How to Prevent the Side Effects of Niacin?

Woman holding face in hands, eyes closed
PhotoAlto/Frederic Cirou

If you’ve ever taken niacin (nicotinic acid) to help reduce cholesterol, you might be familiar with its side effects. These include flushing, itching, and hot flashes. Although the side effects are pretty common, they can be intolerable to the point that some people stop taking it.

While the side effects usually subside over a couple of weeks, they might be very bothersome in the meantime. There are some simple things you can do to reduce these annoyances.

Ease Into the Full Dose

If you are taking an immediate-release form of niacin, you may want to gradually increase your dose. For instance, if you are supposed to take 500 milligrams a day, take 250 milligrams the first few days until you are able to tolerate the side effects. Then, gradually increase your dose until you reach the recommended dose.

Also, you might try to divide your dose throughout the day. In this case, you would take 250 milligrams twice a day, instead of 500 milligrams once a day.

This only works for immediate-release products. You should never cut sustained or extended-release pills in half.

Aspirin Before Niacin

Studies have shown that taking an aspirin first can decrease the flushing and itching associated with niacin. If you are having trouble with these side effects, you may try to take a 325-milligram aspirin dose at least 15 to 30 minutes prior to taking the niacin. 

Avoid Hot Drinks and Alcohol

Hot beverages like coffee and tea as well as alcohol may increase the likelihood of flushing. Try to avoid drinking any of these around the time that you take your niacin.

Slow Down the Niacin Release

If you continue to have trouble tolerating the immediate-release form of niacin, you might want to ask your health care provider about a sustained-release or extended-release form.

These forms of niacin release nicotinic acid into the body gradually and somewhat reduce the side effects.

  • Sustained-release forms are available over-the-counter. However, they have been found to cause hepatitis in some cases.
  • Niaspan is the only extended-release form of nicotinic acid. It is only available by prescription.

Try Flush-Free Niacin

There are also other forms of niacin, such as nicotinamide and inositol hexaniacinate, that are designated as ​"flush-free" forms of niacin. Although they may not produce the side effects that nicotinic acid can cause, some studies have shown that these forms of niacin may not be effective in lowering cholesterol.

A Word From Verywell

Before trying any of these tips, make sure your healthcare provider is aware that you are taking a nicotinic acid product. Some individuals may need to be monitored more closely due to health conditions or other medications they are taking.

Sources:

Cefali EA, Simmons PD, Stanek EJ, et al. Aspirin Reduces Cutaneous Flushing After Administration of an Optimized Extended-Release Niacin Formulation. ​International Journal of Clinical Pharmacology and Therapeutics. 2007;45(2):78-88.

Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. Columbus, Ohio: McGraw-Hill Education; 2016.

Lai E, De Lepeleire I, Crumley TM, et al. Suppression of Niacin-Induced Vasodilation With an Antagonist to Prostaglandin D2 Receptor Subtype 1. Clinical Pharmacology & Therapeutics. 2007;81(6):849-57.

Continue Reading