Nicotinic acid

Nicotinic acid

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Nicotinic acid decreases plasma triglyceride and low-density lipoprotein (LDL) levels, increases high-density lipoprotein (HDL), and lowers the potentially atherogenic lipoprotein (a). It is rapidly removed by renal excretion, and is usually given in two or more divided doses per day.

Adverse effects and precautions: Nicotinic acid is poorly tolerated due to flushing and pruritus in most patients. Flushing can be minimised by administration with food, gradual dose increase, and prophylactic aspirin cover (75 to 150 mg orally, 30 minutes before dosing). Most adverse effects are dose related; they include hypotension, dyspepsia, nausea, aggravation of peptic ulcer disease, vomiting and diarrhoea, hyperuricaemia, and aggravation of gout. Long-term use may lead to impaired glucose tolerance. In patients with diabetes, increases can occur in the blood glucose concentration that require dosage adjustments of insulin and/or other antidiabetic drug therapy. Nicotinic acid should not be started within 3 months of a myocardial infarction. Abnormal liver function tests, jaundice and chronic liver damage have occurred, and appear to be dose related. Nicotinic acid can exacerbate hepatic impairment. Myotoxicity has been reported, and patients who are also on statins should be monitored for signs and symptoms.