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Doctors' Answers to "Frequently Asked Questions" - Niacin

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 11/24/1999]
Question: I'm taking 120mg Xenical with each meal that contains fat. I'm also on 50mg Atenolol once a day for hypertension. I recently started taking 100mg Niacin because I read that the "Niacin Flush" was good for your circulation and clears 'toxins' in your fatty tissue. Is this true? Is it safe to take 100mg Niacin per day to keep my cholesterol from becoming high?

Answer: No truth to this that I'm aware. The flush is dilation of peripheral arteries and does nothing except cause a hot flash and lower your blood pressure. Niacin has potential liver toxicity and needs ongoing liver function tests, however, this is a pretty low dosage.

Question: What is the optimal dosage for the non-prescription drug, niacin, available in several forms? I understand that it is beneficial in lowering triglycerides and raising HDL cholesterol, but that it can also be quite hepatotoxic.

Answer: Niacin is a naturally occuring vitamin. Many years ago it was found to lower cholesterol and until the advent of zocor and some of the newer drugs was used extensively. Although it is non-prescription use in excess of 500-750mg a day can produce elevated liver enzymes and in some cases liver damage. Consequently, it needs to be monitored regularly. The optimim dose is dictated by ones cholesterol. Some patients are very sensitive to this drug and will have their cholesterol lowered by 750-lOOOmg a day. Others will need 1500-2000mg a day. Diarrhea and flushing are usually the limiting side effects-the flushing can sometimes be blocked by an aspirin taken 20-30 minutes before the drug.
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