Niaspan ER extended release works by reducing LDL ("bad") cholesterol and triglycerides and increasing HDL ("good") cholesterol. Niaspan contains niacin, also called nicotinic acid, a B vitamin (vitamin B3). It occurs naturally in plants and animals and is present in many multiple vitamin supplements.

Niaspan ER is used to lower cholesterol and triglycerides (types of fat) in the blood. It is also used to lower the risk of heart attack in people with high cholesterol who have already had a heart attack. It is sometimes used to treat coronary artery disease (also called atherosclerosis).

Niaspan ER may also be used for purposes not listed in this medication guide.

You should not take Niaspan ER if you are allergic to niacin, or if you have severe liver disease, a stomach ulcer, or active bleeding.

Niaspan ER 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 Niaspan ER. 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 Niaspan ER. If you take either of these other medications, take them at least 4 to 6 hours before or after you take this medicine.

Niaspan ER 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 Niaspan ER if you are allergic to niacin, or if you have severe liver disease, a stomach ulcer, or active bleeding.

To make sure you can safely take Niaspan ER, tell your doctor if you have any of these other conditions:

• liver or kidney disease;

• heart disease or uncontrolled angina (chest pain);

• a stomach ulcer;

• diabetes;

• gout; or

• a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. Niaspan ER may be harmful to an unborn baby when the medication is taken at doses to treat high cholesterol or other conditions. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Niacin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Use Niaspan ER exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Niaspan ER is sometimes taken at bedtime with a low-fat snack. Follow your doctor's instructions.

Niaspan ER 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 Niaspan ER. These effects should disappear over time as you keep taking the medication.

Take Niaspan ER with a full glass of cold or cool water. Taking the medication with a hot drink may increase your risk of side effects such as flushing. Do not crush, chew, break, or open an extended-release Niaspan ER tablet. Swallow it whole. Breaking or opening the tablet may cause too much of the drug to be released at one time. Extended-release tablets contain higher strengths of niacin than the regular tablets.

Niaspan ER can cause you to have unusual results with certain medical tests (urine tests). Tell any doctor who treats you that you are using this medicine.

If you stop taking Niaspan ER 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.

While using Niaspan ER, you may need blood tests at your doctor's office. Your kidney or liver function may also need to be checked. Visit your doctor regularly.

Niaspan ER 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.

Store at room temperature away from moisture and heat.

You should not take Niaspan ER if you are allergic to niacin, or if you have severe liver disease, a stomach ulcer, or active bleeding.

To make sure you can safely take Niaspan ER, tell your doctor if you have any of these other conditions:

• liver or kidney disease;

• heart disease or uncontrolled angina (chest pain);

• a stomach ulcer;

• diabetes;

• gout; or

• a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. Niaspan ER may be harmful to an unborn baby when the medication is taken at doses to treat high cholesterol or other conditions. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Niacin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Take the missed dose as soon as you remember. Be sure to take the missed dose with food if you normally take your Niaspan ER dose with a meal or snack.

Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

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

Overdose symptoms may include nausea, dizziness, itching, vomiting, upset stomach, and flushing (warmth, redness, or tingly feeling).

Avoid drinking hot beverages shortly after taking Niaspan ER. Hot drinks can worsen the flushing effect (warmth, itching, redness, or tingly feeling under your skin).

Avoid drinking alcohol while taking Niaspan ER. Alcohol may increase your risk of liver damage, and can also worsen the flushing effects of this medicine.

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

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.

Get emergency medical help if you have any of these signs of an allergic reaction to Niaspan ER: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling like you might pass out;

• fast, pounding, or uneven heart beats;

• feeling short of breath;

• swelling;

• jaundice (yellowing of your skin or eyes); or

• muscle pain, tenderness, or weakness with fever or flu symptoms and dark colored urine.

If you are diabetic, tell your doctor about any changes in your blood sugar levels.

Less serious Niaspan ER side effects include:

• mild dizziness;

• warmth, redness, or tingly feeling under your skin;

• itching, dry skin;

• sweating or chills;

• nausea, diarrhea, belching, gas;

• muscle pain, leg cramps; or

• sleep problems (insomnia).

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.

Tell your doctor about all other cholesterol-lowering drugs you are taking with Niaspan ER, especially atorvastatin (Lipitor, Caduet), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev, Advicor), pravastatin (Pravachol), or simvastatin (Zocor, Simcor, Vytorin, Juvisync).

Ask a doctor or pharmacist if it is safe for you to use Niaspan ER if you are also using any of the following drugs:

• a blood thinner such as warfarin (Coumadin, Jantoven);

• multivitamins or mineral supplements that contain niacin;

• blood pressure or heart medications such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Diltzac, Taztia, Tiazac), felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan); or

• heart medications such as doxazosin (Cardura), isosorbide (Dilatrate, Imdur, Isordil, Monoket, Sorbitrate), nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat), prazosin (Minipress), or terazosin (Hytrin).

This list is not complete and other drugs may interact with Niaspan ER. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.