a bottle of niacin, fight niacin flush

Q. A heart doctor put me on Niaspan because my good cholesterol is very low. I am taking 2,000 mg a night. He only told me I would have a little facial flushing.

I woke up one night red as a lobster and itching all over. When I called my regular doctor the next day,he laughed and said lots of people will not take Niaspan because of these side effects. A heart doctor he knows told him to have his patients on niacin take aspirin half an hour before taking the niacin and to eat a few tablespoons of unsweetened applesauce when taking the pills. Problem solved. No more flushing or itching.

My doctor keeps a check on my liver enzymes regularly. My good cholesterol has come up to normal levels without causing any problems.

A. Your doctor’s recommendations are on target. It is a shame the cardiologist didn’t prepare you better to take this medicine.

Niacin can be helpful in normalizing cholesterol levels, but as you discovered the flushing can be uncomfortable or even alarming. Pretreating with aspirin and taking the controlled-release niacin with a meal or with an applesauce snack helps prevent flushing for many patients (Mayo Clinic Proceedings, April, 2010). Our Guide to Cholesterol and Heart Health offers other ways to control cholesterol in addition to niacin or statin-type drugs.

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  1. Judie25

    I started on Niaspan 2 years ago. 2 500 mg tablets. For over a year I had no side effects, flushing, tingling, nausea. Last summer, I started to have a burning feeling in my legs at night. It went away as fall came. Now this summer, the burning sensation came back, so I split my dosage into 1 pill in th AM, and one at night. That seemed to work until I got a bunch of horsefly bites on my ankles.
    Now, not only do I have the burning sensation, my ankles have swollen up especially when I go out in the sun. Has anyone had a reaction to the sun from Niaspan?

  2. DM

    And, yes, I took it with food.

  3. DM

    My problem is not flushing but terrible upset stomach. My second dose was last night and it was worse than the night before. The painful, gassy upset stomach lasts through breakfast. I took 1 81mg aspirin before each dose but may stop doing that in case that’s part of the problem (I never use aspirin). I hope this will get better if I stick it out because I don’t want to use statins. Had to beg my doc to consider non-statin option.

  4. KGD

    Is there anything to do once you wake up with the horrible itching reaction. It happens regularly, but usually not often.
    Tonight, however, is the second night in a row with the itching. It woke me up at 2:15 and it’s now almost 3:30. I’ve taken 4 more aspirin (regular strength), which never bother my stomach, in addition to the 1 I took before the pill…no effect.
    Then, I took a hot shower, which resolved things for about 5 minutes…then no effect. Then I took a hot bath, which resolved things for about 10 minutes…then no effect.
    I will deal with my physician on Monday, but I need to know if there is anything one can do to fix this once it happens.
    I understand that Niaspan does what the doctor wants it to do. This, however, is too high a price to pay. There MUST be an alternative.

  5. GDV

    My Dr. has asked me to try Niaspan for the second time. I could not deal with the flushing the first time and have not been able to take statins (have tried them all) due to muscle spasms. I take warfarin for factor five leiden. My Dr. told me to take either an 81 mg or a 325 mg aspirin and come back in 3 weeks to check my blood. Is this safe and does it matter which mg. I take?
    PEOPLE’S PHARMACY RESPONSE: The drug reference Epocrates suggests that the low dose is better. It should be adequate to ease the flushing (if taken one-half hour before the Niaspan). It might make you bleed too easily, though, in combination with the warfarin, so pay attention to how your body responds and don’t miss your follow-up blood test.

  6. ew

    Is it safe to continue to take niaspan when I have repeated reaction of flushing, itching, burning ftlm it. What is this doing to my body? I am allergic to aspirin. I have tried taking ibuprofen prior to taking niaspan and I take it with low fat food.
    PEOPLE’S PHARMACY RESPONSE: In most cases, the flushing, itching and other reactions will eventually diminish. They are uncomfortable but not usually serious. You should definitely talk with your doctor about this to ensure that is what you are experiencing.

  7. MRW

    The first few times I took niaspan, I was awakened with itching over my entire body that was so intense that it was painful and before awaking fully I had scratched enough to draw blood. My cardiologist’s nurse recommended I take my daily aspirin (325) along with a low fat snack shortly before niaspan taken at bedtime. This helped though there were still incidents of much milder itching from time to time (again, however, enough to awaken me).
    All was bearable until a few weeks ago when because of slight internal bleeding, I was advised by the cardiologist to go to 81 aspirin instead of the 325. The intense flushing has begun again. This week I have a cardiology appointment and hope the doctor can recommend something. I’d rather undergo an occasional blood transfusion than go through the flushing.

  8. T.B.

    I had just been on Niaspan (to lower triglycerides) for a few weeks when I had a terrible reaction to it. Sometimes I would wake up with itchy skin, but I would be able to go back to sleep. The bad reaction happened when I was tent camping with my kids. I woke up with the itchy skin and it actually hurt. I tried to relax hoping it would stop. Then quite suddenly I felt like I would have diarrhea and the toilet was about a 3-5min walk away.
    I got up to try to go and felt so sick I laid on the ground outside the tent and messed myself. I don’t know how long I laid there. I would try to get up and feel so nauseous and dizzy I couldn’t get up. Fortunately my Mother-in-law had joined us that night and she helped me get to the bathroom/showers. When I looked at my body I was red from head to toe and it was painful. I felt sick the rest of the night and the next day I felt like I was recovering from a hangover. I had not been taking an aspirin as my doctor said I didn’t need to take it. I would eat a little something and then take the pill.
    I had this same reaction to a statin med when I forgot to take the asprin. I just feel like this med. isn’t safe for me. Is it really safe? Is it really safe to have to take one medication (aspirin) to counter the effects of another medication?

