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Medication Matters Blog

Lipid Therapy: Taking the Risks of Niacin to Heart


Wednesday, May 13, 2015 10:45 AM

Niacin Lipid TherapyBe 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.

Need to know more?

The above post was created from recommendations on the topic published in our trusted newsletters. These recommendations also include Detail-Documents to help explain the rationale behind our recommendations and provide you with additional tools to help improve patient care: tools such as patient education handouts, drug comparison charts, FAQs, and more. Download our PL Detail-Document: Niacin: Who Needs It? to view a sample. To view the Detail-Documents on this month’s topics and 10-12 recommendations every month, subscribe today

Want to know more about other hot medication management topics?

This is just one topic of many. Every month we publish 10-12 recommendations and supporting Detail-Documents on the hottest topics in drug therapy and medication management. This month’s topics include:

  • When to use Daliresp (roflumilast) to prevent COPD exacerbations.
  • How to prevent kidney stones.
  • More awareness about how a patient's culture can impact their health.
  • How to manage pressure ulcers.
  • Options for irritable bowel syndrome (IBS).

Go to the table of contents now for each Letter to see the full list:

Tell us what you’re doing:

Share with us below in the comments!

  • Prescribers: What has your patient experience been with niacin side effects?
  • Pharmacists:  Have patients been inquiring about niacin safety?

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Topics: Niacin

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