A case for immediate-release niacin

Heart Lung. 2012 Jan-Feb;41(1):95-8. doi: 10.1016/j.hrtlng.2010.07.019. Epub 2011 Mar 17.


Niacin is currently a favored drug for increasing high-density lipoprotein, especially in patients with ischemic heart disease or at high risk of developing it. In addition, niacin further decreases low-density lipoprotein in statin-treated patients and has been shown to reduce morbidity and mortality. Among the available niacin preparations, crystalline, immediate-release niacin is the most effective for increasing high-density lipoprotein and is relatively free of hepatic toxicity. We present the case of a patient who had an excellent clinical and laboratory response to 3 g daily of immediate-release niacin, but who later developed clinical hepatitis when he inadvertently switched to the same dose of slow-release niacin. We encourage the use of niacin in general, immediate-release niacin in particular, and caution that niacin is a drug and not a dietary supplement. We also present practical steps for starting niacin, including close patient contact and support, and beginning with a therapeutic dose of 2 g per day right from the start.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cholesterol, HDL / drug effects
  • Cholesterol, LDL / drug effects
  • Humans
  • Hyperlipidemias / drug therapy*
  • Hypolipidemic Agents / administration & dosage
  • Hypolipidemic Agents / adverse effects
  • Hypolipidemic Agents / therapeutic use*
  • Liver / drug effects*
  • Liver / pathology
  • Male
  • Niacin / administration & dosage
  • Niacin / adverse effects
  • Niacin / therapeutic use*
  • Risk Factors
  • Vitamin B Complex / administration & dosage
  • Vitamin B Complex / adverse effects
  • Vitamin B Complex / therapeutic use*


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Hypolipidemic Agents
  • Vitamin B Complex
  • Niacin