy it over the counter as a dietary supplement. You should not take high-dose niacin without medical supervision. Niacin has potential side effects—most commonly, intense flushing and itching. It can also produce stomach upset and, in rare cases, liver damage. (Nonprescription extended-release niacin is more likely to cause liver damage, so you should avoid it.) As with other cholesterol-lowering drugs, you will need to be monitored to make sure it is achieving the desired results.

Niacin reduce LDL (“bad”) cholesterol by as much as 30%, but not as much as statins do. One advantage of niacin, however, is that it raises HDL (“good“) cholesterol substantially; statins raise HDL only modestly. No one is sure exactly how niacin works, but it does change the proportion of LDL to HDL in a favorable direction. It also decreases triglycerides, fats in the blood that may increase the risk of heart disease. It may raise blood sugar slightly, but it is now considered safe for people with diabetes.

In clinical trials niacin has proved to reduce the risk of heart attacks, perhaps because it boosts HDL so much. Dr. John Guyton of Duke University, in a review of recent studies, emphasizes the safety and efficacy of niacin, taken alone or with a statin. Niacin does not cause muscle disorders, as statins can do in rare cases.

The flushing (a kind of hot flash) caused by niacin is not harmful or long-lasting, but many people find it hard to put up with. Sometimes the flushing decreases with time. Extended-release niacin usually produces less flushing. Taking aspirin before niacin may reduce flushing, as may taking the niacin with food and avoiding hot drinks or alcohol near the time you take niacin.

Bottom line: If you need medication to improve your cholesterol levels, ask your doctor about your choices, including niacin. 

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