What Do I Need to Know About Nicotinic Acid to Lower Cholesterol?

Nicotinic acid is one type, or class, of medicine used to lower cholesterol. It is pronounced nick-oh-TIN-ick AS-sid. It is a form of vitamin B3, or niacin. It has been used safely for decades to lower cholesterol.

When Is Nicotonic Acid Prescribed?

Nicotinic acid is especially helpful for people with moderately elevated LDL and triglycerides and low HDL. Doctors suggest it along with diet changes and exercise for people whose levels aren't improving with these methods alone. Your doctor may suggest it if any of these is true.

  • You have heart disease.
  • You have borderline-high LDL - the bad cholesterol. And you also have low HDL - the good cholesterol.

  • You are at high risk for heart disease and have low HDL cholesterol.

Sometimes doctors suggest nicotinic acid along with other medicines that lower cholesterol. These may include bile acid resins, some statins, and some fibrates.

Common Names of Nicotinic Acid

Don't confuse nicotinic acid with nicotinamide, which is a different form of vitamin B3. The following table shows some of the most common brand and generic names for this type of medicine.

brand generic
Niacor crystalline nicotinic acid
Niaspan sustained-release nicotinic acid
Nicotinic Acid sustained-release nicotinic acid

How to Take Nicotinic Acid

Some forms of crystalline nicotinic acid are available only with a prescription. Your doctor may prefer a prescription form since these go through a more careful analysis than over-the-counter types. However, your doctor may recommend an over-the-counter form for use as a vitamin supplement. Even over-the-counter forms can cause serious side effects if your doctor is not monitoring your condition carefully. So you should not take nicotinic acid to lower your cholesterol on your own. Take this drug only if your doctor tells you to and monitors your condition.

Most people take nicotinic acid as a tablet or capsule one to three times a day, along with or after meals. A typical dose is 1,500 mg and 3,000 mg per day. Your doctor will likely start you at a very low dose. Then he or she will increase your dose gradually over 6 weeks or so until you reach the dosage that works for you. Follow your doctor's guidance about when and how to take your medicine and how much to take.

How Nicotinic Acid Works

Nicotinic acid works by affecting enzymes in your liver. It also affects enzymes in the fatty tissue stored in your body. In your liver, nicotinic acid reduces the production of very-low-density lipoproteins, called VLDL. Normally some VLDL particles are converted into LDL cholesterol. Reducing VLDL lowers LDL levels - and that means you've lowered the bad type of cholesterol.

Nicotinic acid also changes the way your body breaks down fat. By doing this, it may help reduce your triglyceride level. It may lower LDL cholesterol by 5% to 25%. It may lower triglycerides by 20% to 50%. It may also raise HDL cholesterol - the good type - by 15% to 35%.

Precautions and Possible Side Effects of Nicotinic Acid

Precautions to take when you are on nicotinic acid:
  • Keep follow-up appointments with your doctor. When you take any form of niacin, your doctor must monitor you for liver problems.

  • Tell your doctor about all your medical problems. If you have certain health conditions, you may not be able to take nicotinic acid safely. Or you may need close monitoring while taking it. Talk with your doctor about the potential effects of nicotinic acid if you have any of the following conditions:

    • frequent chest pain, called angina
    • liver disease
    • gout or high uric acid levels
    • active stomach ulcers
    • diabetes
  • Tell your doctor if you are pregnant or breastfeeding. Pregnant women should not take niacin unless told to by their doctors.

  • If you are breast-feeding, do not take niacin at all.
Taking these actions will help ensure that you take your nicotinic acid safely.

Possible Side Effects. The most noticeable side effect with nicotinic acid is flushed skin. This usually decreases after your body gets used to the medicine.

If you have experienced flushing, take these actions to help avoid it.

  • Take the medicine with food or milk.
  • Do not take it with hot liquids, such as soups or coffee. Also don't take it with alcohol.
  • Take a regular-release aspirin 30 to 60 minutes before taking nicotinic acid.
  • Ask your doctor whether you can start with a lower dose and work up to your target dose gradually over several weeks.
  • Ask your doctor whether you can take slow-release, long-acting nicotinic acid. This type causes less flushing for some people.

Other Possible Side Effects. Some people who take nicotinic acid develop dry skin. Gastrointestinal upset is also possible, including:

  • diarrhea
  • gas
  • indigestion
  • nausea
  • stomach ulcer
  • vomiting
Taking nicotinic acid with food can help to decrease gastrointestinal side effects.

More Serious Side Effects. Talk with your doctor immediately if you experience any of the following:

  • dizziness
  • increase in blood glucose
  • irregular heartbeat
  • malaise
  • vision problems
  • yellowing eyes or skin, which could be a result of severe liver damage
If your doctor prescribes high doses, you have an increased risk of more serious side effects. These include liver toxicity, gout, and high blood glucose.

Possible Drug Interactions With Nicotinic Acid

Make sure that your doctor is aware of all medicines you are taking. Also, ask your pharmacist for a complete list of possible drug interactions.

Nicotinic acid may interact with:

  • Any of the statin medicines used to treat high cholesterol. If you take it with a statin, there is a much higher risk for liver and muscle problems.

  • The fibrates gemfibrozil or fenofibrate. These are medicines that are also used to control cholesterol.

  • Some medicines taken for high blood pressure. Taking nicotinic acid may increase the effects of some medicines taken to lower blood pressure.

  • Alcohol. Because of alcohol's effects on your liver, it may be dangerous to drink alcohol if you take nicotinic acid. If you drink any alcohol, ask your doctor and pharmacist about the effects it may have on your medicine.