Is Niacin Safe to Take to Lower Your Lipids?

Niacin (nicotinic acid)  is a cholesterol-lowering medication that can affect all aspects of your lipid profile, Specifically, studies have shown that nicotinic acid can:

  • Increase HDL levels by up to 25%
  • Lower  LDL cholesterol by up to 35%
  • Lower triglycerides by up to 50%

Although you can obtain extended-release niacin (nicotinic acid) by prescription, there are other formulations of niacin are available without a prescription and are relatively inexpensive.

Even though niacin may not require a visit to your healthcare provider for a prescription, this doesn’t mean that it is completely safe to take it. A recent, large study (AIM-HIGH study) revealed that individuals with cardiovascular disease taking extended-release niacin saw increased HDL levels - but did not see a reduction in their risk experiencing a cardiovascular event - such as a stroke or heart attack - or death. In fact, no differences were noted between individuals in this study taking a statin and niacin versus taking a statin alone. Additionally, individuals taking nicotinic acid in this study had a higher incidence of ischemic strokes. Due to the fact that there was no change in risk of death or complications from cardiovascular disease and the concern over an increase in ischemic strokes, the investigators stopped this study early.

Common side effects noted with niacin include skin flushing, nausea, hot flashes, and heart palpitations. However, other serious side effects may also occur, and could be increased if you have one of the following medical conditions:

  • Gout – Niacin could increase your uric acid levels, increasing your chances of experiencing a gouty attack.
  • Diabetes – Diabetics taking niacin could note an increase in their fasting blood sugar levels.
  • Peptic ulcer disease – Studies examining the use of extended release nicotinic acid had reports of peptic ulcer development. The mechanism by which this occurs is not known.
  • Liver disease – Taking niacin could cause an increase in liver enzymes, which could become even more elevated in individuals already diagnosed with liver disease.
  • Kidney disease - Having poor kidney function may cause niacin to accumulate in your blood, possibly toxic effects.
  • Pregnancy – There have not been enough studies to adequately assess the safety of niacin on your baby. Therefore, you should consult your healthcare provider if you are pregnant, or planning to become pregnant.
  • Breast feeding – Studies have shown that niacin is excreted in breast milk, however, it is not fully known if doses given to lower cholesterol could also harm the baby.
  • Cardiovascular disease – Taking niacin could worsen certain cardiovascular conditions, such as unstable angina.
  • Bleeding disorders – Taking niacin products could decrease your ability to clot – and increase your ability to bleed. This can also occur if you are taking anticoagulants, or “blood thinners”, such as Coumadin (warfarin) or aspirin.

In studies, some individuals taking niacin warranted a lowering of the dose or resulted in niacin being discontinued due to side effects. Because of the potentially serious side effects and lack of benefit on cardiovascular health, niacin is not recommended as a medication to take if you are wanting to lower your lipid levels. Niacin is only likely to be considered by your healthcare provider if you are not able to fully control your lipid levels with other medications - such as taking a statin alone or a statin and ezetimibe combination.

So, if you are looking to include niacin in your lipid-lowering regimen, talk to your healthcare provider first. He or she may have other ways of safely lowering your cholesterol and triglyceride levels, and may later consider niacin if other therapies are not working.

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Article Sources

  • AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels and receiving intensive statin therapy. N Eng J Med 2011;365:2255-2267.
  • Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 9th ed 2014.
  • Micromedex 2.0.  Truven Health Analytics, Inc. Greenwood Village, CO.  Available at:  Accessed February 10, 2016
  • Stone NJ et al. 2013 ACC/AHA Guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation 2014; Circulation 129(25 Suppl 2):S1-45