Be prepared for patients’ questions about the safety of niacin.
Niacin has been making headlines not just for failing to benefit patients, but even for harming them, in the form of dyspepsia, diarrhea, rash, muscle pain, flushing, bleeding, possible infections, and hyperglycemia.
In fact, for every 1,000 patients treated for about 4 years with a statin plus niacin and an antiflushing agent, about 18 more will develop diabetes and 37 more diabetics will have worse glycemic control, compared to patients on a statin alone.
Considering these statistics, avoid niacin in patients with diabetes or those at a high risk for developing diabetes. Continue to use statins first-line to lower CV risk.
Using niacin along with a statin doesn’t improve CV outcomes more than a statin alone when LDL is around 70 mg/dL. Likewise, adding niacin or fenofibrate to a statin to raise HDL does not improve cardiovascular outcomes. The bottom line is that there’s some evidence that niacin improves CV outcomes when used as monotherapy, but none when used with a statin.
Re-evaluate the treatment regimen if niacin is already in use, particularly in patients who are on a statin and have low LDL and stable CV disease.
Reserve niacin for special cases, such as patients who can’t take a statin.
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- Prescribers: What has your patient experience been with niacin side effects?
- Pharmacists: Have patients been inquiring about niacin safety?