Vitamin B3 / lipid-modifying agent
Nicotinic acid
Brand names: Niaspan
Adult dose
Dose: Lipid: 375mg–2g/day at bedtime. Pellagra: 100–500mg/day
Route: PO
Frequency: OD nocte
Clinical pearls
- Lipid use largely abandoned — AIM-HIGH/HPS2-THRIVE showed no CV benefit + adverse events
- Pellagra (nicotinamide preferred — no flush)
Contraindications
- Active liver disease
- Active peptic ulcer
- Arterial bleeding
- Severe hepatic impairment
Side effects
- Flushing/itch (very common — pre-medicate aspirin 30 min before)
- Hepatotoxicity
- Hyperuricaemia/gout
- Hyperglycaemia
- Myopathy with statins
Interactions
- Statins (myopathy)
- Antihypertensives (additive)
- Bile-acid sequestrants (separate)
Monitoring
- LFTs
- Lipids
- Glucose
- Uric acid
- CK
Reference: BNF; NICE CG181; HPS2-THRIVE; https://bnf.nice.org.uk/drugs/nicotinic-acid/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- LDL Cholesterol — Friedewald Equation · Lipid Management
- Tumor Lysis Syndrome Risk (Cairo-Bishop) · Oncological Emergency
- Expanded Disability Status Scale (EDSS) · Multiple Sclerosis
- Urine Anion Gap · Acid-Base
- Bicarbonate Deficit Calculator · Acid-Base
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines