Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Lipid modification - primary and secondary CVD prevention - Management
What dose of nicotinic acid is recommended?

  • CKS could find no trials for nicotinic acid modified-release tablets that reported health-related quality of life or clinical endpoints such as cardiovascular morbidity and mortality. Consequently, only licensed dosages are recommended.
  • Nicotinic acid is only available as modified-release tablets (Niaspan®) in the following strengths: 375 mg, 500 mg, 750 mg, and 1000 mg.
    • A starter pack (containing seven 375 mg tablets, seven 500 mg tablets and seven 750 mg tablets) is also available.
    • The manufacturer advises that the different tablet strengths have different bioavailability and are not interchangeable.
  • Dose titration:
    • Start with 375 mg daily for 1 week.
      • Niaspan® should be taken at bedtime, after a low fat snack (e.g. an apple, low fat yoghurt, slice of bread).
    • Titrate the dose to 500 mg daily in the second week, 750 mg in third week, and then 1000 mg (two 500 mg tablets) in the fourth week.
    • The recommended maintenance dose is 1000 mg (two 500 mg tablets) to 2000 mg (two 1000 mg tablets) daily, depending on response and tolerance.
    • The daily dosage should not be increased by more than 500 mg in any 4-week period after the initial titration to 1000 mg. The maximum dose is 2000 mg per day.
    • If therapy is discontinued for an extended period or transferred from a different nicotinic acid product, the manufacturer advises that re-institution of therapy must include a dose escalation.
    • No dose adjustment is necessary for the elderly.

[ABPI Medicines Compendium, 2006a]

© NHS Institute for Innovation and Improvement