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Lipid-modifying agent (Nicotinic acid derivative) Pregnancy: There is only limited experience of administration of acipimox to humans and no epidemiological data; animal studies have shown reproductive toxicity at high doses. It is recommended that acipimox is NOT administered to women who are, or may be, pregnant. Breast-feeding: in the absence of animal data on levels excreted in milk, acipimox should not be administered to women who are breast-feeding. Fertility: no human data; in rats there was no effect on mating or fertility.

Acipimox

Brand names: Olbetam

Acipimox is a nicotinic acid derivative used as a lipid-lowering agent, principally to reduce raised triglycerides and as an adjunct in mixed dyslipidaemia.

Adult dose

Dose: Hyperlipidaemia (hyperlipoproteinaemia of a degree and type considered appropriate for treatment): one 250 mg capsule
Route: Oral — to be taken with or after meals
Frequency: 2 or 3 times daily. The lower dose is advised in type IV and the higher dose in type IIb hyperlipoproteinaemias; the daily dosage should be adjusted individually depending on plasma triglyceride and cholesterol levels.
Max: 250 mg per dose, up to three times daily — the highest recommended regimen in the SPC ('one 250 mg capsule 2 or 3 times daily'). The SPC adds that 'Daily dosages of up to 1200 mg have been safely administered for long periods'; this is a tolerability statement, not the recommended regimen.
Improvement in the plasma lipid picture is usually seen within the first month of therapy. Low-cholesterol and low-fat diets, cessation of alcohol, exercise and weight loss are preferable approaches to be tried before starting acipimox. RENAL IMPAIRMENT: creatinine clearance above 60 ml/min — no dose reduction required; creatinine clearance between 60 and 30 ml/min — reduce to one 250 mg capsule 1 or 2 times daily with or after meals; creatinine clearance below 30 ml/min — contraindicated. Acipimox is eliminated entirely through the kidneys, so accumulation is expected in proportion to the degree of renal impairment, and longer intervals between doses are advised in renal impairment. PAEDIATRIC: the SPC section 4.2 gives no paediatric posology — verify any under-18 use against a children's formulary. Source product: Olbetam Capsules 250 (UK SPC) — section 4.2 was retrieved complete (no truncation); sections 4.1 and 4.9 were not fetched.

Dose adjustments

Renal

Creatinine clearance above 60 ml/min: no dose reduction required. Creatinine clearance between 60 and 30 ml/min: reduce to one 250 mg capsule 1 or 2 times daily, taken with or after meals, and leave longer intervals between doses. Creatinine clearance below 30 ml/min (severe renal impairment): contraindicated. Acipimox is eliminated entirely through the kidneys, therefore accumulation can be expected in relation to the degree of renal impairment.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
  • Peptic ulceration
  • Severe renal impairment (creatinine clearance below 30 ml/min)

Side effects

  • Headache (very common)
  • Flushing (very common)
  • Dyspepsia (very common)
  • Upper abdominal pain (common)
  • Urticaria (common)
  • Asthenia (common)
  • Anaphylactoid reaction, bronchospasm, angioedema, pruritus, rash, erythema (uncommon)
  • Myositis, myalgia, arthralgia (uncommon)
  • Nausea, feeling hot, malaise (uncommon)
  • Eye symptoms (dry or gritty eyes), vasodilatation, diarrhoea (frequency not known)
  • Skin vasodilatation causing a sensation of heat, flushing or itching — especially at the start of therapy; these reactions usually disappear rapidly during the first day of treatment

Interactions

  • Statins (HMG-CoA reductase inhibitors) — combination should be used with caution; the risk of muscle toxicity is increased when nicotinic acid, a structural analogue of acipimox, is given with a statin. In one study, Chinese patients taking nicotinic acid plus laropiprant with simvastatin had a higher incidence of myopathy and rhabdomyolysis than Caucasians
  • Fibrates — use with caution, because of reports of increased musculoskeletal events with nicotinic acid in combination with lipid-lowering agents
  • Other lipid-lowering agents — no interaction has been shown
  • Colestyramine — the absorption of acipimox is not affected by concomitant administration
  • Digoxin and warfarin — no interaction has been shown

Monitoring

  • Measure all baseline values, including the lipid profile, before starting treatment
  • Obtain periodic determinations of serum lipids to confirm the desired therapeutic effect, as long-term administration is intended
  • Monitor hepatic and renal function

Clinical monograph

How it works

It inhibits lipolysis in adipose tissue, reducing the flux of free fatty acids to the liver and thereby lowering triglyceride and VLDL production.

Prescribing in practice

  • Cutaneous flushing, itching and a sensation of warmth are common, particularly at the start of treatment, and may limit tolerability.
  • Take with or after food to improve gastrointestinal tolerability and reduce flushing.
  • Dose adjustment is needed in renal impairment as the drug is largely eliminated unchanged by the kidneys.

Monitoring

Monitor the fasting lipid profile to assess response and review renal function where impairment is suspected.

Counselling the patient

  • Flushing and warmth are common when starting and usually settle with continued use.
  • Take it with food, and continue your recommended diet alongside the medicine.

Evidence & guidelines

Acipimox is an established lipid-modifying agent used as an alternative or adjunct in hypertriglyceridaemia as described in the SPC.

Reference: SmPC Olbetam; AIM-HIGH NEJM 2011; 365:2255-67; HPS2-THRIVE NEJM 2014; 371:203-12; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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