The mechanism by which niacin alters lipid profiles has not been well defined. It may involve several actions including partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma.

Primary hyperlipidemia and mixed dyslipidemia: Reduces total cholesterol (TC), LDL-C, Apo B, triglycerides (TG), and increases HDL-C.

Post-myocardial infarction: Lowers the risk of recurrent nonfatal MI in patients with prior MI and hyperlipidemia.

Coronary artery disease (CAD): In combination with bile acid sequestrants, slows progression or promotes regression of atherosclerosis.

Severe hypertriglyceridemia: Used when diet alone is inadequate.

500 mg at bedtime with a low-fat snack.

Increase by 500 mg every 4 weeks.

Max recommended dose: 2000 mg once daily.

Flushing (most frequent)

Diarrhea, nausea, vomiting

Cough

Rash, pruritus

Do not use in patients with:

• Active liver disease or unexplained liver enzyme elevations.
• Active peptic ulcer disease.
• Arterial bleeding.
• Known hypersensitivity to niacin.

Liver toxicity: Can cause severe hepatic damage, especially if switching from immediate-release formulations.

Myopathy/rhabdomyolysis: Especially with statin co-use, or in elderly, diabetics, or those with renal or thyroid disorders.

Hyperglycemia: Monitor in diabetic or pre-diabetic patients.

Gout and hyperuricemia: May elevate uric acid levels.

Hypophosphatemia: Small dose-dependent phosphorus reductions noted.

Prolonged PT and low platelet count: Caution in surgical patients and those on anticoagulants.