Aspirin Halts the Niacin Flush

It is well established that reducing serum lipid content is beneficial in those who have cardiovascular disease. There are several pharmacological and non-pharmacological ways to reduce serum lipids. One popular way is using the B vitamin niacin, which has been found effective in reducing serum lipids, including cholesterol, low-density lipoprotein cholesterol, and triglycerides. However, niacin has unpleasant side effects–many patients flush and itch within an hour of swallowing the pill. This often leads to a marked reduction in the compliance of patients to the niacin regimen. The mechanisms producing the skin reactions are not completely understood, but they could be mediated by a transient release in certain prostaglandins. Can the release of these prostaglandins, and thus the onset of cutaneous reactions, be prevented?

Yes. In a randomized, double-blind, placebo-controlled, cross-over study, done at the Department of Clinical Pharmacy at Auburn University in Alabama, 42 healthy subjects (22 male and 20 females) between the ages of 35 and 65 were given 325 mg of aspirin, 650 mg of aspirin, and placebo for 4 consecutive days. On the fourth day they also ingested 500 mg of immediate-release niacin 30 minutes after taking aspirin or placebo. They reported the intensity of flushing, headache, pruritus, tingling, and warmth. Reactions were evaluated at time 0, 15, 30, 60, and 120 minutes following the niacin dose.

The results were clear. The symptom scores for flushing, itching, tingling, and warmth were all significantly reduced by both aspirin regimens. There were no major differences between the 325 mg and 650 mg doses. The researchers conclude, ” An aspirin regimen of 325 mg is effective in suppressing niacin-induced cutaneous reactions. Increasing the dose to 650 mg does not provide additional benefit.”

Jungnickel P, Maloley P, Vander Tuin E, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 12:591-596, 1997.

Comments: Patients with cardiovascular disease generally benefit from taking aspirin as an anti-coagulant. The recommended dose for this regimen is still not well established, but it generally ranges from 80 mg to 325 mg daily. If a patient has elevated serum lipids, and is a candidate to be placed on niacin, it would make sense to take the aspirin a half-hour before the niacin. This study showed that 325 mg of aspirin is as effective as 650 mg. It’s also possible a lower dose could be beneficial, especially if the niacin dose is also lower than 500 mg.

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Written by Ray Sahelian MD

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