Nicotinic Acid

Nicotinic acid, also known as niacin or vitamin B3, is gaining favor as a way to reduce total blood cholesterol, LDL cholesterol, and triglyceride levels, and to elevate HDL levels.

At extremely high doses, nicotinic acid raises HDL cholesterol and transforms small LDL into the less harmful, normal-sized LDL cholesterol. Niacin therapy moderately reduces LDL cholesterol levels. Among all the pharmaceutical choices, nicotinic acid is the most effective in raising HDL cholesterol.

Can you just take high doses of over-the-counter niacin for your high cholesterol?

Self-treatment with niacin is not safe. Since dosage and timing are important, people should not attempt to self-medicate with over-the-counter B3 vitamins. Treatment with this medication should take place only under the recommendation and supervision of a doctor.

Nicotinic Acid Research Studies

Studies demonstrate the power of niacin treatment on lipid disorders. Patients treated with immediate-release niacin have seen their HDL levels increase 15 to 35 percent, along with a 20 to 50 percent reduction in triglycerides and a 10 to 20 percent reduction in LDL cholesterol. Niacin has been shown to help reverse atherosclerosis, therefore likely decreasing the chance of a heart attack or stroke.

Nicotinic Acid Types and Usage

Niacin formulations come in three categories: immediate release, shortterm or intermediate release, and sustained or slow-acting release. If you are a candidate for niacin therapy, your physician will determine what formulation most suits you. Most physicians start patients on a low dose and work up to a daily dose of 1.5 to 3g. This improves the body's acceptance of the drug.

Another important consideration among different products is the quality of the niacin and the amount the body will absorb. A challenge with many over-the-counter supplements is they are prepared in forms that do not break down easily in the digestive system. They essentially pass through the body, without allowing for absorption of any nutrients. Supplements are not regulated by the U.S. Food and Drug Administration and are therefore not guaranteed to provide what is shown on the labels.

Niaspan, produced by KOS Pharmaceuticals, is specially formulated and packaged in a way that makes it clear how to regulate the levels of niacin in the bloodstream. Nicotinamide is another form of niacin; however, it is not effective in lowering cholesterol levels.

Nicotinic Acid Side Effects

The challenge with niacin treatment is tolerability. Flushing or hot flashes and itching, the result of the opening of blood vessels, are the most common side effects. If you titrate the drugs appropriately, however, the side effects should decrease over time as your body becomes more tolerant of the therapy. Taking niacin during or after meals and additional medications recommended by your physician can also decrease flushing. Taking aspirin thirty minutes prior to niacin has shown to reduce the incidence of flushing by 90 percent.

Federal government guidelines suggest nicotinic acid as a therapeutic option for higher-risk people, often as part of combination therapy, or as a single agent if the higher-risk person does not have high LDL cholesterol levels.

Other side effects include gastrointestinal upset such as nausea, indigestion, gas, vomiting, diarrhea, and even peptic ulcers. More serious risks include liver problems, gout, and high blood sugar. These risks increase as the dosage level is increased.

People who take high blood pressure medications also need to exercise caution with niacin therapy. Taking niacin can amplify the effects of blood pressure medications. People with diabetes typically do not receive niacin therapy because of its effect on blood sugar.

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