What is niacin, a drug or a vitamin?

Niacin is nicotinic acid, one of the B vitamins. It’s found in many foods, especially whole grains and milk products. As a vitamin, you need only about 15 milligrams of niacin a day. However, when used to lower cholesterol niacin is used in what are called pharmacological levels rather than in vitamin amounts. One positive side to niacin is that it’s the least expensive of all cholesterol lowering medications available, although the drug does have a high rate of side effects.
The pharmacological levels can range from a few hundred up to 6,000 milligrams per day. If you take 100 milligrams, the only side effect you may experience is some flushing and warmth for a few minutes (this dosage is too low to lower blood cholesterol). When you are taking 1,000 to 6,000 milligrams a day, the rate of side effects is very high. The minimum dose for any real effect on cholesterol is about 1,000 milligrams. One usually starts with 100 milligrams (or a few hundred milligrams), slowly increasing the dose to over 1,000 milligrams. Only about two out of three people can tolerate the required dose. The most common complaints are indigestion and flushing. Some special formulations are becoming available that are absorbed more slowly and appear to cause less flushing and fewer side effects.

Niacin can raise blood sugar levels, so if you have diabetes, niacin should not be taken. Niacin is one of the few drugs that can lower triglycerides as well as cholesterol, and that, together with the very low price, is why it is still prescribed. Nationally, the number of prescriptions written annually for niacin is very low, but that figure is misleading because niacin is available over the counter and could be used for lowering cholesterol without a prescription.

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