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All about: Niacin

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Generic name: Niacin
Brand names: Niaspan

Why is Niacin prescribed?

Although the niacin in Niaspan is one of the B-complex vitamins, Niacin isn't taken to prevent deficiencies. In large doses, niacin also lowers cholesterol, and Niaspan extended-release tablets are designed specifically for this purpose.

Excessive levels of cholesterol in the blood can lead to clogged arteries and increased risk of heart attack. Niaspan is prescribed, along with a low-fat, low cholesterol diet, to reduce blood cholesterol levels, combat clogged arteries, and lower the chance of repeated heart attacks. It is used only when diet alone fails to do the job, and is often taken along with another type of cholesterol-lowering drug known as a bile acid sequestrant (Colestid, Questran, WelChol). It can also be combined with any of the cholesterol-lowering "statin" drugs (Lescol, Lipitor, Mevacor, Pravachol, Zocor).

Niaspan is also used to reduce very high levels of the blood fats known as triglycerides, a condition that can cause painful inflammation of the pancreas.

Most important fact about Niacin

Before starting therapy with Niaspan, your doctor will try to control your cholesterol and triglyceride (fat) levels with a diet low in cholesterol and saturated fat, as well as a program of exercise and, if necessary, weight reduction. It's important to remember that Niaspan (like other cholesterol-lowering drugs) is a supplement--not a substitute--for these measures. To get the most from Niaspan, you need to continue the diet and exercise program prescribed by your doctor.

How should you take Niacin?

Take Niacin exactly as prescribed by your doctor. To minimize the "flushing" effect of Niaspan, your doctor may ask you to take aspirin or a nonsteroidal anti-inflammatory medication (NSAID) such as Motrin or Aleve 30 minutes before taking Niaspan.

Niaspan is taken once a day at bedtime after a low-fat snack. Do not take Niaspan on an empty stomach. If flushing wakes you up during the night, get up slowly, especially if you feel dizzy or faint, or if you are also taking blood pressure medicine.

Niaspan tablets should be swallowed whole, never crushed or chewed.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Niaspan.

  • More common side effects may include:
    Abdominal pain, chills, diarrhea, dizziness, fainting, flushing, headache, indigestion, itching, nasal inflammation, nausea, pain, rapid heartbeat, rash, shortness of breath, sweating, swelling due to fluid retention, vomiting

Why should Niacin not be prescribed?

Do not take Niaspan if you have significant liver disease, an active ulcer, or arterial bleeding. You'll also have to avoid Niaspan if it gives you an allergic reaction.

Special warnings about Niacin

Niaspan is an extended-released form of niacin. It is not interchangeable with immediate-release or sustained-release forms of niacin.

Niaspan can cause problems if your liver is weak. Before you start taking Niacin, your doctor may order a blood test to check your liver. Blood tests will probably be repeated 6 and 12 weeks after you start taking Niaspan and periodically after that. While you are taking Niaspan, your doctor will monitor you very closely if you have ever had liver disease or if you are or have ever been a heavy drinker.

Do not drink alcohol or hot beverages with Niaspan because they may intensify the flushing and itching effect of the medication.

Niaspan should be used with caution if you have diabetes, a heart condition, or problems with gout. If you have diabetes, tell your doctor if you have a change in blood sugar levels while taking Niaspan. Also use Niaspan with caution if you have kidney problems.

Before undergoing surgery, make sure the doctor is aware that you are taking Niaspan. This medication tends to slow the clotting process, and could prolong bleeding.

To reduce the chance of side effects, Niaspan therapy is usually started at a low dosage and gradually increased. If you stop taking Niaspan for an extended period, contact your doctor. You'll probably need to build up to your old dose over a period of several months.

Tell your doctor if you experience any dizziness while taking Niaspan.

Possible food and drug interactions when taking Niacin

There have been occasional cases of muscle damage when Niaspan is combined with a "statin" drug such as Lescol, Lipitor, Mevacor, Pravachol, or Zocor. Tell your doctor if you experience any muscle pain, tenderness, or weakness, especially when starting either Niaspan or one of these drugs, or when increasing the dosage.

The cholesterol-lowering drugs known as bile acid sequestrants can cancel Niaspan's effect when taken at the same time. Try to space doses of the two types of drug at least 4 to 6 hours apart.

Multivitamins containing large doses of niacin and related compounds increase the chance of side effects from Niaspan. Tell your doctor about any nutritional supplements you may be taking.

Combining Niaspan with certain blood pressure medications can lead to excessively low blood pressure. Make sure the doctor is aware of any blood pressure drugs that you're taking.

Niaspan has not been tested in children under 21 years of age.

Special information if you are pregnant or breastfeeding

The high doses of niacin needed to lower cholesterol and triglycerides have not been proven safe in pregnancy. If you are taking Niaspan to lower cholesterol, you should discontinue the drug while pregnant. If you need it to control triglyceride levels, your doctor will weigh the benefits of treatment against the potential risk to the baby.

Niacin appears in breast milk and high doses could cause side effects in the nursing infant. You'll need to choose between breastfeeding your baby or continuing Niaspan therapy.

Recommended dosage

ADULTS

The usual starting dose is one 500-milligram tablet taken at bedtime after a low-fat snack. Every 4 weeks, your doctor may increase your dosage by 500 milligrams, up to a maximum dosage of 2,000 milligrams taken once a day, depending on your response to the drug. Women generally respond to lower doses than men do.

Overdosage

Excessive doses of niacin--more than 2,000 milligrams a day--taken for a long period of time can damage the liver or cause a stomach ulcer to flare up. Nausea, vomiting, abdominal cramps, faintness, and yellowish skin and eyes can be warning signs of long-term overdose. If you develop any of these symptoms, check with your doctor without delay.

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