Before the introduction of statins, doctors often prescribed niacin to their patients with elevated cholesterol counts. This practice is less common now, because like any other drug, niacin can trigger side effects, some of them serious.
Background
Niacin is vitamin B3, a water-soluble substance that helps regulate metabolism. According to Harvey Simon, M.D., niacin helps diminish overall cholesterol counts by lowering triglyceride levels, which statins do less effectively. Niacin also elevates the levels of HDL, sometimes called "good" cholesterol, in the blood.
Types
The website www.drugs.com describes two types of niacin products: fast and controlled release. Since niacin is a vitamin, it is available over the counter, though doctors also can order prescription-strength niacin from pharmacies.
Dosage
Dr. Simon notes that the recommended daily allowance for niacin is 18 mg, but the dosage needed to affect cholesterol counts is much higher than that. Doctors typically prescribe 500 mg per day to begin and may raise the dose to three times that if there's no discernible improvement.
Side Effects
At such high dosages, the prospect that the patient may suffer side effects becomes a possibility. Michael Richman, M.D., describes the most common side effects as flushing, peptic ulcer disease and gastritis, hyperglycemia, diabetes in patients who were borderline diabetic before taking the medication and liver toxicity.
In addition to these symptoms, Dr. Harvey reports instances of itching and headaches, gout, blurred vision, nausea, fatigue and erectile dysfunction.
Dr. Richman states that flushing is the most common side effect and "is also the most common reason patients stop using the medication." A patient prone to this side effect will begin flushing within 20 minutes of ingestion and may experience it for as long as an hour. This side effect is annoying and uncomfortable, but not potentially life-threatening.
Diabetes and liver toxicity are the most worrisome side effects. Dr. Richman says that diabetics can continue taking niacin under their doctor's care, but patients whose liver enzyme levels reach or exceed three times the norm should stop taking it.
Effectiveness
The jury is still out on whether massive doses of niacin are a better course of treatment than statins. Research into the subject does not conclusively prove that niacin lowers cholesterol levels effectively enough to make it the preferred medication for these conditions. Both Dr. Harvey and Dr. Richman prefer statins to niacin, though Dr. Harvey says that "I primarily use it in patients with high triglycerides with known coronary artery disease---in addition to a statin."
Tags: cholesterol counts, , side effect, side effects, common side, liver toxicity