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Tips To Manage Niacin Flushing

Niacin (nicotinic acid) holds an important place in the treatment of dyslipidemia by virtue of its favorable effect on all plasma lipoproteins and lipids, especially high-density lipoprotein cholesterol (HDL-C), which can be increased by up to 35%. In randomized controlled trials, niacin combined with a statin reduced carotid intima thickness and the incidence of stroke and coronary events. However, cutaneous vasodilation with flushing occurs in > 60% of patients and up to 20% discontinue niacin because of it. This hot topic has been addressed in recent clinical studies and an analysis in the Mayo Clinic Proceedings show flushing can be minimized by taking niacin with meals, avoiding exacerbating factors (e.g., hot beverages, alcohol), using slow initial dose escalation, and taking 325 mg of aspirin 30 minutes before niacin doses. Pharmacists can provide these suggestions to patients and physicians to enhance niacin adherence and help improve cardiovascular outcomes.