Lipid-modifying agent (Nicotinic acid derivative) Pregnancy: Avoid — insufficient human safety data; use only if essential and after specialist input.

Acipimox

Brand names: Olbetam

Adult dose

Dose: 250 mg BD–TDS with meals; max 1.2 g/day

Route: Oral

Frequency: Two to three times daily with meals

Max: 1.2 g/day

Take with food to reduce flushing. Aspirin 30 minutes before may further reduce flushing.

Dose adjustments

Renal

CrCl 30–59: 250 mg BD. CrCl 15–29: 250 mg OD. CrCl <15: contraindicated.

Hepatic

Caution; no specific dose adjustment.

Clinical pearls

Niche role since the AIM-HIGH and HPS2-THRIVE trials showed niacin adds no CV benefit on top of statin therapy.
Modest LDL ↓10–15%, TG ↓20–30%, HDL ↑15–25% — useful in mixed dyslipidaemia when statins not tolerated or contraindicated.
Flushing is dose-related and usually subsides over 2–4 weeks.
Avoid in patients with gout — may precipitate acute attacks.

Contraindications

Active peptic ulcer disease
Severe renal impairment (CrCl <15)
Hypersensitivity to nicotinic acid derivatives

Side effects

Cutaneous flushing (less than parent nicotinic acid)
Pruritus, erythema
Dyspepsia, nausea, abdominal pain
Hyperuricaemia and gout
Hyperglycaemia / impaired glucose tolerance
Rash, urticaria
Headache

Interactions

Statins: increased risk of myopathy / rhabdomyolysis (caution with high-dose statin)
Antidiabetic agents: may reduce glycaemic control
Allopurinol / febuxostat: may need dose review due to hyperuricaemia

Monitoring

Lipid profile at 6–12 weeks
FBG / HbA1c if diabetic
Urate if history of gout
LFTs annually

Reference: BNF 90; SmPC Olbetam; AIM-HIGH NEJM 2011;365:2255-67; HPS2-THRIVE NEJM 2014;371:203-12. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways