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Medications: HMG CoA Reductase Inhibitors | Niacin | Nitroglycerin Sublingual or Spray



Also known as Vitamin B3, niacin is available in many generic and brand name formulations for use in lipid-lowering applications.



Doses of niacin (1000 milligrams) significantly above the recommended daily requirement of 20 milligrams a day will decrease the liver’s production of lipoprotein particles and can enhance the breakdown of these particles. A large study has shown that niacin may increase life expectancy in patients with coronary heart disease. Reversal of coronary artery disease has been achieved with the combination of niacin and bile acid binding resins.

Effects On Blood Lipids

  • Triglycerides are reduced zero to 20 percent
  • HDL cholesterol is increased 10 to 25 percent
  • Total cholesterol and LDL cholesterol are reduced up to15 to 25 percent


Adverse Reactions

  • Flushing and itching (temporary, can be controlled with dosage adjustment)
  • Mild dryness of the skin
  • Nausea
  • Indigestion
  • Diarrhea
  • Liver enzyme elevations
  • Stomach ulcers
  • Gout
  • Arthritis
  • Increased blood sugar
  • Skin rash
  • Certain heart rhythm disturbances
  • Liver inflammation
  • Rapid drop in blood pressure

Schedule regular blood tests so your physician can monitor you for any side effects.



Niacin should always be taken with some food in the stomach, and the same brand should be continually used to prevent flushing or diminished effect. Do not use niacinamide or nicotinamide as substitutes, as they have no lipid-lowering effects.

Do not use time-released niacin.

Work with your physician to schedule the proper dosing schedule of niacin, which is typically taken several times a day for lipid-lowering purposes. A specific schedule will be provided to you by your TCA doctor. This schedule will also tell you when you are to return to lab work.