niacin ER
Niacin ER (also known as vitamin B3) is a prescription antilipemic medication for adults. It's used to lower high cholesterol and triglycerides (a common form of fat) levels, but it's not a first-choice option for this condition. Niacin ER is taken by mouth once daily, while niacin (Niacor) is typically taken three times daily. Some side effects of niacin ER include flushing and stomach upset. Please note that niacin is also available over-the-counter to treat vitamin B3 deficiency.
What is Niacin ER?
What is Niacin ER used for?
High cholesterol and high triglycerides
Lower risk of repeat heart attack in people with a history of heart attack and high cholesterol
Slow plaque buildup in the arteries of people with a history of coronary artery disease (CAD) and high cholesterol (as an add-on medication)
Severely high triglycerides in people who are at risk of pancreatitis (as an add-on medication)
How Niacin ER works
Niacin ER is an antilipemic medication and a naturally occurring vitamin (vitamin B3). It's thought to work by blocking the release of fat from fatty tissue and slow down the production of cholesterol in the liver. It also turns on certain key pathways responsible for removing triglycerides from the body. As a result of these actions, it can help lower "bad" (LDL) cholesterol and triglyceride levels, while raising the "good" (HDL) cholesterol levels.
Drug Facts
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What are the side effects of Niacin ER?
Common Side Effects
- Flushing (up to 69%)
- Diarrhea (up to 14%)
- Nausea (up to 11%)
Other Side Effects
- Vomiting
- Cough
Serious Side Effects
- Liver damage: severe abdominal pain, yellowing of the skin or whites of your eye, severe nausea, or vomiting
- Muscle pain (rhabdomyolysis): unexplained severe muscle pain, muscle tenderness, or weakness
Source: DailyMed
More on Niacin ER side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Darkening of urine
light gray-colored stools
loss of appetite
severe stomach pain
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Abdominal or stomach pain
feeling of warmth
flushing or redness of the skin, especially on the face and neck
headache
nausea or vomiting
rash or itching
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Niacin ER
Pros
Can lower “bad” (LDL) cholesterol and raise “good” (HDL) cholesterol in people who have trouble doing so with diet and exercise alone
Can also lower triglycerides
An option for people who didn’t have success or had side effects with statins
Available as a lower-cost generic medication
Cons
Doesn’t work as well as statin medications in lowering cholesterol and triglycerides
Can cause flushing, a bothersome side effect
Need to take immediate-release form multiple times a day
Not recommended during pregnancy or breastfeeding
Pharmacist tips for Niacin ER
If you're taking immediate-release form of niacin ER, start by taking the medication after your evening meal. If you’re taking the extended-release form of niacin ER, take the medication at bedtime after you eat a low-fat snack such as fruit, pretzels, or carrots. This lowers your risk of side effects like flushing and stomach upset.
Swallow the extended-release tablets whole. Don't crush or chew them as too much medication might get released at once, which can cause side effects.
Don't drink alcohol, hot beverages, or eat spicy food right before you take this medication as it might raise the chance of flushing and itching of the skin.
Niacin ER might make your skin feel hot and turn red (flushing). Typically, people get used to the medication and flushing can go away after several weeks. If you’re taking the immediate-release form of niacin ER, your healthcare provider might recommend that you take an aspirin or non-steroidal anti-inflammatory drug (NSAID) before you take niacin ER to lower your risk of flushing.
Niacin ER might affect your blood sugar levels. If you have a history of diabetes or high blood sugar levels, your healthcare provider might have you monitor your blood sugar levels at home more often. Be sure to tell your provider if you notice any changes in your sugar levels.
Niacin ER can raise uric acid levels, which can worsen your gout. Talk to your healthcare provider if you're having more gout attacks.
Frequently asked questions about Niacin ER
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What are the risks and warnings for Niacin ER?
Niacin ER can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Muscle breakdown that can lead to kidney and heart damage (rhabdomyolysis)
Risk factors: Taking niacin ER with statins | Age 65 years or older | History of diabetes, kidney problems, or low thyroid levels
Although rare, taking niacin ER together with a statin medication can cause a serious condition called rhabdomyolysis. This is when damaged muscle tissue is broken down in your body and releases proteins into the bloodstream, which can cause very serious and sometimes deadly kidney and heart damage. Talk to your healthcare provider if you develop sudden unexplained muscle pain, weakness, and tenderness, especially after you first start taking niacin ER or after your dose is raised.
