Niacin use and cutaneous flushing: mechanisms and strategies for prevention

Niacin, or nicotinic acid, has established efficacy for the treatment of dyslipidemia, but the clinical use of niacin has been limited by cutaneous flushing, a well-recognized associated adverse effect. Flushing has been cited as the major reason for the discontinuation of niacin therapy, estimated at rates as high as 25%-40%. A number of studies have established that moderate doses of prostaglandin inhibitors reduce the cutaneous flushing response from niacin administration. Other strategies for reducing flushing include regular consistent dosing, the use of extended-release formulations, patient education, dosing with meals or at bedtime, and the avoidance of alcohol, hot beverages, spicy foods, and hot baths or showers close to or after dosing. Because niacin has recognized cardiovascular benefits, promoting patient awareness of factors that can minimize niacin-induced flushing can help enhance the tolerability of this valuable dyslipidemic agent.