Nicotinic acid, commonly known as niacin, plays a significant role in managing cholesterol levels. As a form of vitamin B3, it is not only essential for human nutrition but also serves as a prescription medication. This article delves into how nicotinic acid is utilized in the medical field to treat conditions related to cholesterol and triglycerides, highlighting its effectiveness and limitations.
Prescription Use and Dosage
Nicotinic acid is available in both immediate-release
and sustained-release formulations. It is prescribed to treat primary hyperlipidemia and hypertriglyceridemia, either as a standalone therapy or in combination with other lipid-modifying drugs. The initial dosage typically starts at 500 mg per day and can be increased to as high as 3,000 mg per day for immediate-release formulations or 2,000 mg per day for sustained-release formulations. These dosages aim to achieve targeted lipid changes, such as lowering LDL cholesterol and triglycerides while increasing HDL cholesterol.
Despite its proven ability to alter lipid levels, nicotinic acid has not been shown to reduce the risk of cardiovascular disease in patients already taking statin drugs. A review in 2010 suggested its effectiveness as a monotherapy, but a subsequent review in 2017 concluded that while it affects lipid levels, it does not reduce all-cause mortality or the incidence of cardiovascular events.
Decline in Prescriptions
The use of prescription nicotinic acid peaked in the United States in 2009, with 9.4 million prescriptions. However, by 2020, this number had declined to 800,000. In 2023, it was the 288th most commonly prescribed medication in the U.S., with over 500,000 prescriptions. This decline can be attributed to the lack of evidence supporting its effectiveness in reducing cardiovascular events when used alongside statins.
The American Heart Association advises against substituting dietary supplement nicotinic acid for prescription forms due to potential side effects and less stringent manufacturing regulations. High doses of nicotinic acid can cause skin flushing, a common side effect characterized by redness and warmth in the face, arms, and chest.
Side Effects and Risks
While nicotinic acid can effectively modify lipid levels, it is associated with several side effects. Common adverse effects include flushing, headache, abdominal pain, and nausea. Long-term use can lead to more serious issues such as liver damage, increased risk of type 2 diabetes, and gastrointestinal problems.
Flushing, a short-term dilation of skin arterioles, is often accompanied by itching and tingling sensations. This side effect can be minimized by taking aspirin or ibuprofen before nicotinic acid, or by using sustained-release formulations. However, sustained-release forms are more likely to cause liver damage.
In conclusion, while nicotinic acid is effective in managing cholesterol levels, its use as a prescription medication has declined due to its limited impact on cardiovascular outcomes and potential side effects. Patients should consult healthcare professionals before using nicotinic acid, especially in high doses.