Liver damage
Risk factors: Heavy alcohol use | Past or current liver disease | Using sustained-release niacin ER in place of the immediate-release form at equal doses
Niacin ER can cause serious and life-threatening liver damage, especially if you switch from the immediate-release form of niacin ER to the sustained-release form at equal doses. These forms are not the same and you should not switch between them, even at equivalent doses. This can cause you to take a much higher dose than recommended and raise your risk of liver damage. Additionally, if you're a heavy drinker of alcohol or have a history of liver problems you might be at higher risk for liver damage. Don't take niacin ER if you have active liver disease. Your healthcare provider will monitor your liver by doing blood tests while you're taking niacin ER. If you start to notice severe abdominal pain, nausea or vomiting, or yellowing of the skin or whites of the eye, contact your healthcare provider right away.
Niacin ER dosage forms
Typical dosing for Niacin ER
Only prescription-strength niacin ER is FDA-approved to treat high cholesterol levels. Also, immediate-release and extended-release forms of niacin aren't the same and can't be substituted, one for the other.
Niacin immediate-release tablets: The typical starting dose is 250 mg by mouth once a day with dinner. Your provider might raise your dose every few days or weeks until you reach your target cholesterol levels. The typical maintenance dose is 1,000 mg to 2,000 mg two to three times a day. Don't take more than 6,000 mg of niacin immediate-release a day.
Niacin extended-release tablets: The typical starting dose is 500 mg by mouth at bedtime, after a low-fat snack. After 4 weeks, your provider will raise your dose depending on how you’ve tolerated and responded to the medication. The typical maintenance dose is 1,000 mg to 2,000 mg daily at bedtime. The maximum recommended dose is 2,000 mg daily.
Interactions between Niacin ER and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Niacin ER cost?
Niacin ER contraindications
Active liver disease
Active peptic ulcer disease
Unexplained high liver enzymes
Arterial bleeding
What are alternatives to Niacin ER?
High cholesterol and high triglycerides
Lower risk of repeat heart attack in people with a history of heart attack and high cholesterol
Slow plaque buildup in the arteries of people with a history of coronary artery disease (CAD) and high cholesterol (as an add-on medication)
Severely high triglycerides in people who are at risk of pancreatitis (as an add-on medication)
Treatment of high cholesterol in certain people
Lower the risk of heart or blood vessel problems (e.g., heart attack, stroke) in adults at risk for heart problems
Lower "bad" cholesterol and triglyceride levels in certain adults
Lower "bad" cholesterol levels in children age 8 years and older with heterozygous familial hypercholesterolemia (HeFH)
Niacin ER images
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References
Best studies we foundAvPAK. (2017). Niacin- niacin tablet, extended release [package insert]. DailyMed.
Grundy, S. M., et al. (2018). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation.
Guyton, J. R. (2004). Extended-release niacin for modifying the lipoprotein profile. Expert Opinion on Pharmacotherapy.
Jacobson, T. A. (2010). A "hot" topic in dyslipidemia management--"how to beat a flush": Optimizing niacin tolerability to promote long-term treatment adherence and coronary disease prevention. Mayo Clinic Proceedings.
Kamanna, V. S., et al. (2009). The mechanism and mitigation of niacin-induced flushing. International Journal of Clinical Practice.
Macleods Pharmaceuticals Limited. (2023). Niacin tablet [package insert]. DailyMed.
Mani, P., et al. (2015). Niacin therapy, HDL cholesterol, and cardiovascular disease: Is the HDL hypothesis defunct? Current Atherosclerosis Reports.
National Institutes of Health. (2022). Niacin: Fact sheet for health professionals.
Redmont Pharmaceuticals, LLC. (2024). Niacin- niacin tablet [package insert]. DailyMed.
Wilson, P. W. F., et al. (2018). Systematic review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation.
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