Niacin is indicated as an adjunct to diet for the reduction of elevated total cholesterol (TC), LDL-C, Apo B, and triglyceride (TG) levels, and for increasing HDL-C in patients with primary hypercholesterolemia (heterozygous familial and non-familial) and mixed dyslipidemia when response to diet alone is inadequate. In patients with a history of myocardial infarction and hypercholesterolemia, Niacin is indicated to reduce the risk of recurrent non-fatal myocardial infarction. It is also indicated as adjunctive therapy in adult patients with very high serum triglyceride levels (Type IV and V hyperlipidemia) who are at risk of pancreatitis and do not respond adequately to dietary measures. Before starting therapy with Niacin, secondary causes of hypercholesterolemia (such as poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, and alcoholism) should be excluded and a full lipid profile should be obtained.

Niacin is a preparation of nicotinic acid. It effectively reduces VLDL, LDL, total cholesterol, and triglyceride levels while increasing HDL levels. Due to these lipid-modifying effects, Niacin is used in the management of cardiovascular diseases, particularly hyperlipidemia.

Initial Dose: 500 mg tablet at bedtime from 1 to 4 weeks.

Maintenance Dose: the daily dosage should not be increased by more than 500 mg in any 4 week period. The recommended maintenance dose is 1000 mg (two tablet) to 2000 mg (4 tablets) once daily at bedtime. Dose greater than 2000 mg daily is not recommended. Or, as directed by the registered physician.

Niacin may enhance the effects of ganglionic blocking agents and other vasoactive drugs, leading to postural hypotension. Concomitant use of aspirin may reduce the metabolic clearance of nicotinic acid, although the clinical significance is unclear. Approximately 98% of Niacin may bind with colestipol and about 10–30% with cholestyramine. Therefore, Niacin should be administered at least 4–6 hours apart from bile acid-binding resins, or with as long an interval as possible.

Niacin is contraindicated in patients with known hypersensitivity to Niacin or any component of the formulation, significant or unexplained hepatic dysfunction, active peptic ulcer disease, or arterial bleeding.

Niacin is generally well tolerated. The most common adverse effects include flushing, itching, pruritus, nausea, gastrointestinal upset, jaundice, hypotension, tachycardia, increased blood glucose, and elevated uric acid levels, as well as myalgia.

Niacin is not recommended during pregnancy and lactation due to lack of sufficient safety data.

Before starting Niacin therapy, attempts should be made to control hyperlipidemia through diet, exercise, weight reduction, and treatment of underlying conditions. Patients with a history of jaundice, hepatobiliary disease, or peptic ulcer should be closely monitored. Liver function tests and blood glucose should be checked regularly. Diabetic patients may experience dose-related glucose intolerance and should be closely observed, with possible adjustment of diet or antidiabetic therapy.

Caution is required in unstable angina or acute myocardial infarction, especially when used with nitrates, calcium channel blockers, or adrenergic blockers. Niacin may increase uric acid levels and should be used carefully in patients with gout. It may also reduce platelet count and increase prothrombin time; therefore, monitoring is required when used with anticoagulants. Phosphorus levels may decrease slightly; periodic monitoring is recommended in at-risk patients.

Supportive treatment should be provided in case of overdose. Symptoms may include nausea, dizziness, vomiting, itching, stomach upset, and flushing.

Store in a cool, dry place, protected from light and moisture. Keep all medicines out of the reach of children.