Oh, the flush of some medications

January 15, 2013 By

Q: I battle high cholesterol. Niacin makes me flush. I have found a flush-free niacin, inositol hexanicotinate. Is this really niacin and what have you heard about its effectiveness in helping to lower bad cholesterol?

A: To begin with, the regular use of niacin can be preceded by either diphenhydramine (Benadryl) or aspirin that will prevent the flushing aspect that is so difficult for patients to deal with. However, I strongly urge you to speak with your primary care physician before putting this into play because of an anti-coagulant issue that could present problems for some individuals.

Inositol hexanicotinate is used for a variety of conditions to include hypertension, insomnia, atherosclerosis, restless legs syndrome, poor circulation, Raynaud’s disease, high cholesterol levels, and more. It is a compound of niacin (vitamin B3) and inositol. This form of niacin is purported to reduce or prevent flushing, simply because it breaks down at a slower rate. Inositol hexanicotinate appears safe for most individuals, works to reduce cholesterol levels in some people but the results of tests are contradictory. [Read more…]

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Which niacin is the right one?

December 13, 2011 By

DEAR DR. GOTT: If it has any value, perhaps sometime you might write a little about the three forms of niacin that can be bought over-the-counter: plain niacin, flush-free niacin and extended-release niacin.

I am assuming that the value of niacin in its blood vessel dilating properties which could tend to move the free cholesterol out of the blood stream. If that is true, then I question the value of either the extended-release or flush-free niacin.

My reason for asking is that the plain niacin seems to be disappearing from store shelves. CVS cannot order it for me any more and directed me to Whole Foods. I have looked elsewhere (but not the internet). If this is a stupid question, please disregard it.
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Niacin handles cholesterol numbers

July 8, 2010 By

DEAR DR. GOTT: I am a 75-year-old male who has struggled for years getting my HDL cholesterol up above the minimum desired, even though I was taking over-the-counter nonflushing niacin. My doctor then convinced me to take prescription niacin, even though it was the same strength. It is quite expensive, but my HDL jumped from the mid-20s to the mid-40s. The only difference seems to be an ingredient to prevent flushing in the OTC variety.

This seems to nullify any value the niacin has, so why does the Food and Drug Administration allow OTC niacin with the antiflushing additive to be sold when it obviously does no good?
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Daily Column

November 5, 2008 By

DEAR DR. GOTT:
You have written several times about restless legs syndrome but I feel you left out one very important thing. Were any of these people taking statin drugs?

I took simvastatin for four years. After about two years, I started having a slight weakness and muscle pain in my left leg. I talked to my doctor about whether the statin was to blame and he said no. The pain got worse and I started having restless legs syndrome and cramps at night in my left leg. The weakness progressed to the point that I had to hold on to a railing to climb stairs. When it got to the point that I couldn’t depress the clutch pedal in my stick shift truck I stopped the simvastatin without my doctor’s approval. One month later the weakness, pain, cramps and restless legs syndrome were gone. [Read more…]

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Sunday Column

September 14, 2008 By

DEAR DR. GOTT:
After being told that his cholesterol was elevated, my 70-year-old husband was given a prescription for Lipitor. Before filling it, he researched the side effects first and then opted for red yeast rice instead. After nearly two months on the medication, he had a Transient Global Amnesia (TGA) episode. It lasted most of the day and he had no idea that he had asked the same question over and over. He also couldn’t recall what he had done the day before, what he planned to do later that day and when it was over he couldn’t remember what had happened but knew something was wrong. He saw his doctor who assured him that he did not have a mini-stroke and again prescribed Lipitor.

After doing another internet search, this time on TGA episodes, [Read more…]

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Daily Column

August 9, 2008 By

DEAR DR. GOTT:
I am a faithful reader of your column and hope that you can give me some advice regarding information provided by several individuals.

You have repeatedly recommended niacin instead of statins for lowering cholesterol. I will be going to my doctor soon for my routine physical and plan on asking if this is an appropriate option for me as I realize every case and body is different.

My concern, however, is that many people have told me that some vitamins and supplements can cause anal leakage. I would like to know what you think of this and, if it is true, to what vitamins it applies.

DEAR READER:
To the best of my knowledge, vitamins and supplements do not cause anal leakage (also known as bowel or fecal incontinence). This is not to say that there is no possibility for problems from the medication, [Read more…]

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Daily Column

July 22, 2008 By

DEAR DR. GOTT:
In a past column you recommended replacing Lipitor with either omega-3 fish oil capsules or niacin. I have elected to try the niacin. You said to START with 500 milligrams per day and I have done this for a couple of weeks. Now I want to increase the dosage but don’t know what to increase it to. Should I go to 1000, 1500 or 2000 mg? Maybe more? Also, how long should I stay on the niacin? I would also like to know your opinion on red yeast rice. I have noticed that you don’t mention it.

DEAR READER:
Niacin is an excellent alternative choice for lowering cholesterol levels. I often recommend patients to start with a relatively low-dose of 250-500 mg daily and then slowly work up to 1000-1500 mg daily, usually in increments of 250 mg. This is primarily to allow the body to become accustomed to the vitamin and reduce the chance of side effects, namely, flushing. [Read more…]

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Daily Column

July 1, 2008 By

DEAR DR. GOTT:
During my last visit to my physician, I commented that since taking Lipitor I have had sleepless nights. He recommended I start taking it in the morning rather than before bedtime as I had been. I am willing to do this as long as the drug will be as effective if I take it in the morning.

DEAR READER:
Lipitor will work the same regardless of what time of day it is taken or even if it is taken with or without food. In my experience most physicians recommend some medications be taken in the morning and others at night simply to reduce the number of pills taken simultaneously and to reduce the chance of drug interactions. If your physician has said you can safely take the Lipitor in the morning, I recommend you take his advice. If that fails to stop the sleeplessness, perhaps you could successfully be switched to another cholesterol lowering medication. [Read more…]

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Daily Column

June 20, 2008 By

DEAR DR. GOTT:
I never fail to read your column in my daily newspaper for your good advice, although your article about niacin being an excellent choice for a non-prescription treatment for cholesterol was rather confusing to me.

The only niacin a person can buy without a prescription is the non-flushing kind that does nothing for high density lipoprotein (HDL) levels. The one that helps is Niaspan that requires a prescription and can definitely cause flushing — to the degree that some people cannot take it at all.

Can you please clear this up?

DEAR READER:
Non-flushing niacin contains an ingredient called inositol which does nothing for reducing cholesterol levels and may prevent the niacin from working correctly. Straight niacin or sustained-release niacin is available over-the-counter and does [Read more…]

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Niacin causes severe itching

March 2, 2008 By

DEAR DR. GOTT: I read your column often and notice that you mention taking niacin for many things. I started taking one tablet of 250 mg time released niacin to see if it would help lower my blood pressure and my cholesterol levels. After taking it for about 30 days, I was feeling great. However, one day I began having little pricks throughout my body. Thinking something was terribly wrong with me, I looked on the internet and discovered some diseases with that symptom. I was just about to make an appointment with my doctor when I looked for information on niacin and discovered that one of the side effects is itching. I discontinued it and my prickly sensations stopped very quickly.

Does this mean I will not ever be able to take niacin again? Are there other forms that might work better? I had renewed energy and really felt great while taking it.
[Read more…]

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