Niacin, also called nicotinic acid, is a B vitamin (vitamin B3). It occurs naturally in plants and animals, and is also added to many foods as a vitamin supplement. It is also present in many multiple vitamins and nutritional supplements.

Niacin is used to lower blood levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides, and increase levels of "good" cholesterol (high-density lipoprotein, or HDL).

Niaspan is used to lower the risk of a heart attack in people who have high cholesterol and who have a history of heart attacks. Niaspan can also be used with another cholesterol medicine to slow down the build-up of fatty deposits in your arteries.

You should not take niacin if you have severe liver disease, a stomach ulcer, or active bleeding.

Niacin can cause certain side effects, such as flushing (warmth, itching, redness, or tingly feeling under your skin). These effects can be made worse if you drink alcohol or hot beverages shortly after you take this medicine. These effects should disappear over time as you keep taking the medication.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid taking colestipol (Colestid) or cholestyramine (Locholest, Prevalite, Questran) at the same time you take niacin. If you take either of these other medications, take them at least 4 to 6 hours before or after you take this medicine.

Niacin is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.

Before taking this medicine

You should not take niacin if you are allergic to it.

To make sure you can safely take niacin, tell your doctor if you have ever had:

• severe liver disease;

• a stomach ulcer; or

• active bleeding.

Tell your doctor if you have ever had:

• liver disease;

• kidney problems;

• heart disease, chest pain (angina);

• gout; or

• diabetes.

It is not known whether niacin will harm an unborn baby. You may not be able to use this medicine during pregnancy. Tell your doctor right away if you become pregnant.

You should not breastfeed while using this medicine.

Do not give niacin to a child without medical advice.

Niacin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet usually is taken two to three times a day with meals, and the extended-release tablet is taken once a day, at bedtime, after a low-fat snack. Follow the directions on your prescription label or package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take niacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release tablets whole; do not split, chew, or crush them.

Your doctor will probably start you on a low dose of niacin and gradually increase your dose.

Continue to take niacin even if you feel well. Do not stop taking niacin without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Use niacin exactly as directed on the label, or as prescribed by your doctor. Read all medication guides or instruction sheets.

Niacin can cause flushing (warmth, itching, redness, or tingly feeling under your skin). These effects should disappear over time as you keep taking the medicine. Flushing may be worse if you drink alcohol or hot beverages shortly after taking niacin.

Swallow the capsule or tablet whole and do not crush, chew, break, or open it.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the form and strength your doctor prescribes.

If you stop taking niacin for any length of time, talk with your doctor before starting the medication again. You may need to restart the medication at a lower dose.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using this medicine.

Niacin is only part of a complete treatment program that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Your doctor may recommend you take aspirin or an NSAID (such as ibuprofen, Advil, or Aleve) to help prevent flushing. Keep using these medicines for as long as your doctor has prescribed.

Store at room temperature away from moisture and heat.

You should not take niacin if you are allergic to it.

To make sure you can safely take niacin, tell your doctor if you have ever had:

• severe liver disease;

• a stomach ulcer; or

• active bleeding.

Tell your doctor if you have ever had:

• liver disease;

• kidney problems;

• heart disease, chest pain (angina);

• gout; or

• diabetes.

It is not known whether niacin will harm an unborn baby. You may not be able to use this medicine during pregnancy. Tell your doctor right away if you become pregnant.

You should not breastfeed while using this medicine.

Do not give niacin to a child without medical advice.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.

Avoid drinking alcohol. It may increase your risk of liver damage, and can also worsen the flushing effects of niacin.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid eating foods high in fat or cholesterol, or niacin will not be as effective.

Get emergency medical help if you have signs of an allergic reaction to niacin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

• high blood sugar - increased thirst, increased urination, dry mouth, fruity breath odor;

• unexplained muscle pain, tenderness or weakness;

• a light-headed feeling, like you might pass out;

• irregular heartbeats;

• severe warmth or redness under your skin;

• vision problems; or

• jaundice (yellowing of the skin or eyes).

Common niacin side effects may include:

• flushing (sudden warmth, redness, or tingly feeling);

• upset stomach, nausea, vomiting, diarrhea;

• abnormal liver function tests;

• itching, rash, dry skin;

• cough;

• skin discoloration; or

• headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

You should not take colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking niacin.

Tell your doctor about all your other medicines, especially:

• other medicines to lower cholesterol or triglycerides;

• aspirin;

• blood pressure medicine; or

• a blood thinner - warfarin, Coumadin, Jantoven.

This list is not complete. Other drugs may interact with niacin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to niacin.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking niacin.

Only use the brand and type of niacin that your doctor prescribed. Do not use another brand of niacin or switch between products without talking to your doctor. If you switch to a different brand or type of niacin, your dose may need to be changed.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Simcor® (containing Niacin, Simvastatin)