Question of the Day

As a service to our loyal readers, we will periodically answer medically-related questions that are emailed to us. Today's question comes from R.M. who asks:

"I am a 56 year old male who had high cholesterol. By watching my saturated fats, exercising, and taking niacin I lowered it. Recently, about an hour or so after eating and taking my vitamins and niacin, twice I have gotten odd tingling feelings and felt like I had a fever. It lasted about 20 minutes. I have taken the niacin and vitamins for several years and have never had this happen before. What could be causing thisto happen now?"

Dr. Ryan responds:

This is an excellent and not uncommon question. The symptoms that you felt were likely due to the niacin that you are taking. Niacin is a member of the B complex family of vitamins and is available in both over-the-counter and prescription forms. At higher doses, niacin is used to treated elevated blood triglyceride levels and may also help with low HDL (good cholesterol) levels.

As with any attempt to treat elevated cholesterol or triglyceride levels, a modification of lifestyle using diet, exercise, and weight reduction should be attempted. It sounds like you have been a model patient in this regard. The use of niacin can reduce total cholesterol 10-25%, reduce triglycerides 20-50%, and increase HDL levels 15-30%.

Patients who have a known allergy to niacin should avoid it. In addition, those with significant liver dysfunction, peptic ulcer disease, or arterial bleeding should not take niacin.

Niacin is typically started at 50 to 100mg two or three times daily. The dose is gradually increased over 6 to 8 weeks to reach a goal dose of 500-1000mg three times daily. Liver function tests should be monitored every 6 to 12 weeks during the first year of therapy and then every 6 months while the medication is continued.

The most common side effect of niacin, which you experienced, is flushing. This flushing can be mild to severe and may make you feel like you have a fever. Other common side effects of niacin include itching, dry skin, headache, nausea, vomiting, diarrhea, and attacks of gout. Flushing can be decreased by first taking 325mg of aspirin. Avoiding hot liquids or alcohol also may decrease the flushing. Flushing, itching, and gastrointestinal symptoms may be decreased by slowly increasing the dose of niacin and avoiding taking niacin on an empty stomach. The good news is that the body develops tolerance to niacin and the flushing usually occurs less frequently, though it may occur now and again.

We hope this helps.
Sincerely,
Dr. Ryan


Sources:
Noble: Textbook of Primary Care Medicine, 3rd ed, Mosby 2001.
Mosby's Drug Consult online, Elsevier 2005.

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