  9. Paul43

    I talked to 2 pharmacists and they both had the same story— if you are using straight Niacin to replace Niaspan—DO NOT– I repeat what they told me DO NOT use the TIME RELEASED VERSION—just take the regular Niacin and they were both adamant about that.

  10. Runnered64

    On May 24, 2011, at 5:26 PM, Joe W. asked:
    is regular niacin the same as niaspan??????
    I did not see your response to this question.
    I, too, as using simvastatin and Niaspan (1000 mg), and occasionally experience flushing and itching, lasting up to 2 hours (plus, I’m drained for hours afterward).
    In addition, Niaspan is quite expensive, currently costing $35 per month (expected to increase with the next renewal of my medical plan).
    Some local stores (Walmart, SAM’s) have niacin (inositol hexanicotinate) priced at $9 for 120 capsules. Even taking 3 capsules a day yields a net cost of less than $9 per month, an important consideration for us senior citizens.
    However, the question remains: is this type of niacin effective? My cardiologist doesn’t think so, but said he’d evaluate the results after I used it for a while.
    Corollary question: Would it be more effective if I took one 500 mg three times a day (one with each meal), instead of all at once?
    (PS – the Walmart niacin, Spring Valley brand, is labeled as Flush Free. So far, four doses, I have had NO adverse effects. I, too, take it with a small amount of applesauce 30 minutes after taking 325 mg of aspirin with my evening meal. I have also heard that it is helpful to avoid spicy foods when taking Niaspan).
    (I have also found that I have flushed with Niaspan when drinking diet cola (Pepsi or Coke) with my evening meal. Also if I exert myself after taking the Niaspan. Hope this helps others).

  11. agatha

    are you saying that niaspan does not contain statins? I cannot tolerate statins, it causes severe muscle aches.

  12. Heather

    There is new info just out on this. Data now show that niacin does NOT increase the good cholesterol, HDL, and that when doctors catch up with the latest research they will no longer be recommending it for this purpose. (It never was effective in lowering LDL the bad cholesterol)

  13. JimP

    I take 2000 mg of Niaspan just before I go to bed. I will have some mild flushing if I wake up in the middle of the night. I rarely wake up, and the flushing is gone by morning. I found that taking an aspirin tablet caused stomach discomfort that was worse than the mild flushing, so I don’t take any aspirin before the Niaspan.
    I also take 10 mg of Zocor. My HDL (good) is now higher than my LDL (bad).
    Niaspan is a prescription-only timed release niacin. I asked my cardiologist about taking over-the-counter timed release niacin, but he said to stick with the prescription Niaspan because of better quality control of the dissolution rate. If I didn’t have good drug insurance, I would take the over-the-counter timed release niacin instead. (My warehouse store has large bottles.) Niaspan is expensive!

  14. Paul43

    If your allergic to Aspirin– try taking the Niaspan right before you go to sleep. Hopefully you won’t feel or be bothered by any flushing if it occurs.

  15. pds

    I thought the purpose for the niacin flush was to open the arteries. If flushing is prevented by aspirin, is that not defeating the purpose of the niacin, as far as cholesterol lowering benefit is concerned?

  16. joe w

    I am allergic to aspirin can I just take niacin?
    is regular niacin the same as niaspan??????

  17. RW

    I have been on niaspan for 9 years. I take one 81mg aspirin (coated) 5 to 30 minutes before the niaspan. I also eat a small wedge of angel food cake to ‘pad the pills’. This eliminates the flushing. My cholesterol numbers are great, as are the readings for my liver, which are all monitored at least twice a year. I don’t have the soreness that people have that are on statin drugs.

  18. DWD

    Half a regular aspirin 20 minutes before the niaspan generally works for me. I occasionally get mild flushing maybe 2-3 times per month. But different dosages work for different folks so you may need more or less. I take my aspirin with supper and the niaspan 20 minutes later.

  19. Paul43

    My Cardiologist told me the same thing — to take a 325 Aspirin 1/2 hour before taking the Niacin.
    At first I was taking Simcor which is a combination of Simavastin & Niacin and got off that because I didn’t want to risk taking the Satins. Then switch to Niaspan and used the Aspirin trick for both pills and the result was NO FLUSHING with both pills.

  20. HM

    What is the dosage of aspirin you take with the niacin?

  21. HW

    I was put on Niaspan (prescription form of Niacin) many years ago for my cholesterol, because I could not tolerate Statin drugs due to pain in my neck, etc. I took one aspirin (350 mg) a day with the Niaspan. Last fall my cardiologist (a top doctor at the Texas Medical Center in Houston, TX) bumped up my Niaspan to 3000 mg. per day. He told me to get off the Aspirin and take one Alka Seltzer (it includes aspirin) with the medication.
    He said it would be easier on my stomach. I have never had any flushing at all, nor any stomach problems, and my cholesterol numbers are all excellent. Please let this writer know what a difference that will make!

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