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Lipid modification - primary and secondary CVD prevention - Management
What are the adverse effects of nicotinic acid?
- Flushing reactions (warmth, redness, itching, tingling) are the most common adverse effects with nicotinic acid (incidence of more than 1 in 10).
- They generally occur during early treatment and the dose titration phase, and are thought to be mediated by the release of prostaglandin D2 (nicotinic acid is a potent vasodilator). Tolerance to flushing usually develops over the course of several weeks.
- The manufacturer advises that concomitant alcohol or hot drinks may increase undesirable flushing and pruritus, and should be avoided around the time of Niaspan® ingestion.
- Other common adverse effects are (incidence between 1 in 10 and 1 in 100):
- Diarrhoea, nausea, vomiting, abdominal pain, dyspepsia.
- Pruritus, rash.
- There have been case reports of hepatotoxicity (apparently a dose-related direct toxic effect), hyperglycaemia, and hyperuricaemia [Aronson, 2006b].
- Muscular adverse effects (e.g. myopathy, myalgia) are very rare (incidence between 1 in 1000 and 1 in 10,000).
- Advise the person to seek urgent medical advice if they develop unexplained muscular symptoms after starting nicotinic acid therapy.
[ABPI Medicines Compendium, 2006a]
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