Nicotinic acid (Niacin, flush form)

Tier 2 — promising · Lipids · Cardiovascular · Vitamin B3

The flushing form of vitamin B3 distinct from niacinamide. At pharmacological doses (1-3 g/day), nicotinic acid robustly raises HDL (+20-30%) and lowers Lp(a) (-22% in meta-analysis of 14 RCTs, N=9,013, Sahebkar 2016, PMID 27733255). However, AIM-HIGH and HPS2-THRIVE — two large RCTs totalling over 28,000 patients — showed no reduction in cardiovascular events when extended-release niacin was added to statin therapy, with HPS2-THRIVE showing net harm (excess serious adverse events). Current cardiology guidelines have largely withdrawn niacin as statin add-on. The NIH tolerable upper limit…

Dose: 500 mg-3 g/day immediate-release, titrated slowly over 4-6 weeks. Use immediate-release only — sustained-release formulations carry hepatotoxicity risk. Maximum studied dose: 3 g/day.