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Nicotinic acid (Niacin, flush form)

Lipids · Cardiovascular · Vitamin B3
Tier 2 — Promising

What it is

The flushing form of vitamin B3, distinct from niacinamide. At pharmacological doses (1.5-3 g/day) nicotinic acid is the single most effective agent for raising HDL (+20-30%) and reducing Lp(a) (-25-35%) — uniquely among lipid drugs. Also lowers LDL and triglycerides. The famous flush results from prostaglandin D2 release and is harmless but uncomfortable. However AIM-HIGH and HPS2-THRIVE showed no cardiovascular benefit added to statins, and adverse effects (hyperglycaemia, hepatotoxicity at sustained-release doses) are meaningful.

Efficacy
4/5
Safety
3/5
Research
4/5
Onset
3/5
Cost
5/5
Drug-int.
4/5

Dose

500 mg–3 g/day, titrated up slowly; use immediate-release, not sustained-release

Time of day & tips

Take with food and 325 mg aspirin 30 min prior to reduce flush; avoid sustained-release (hepatotoxicity risk); monitor LFTs and glucose; physician supervision above 1 g

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