Harvard Men's Health Watch

On call: No-flush niacin

On call

No-flush niacin

Q. In your January 2007 article on cholesterol, you said that no-flush niacin does not lower cholesterol levels. But my problem is low HDL cholesterol. Will no-flush niacin help my HDL even if it won't lower my LDL cholesterol?

A. Niacin can be used for three purposes: to lower the LDL ("bad") cholesterol, to lower triglycerides, and to raise the HDL ("good") cholesterol. Because the statins and other prescription drugs that have such a good ability to lower the LDL have only a modest ability to boost the HDL, niacin can be particularly helpful for people with low HDL levels.

To have benefit, though, niacin has to be absorbed into the bloodstream. Nicotinic acid is well absorbed. "Immediate-release," "crystalline," and "plain" forms of niacin are rapidly absorbed forms of nicotinic acid; in the proper dose, they can improve all three blood lipids, but they also cause flushing and itching. Sustained-release forms of niacin also deliver nicotinic acid to the bloodstream; they cause less flushing, but some preparations have been linked to a significant risk of liver inflammation and other side effects. Intermediate-release niacin delivers effective amounts of nicotinic acid with a modest risk of flushing and a good safety record. Most experts favor intermediate-release niacin.

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