Improving your cholesterol levels can help protect you from:

• Heart disease
• Heart attack
• Stroke

Your health care provider will work with you to lower your cholesterol by improving your diet. If this is not successful, medicines to lower cholesterol may be the next step. Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

Research now suggests that niacin does not add to the benefit of a statin alone for reducing the risk of cardiovascular events, including heart attacks and stroke.

In addition, niacin can cause unpleasant and potentially dangerous side effects. Therefore, its use has been declining. However, some people may be prescribed niacin in addition to other drugs if they have very high cholesterol or if they do not tolerate other medicines. Niacin may also be used to help lower very high triglycerides in people at risk for pancreatitis.

There are different brands of niacin medicines. Most of these also come in a less expensive, generic form.

Niacin may be prescribed along with other medicines, such as a statin, to help lower cholesterol. Combination tablets that include nicotinic acid plus other medicines are also available.

Niacin is also sold over-the-counter (OTC) as a supplement. You should not take OTC niacin to help lower cholesterol. Doing so could have serious side effects.

Take your medicine as directed. The medicine comes in tablet form. Do not break or chew tablets before taking the medicine. Do not stop taking your medicine without talking with your provider first.

You take niacin 1 to 3 times per day. It comes in different doses, depending on how much you need.

Read the label on the pill bottle carefully. Some brands should be taken at bedtime with a light, low-fat snack; others you will take with dinner. Avoid alcohol and hot drinks while taking niacin to reduce flushing.

Store all of your medicines in a cool, dry place. Keep them where children cannot get to them.

You should follow a healthy diet while taking niacin. This includes eating less fat in your diet. Other ways you can help your heart include:

• Getting regular exercise
• Managing stress
• Quitting smoking

Before you start taking niacin, tell your provider if you:

• Are pregnant, plan to become pregnant, or are breastfeeding
• Have allergies
• Are taking other medicines
• Drink a lot of alcohol
• Have diabetes, kidney disease, peptic ulcer, or gout

Talk to your provider about all of your medicines, herbs, or supplements. Certain medicines may interact with niacin.

Regular blood tests will help you and your provider:

• See how well the medicine is working
• Monitor for side effects, such as liver problems

Mild side effects may include:

• Flushing and red face or neck
• Diarrhea
• Headache
• Upset stomach
• Skin rash

Though rare, more serious side effects are possible. Your provider will monitor you for signs. Talk with your provider about these possible risks:

• Liver damage and changes to liver enzymes
• Severe muscle pain, tenderness, and weakness
• Heartbeat and rhythm changes
• Changes in blood pressure
• Severe flushing, skin rash, and skin changes
• Glucose intolerance
• Gout
• Vision loss or changes

Contact your provider if you notice:

• Side effects that are bothering you
• Fainting
• Dizziness
• Fast or irregular heartbeat
• Yellow skin or eyes (jaundice)
• Muscle pain and weakness
• Other new symptoms

Antilipemic agent; Vitamin B3; Nicotinic acid; Niaspan; Niacor; Hyperlipidemia - niacin; Hardening of the arteries - niacin; Cholesterol - niacin; Hypercholesterolemia - niacin; Dyslipidemia - niacin

American Heart Association website. Cholesterol medications. www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications. Updated February 20, 2024. Accessed March 5, 2024.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3234-3237. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

Nambi V, Ballantyne CM, Jones PH. Overview of general approach to management of dyslipidemias. In: Ballantyne CM, ed. Clinical Lipidology: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2024:chap 11.

Updated by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.