How does this medication work? What will it do for me?
Niacin extended release belongs to the family of medications known as lipid metabolism regulators. It is used to treat high cholesterol. It is believed to work by decreasing the production of cholesterol in the body. It helps to lower total cholesterol, LDL-cholesterol (bad cholesterol) and triglycerides, and increases HDL-cholesterol (good cholesterol).
This medication should be used in combination with an appropriate diet and exercise program to reduce cholesterol. It is not intended to be a substitute for healthy eating and exercise.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each white, caplet-shaped, unscored, time-release (extended-release) tablet, engraved "N-500" on one side, contains niacin (nicotinic acid) 500 mg. Nonmedicinal ingredients: methylcellulose, povidone, and stearic acid (plant source). This product does not contain artificial colours, flavours, or preservatives; cornstarch; gluten; lactose; sugar; yeast; soy; or animal by-products.
How should I use this medication?
The usual recommended starting dose of niacin extended release is 500 mg at bedtime, after a low-fat snack. The dose is gradually increased every 4 weeks to a maximum dose of 2,000 mg at bedtime. Niacin extended release should be used in combination with an appropriate exercise program to reduce cholesterol and it is not intended as a substitute for such a program.
Niacin extended release tablets should be swallowed whole and not crushed or chewed.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
This medication is available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms listed here. The forms available for the specific brand you have searched are listed under "What form(s) does this medication come in?"
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to niacin or any ingredients of the medication
- are pregnant or nursing
- have active peptic (stomach or intestine) ulcer disease
- have bleeding
- have severe or unexplained liver or kidney problems or a history of jaundice (yellow skin)
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- joint pain
- severe headache (migraine)
- signs of liver problems (e.g., yellow eyes or skin, abdominal pain, dark urine or pale stools, nausea, vomiting)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- chest pain
- signs of a serious allergic reaction (swelling of the face, tongue, or throat; hives; difficulty breathing)
- symptoms of bleeding in the stomach or intestines (dark, tarry stools; blood coming from rectum; vomiting blood or material that looks like coffee grounds; fast heartbeat; weakness or fainting)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Diabetes: People with diabetes may experience higher blood sugar levels. If you have diabetes, your doctor may ask you to monitor your blood sugar more frequently and report any changes in your usual blood sugar patterns to your doctor. Your doctor may need to adjust the doses of your diabetes medications.
Fluid retention: Niacin may cause fluid retention and swelling, possibly worsening high blood pressure, congestive heart failure, or decreased heart function. If you have these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you develop shortness of breath; fatigue; excessive weight gain; chest pain; or swelling of the legs, feet, or ankles while taking this medication, consult your doctor immediately.
Flushing: Some people taking niacin extended release may experience flushing, usually at the start of treatment or when the dose is increased. The flushing usually occurs during the first 8 weeks of treatment and will become milder and less frequent as treatment continues. Flushing usually occurs within 2 to 4 hours after taking a dose and may last a few hours.
Taking the medication at bedtime with a low-fat snack will help you deal with flushing by making it more likely to happen while you are asleep. If flushing wakes you up at night, get up slowly, especially if you are feeling faint or dizzy or ir you are taking blood pressure medications.
Avoid alcohol, spicy foods, or hot drinks around the time you take niacin extended release, as these may increase flushing. If flushing is bothersome, your doctor may recommend that you take acetylsalicylic acid (ASA), if this is appropriate for you, up to 30 minutes before taking niacin extended release.
Gout: Niacin may cause increased levels of uric acid in the blood, causing flare-ups of gout. If you have gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any joint pain, joint swelling, or warmth to your doctor immediately.
Heart problems: If you have unstable angina and other heart conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney disease: If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver disease: Liver damage has occurred in people switching from niacin extended release to other niacin products. Do not substitute other niacin products for the one your doctor has prescribed for you. If you have liver disease or a large alcohol intake you should be closely monitored by your doctor while taking niacin extended release. People with severe or unexplained liver disease should not take niacin extended release.
Restarting the medication: If you need to restart the medication after you have not taken it for a long period of time, check with your doctor first. You may need to restart treatment at a lower dose and gradually increase the dose over time.
Serious warnings and precautions: If you were previously taking another niacin tablet, do not start NIASPAN (extended-release niacin) at the same dose. You must start with a lower dose of NIASPAN and gradually move up to a higher dose as directed by your doctor.
Do not substitute another niacin product for your NIASPAN; improper substitution can cause severe liver disorders.
Stomach problems: Niacin may cause stomach problems such as ulcers or bleeding. If you have stomach problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Call your doctor immediately if you notice signs such as stomach or abdominal pain, black tarry stools, or vomiting blood. Using acetylsalicylic (ASA) to reduce flushing caused by niacin may increase the risk of stomach problems.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately..
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking niacin extended release, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.
What other drugs could interact with this medication?
There may be an interaction between niacin extended release tablets and any of the following:
- acetylsalicylic acid (ASA)
- bile acid sequestrants (drugs that prevent cholesterol reabsorption by the body)
- certain blood pressure medications (e.g., metoprolol, propranolol, verapamil, diltiazem)
- nitrates (e.g., nitroglycerin)
- "statin" cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
- vitamins or nutritional supplements containing niacin, nicotinic acid, or nicotinamide
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.