Which vitamin causes flushing?

From the Guidelines

Niacin, also known as vitamin B3, is the vitamin that causes flushing. This flushing reaction typically occurs when taking higher doses of niacin (usually 50 mg or more) in its immediate-release form 1. The flushing manifests as temporary redness, warmth, and sometimes itching or tingling of the face, neck, and upper body, usually beginning 15-30 minutes after taking the supplement and lasting for about 30-60 minutes. This reaction happens because niacin causes blood vessels near the skin to dilate, increasing blood flow to those areas. While the flushing is harmless, it can be uncomfortable.

Key Points to Consider

• To minimize this effect, start with a low dose (around 25 mg) and gradually increase over time as tolerance develops, take niacin with food, avoid hot beverages or alcohol when taking it, and consider using extended-release formulations which cause less flushing (though these may have different side effect profiles) 1.
• Some people take a small dose of aspirin 30 minutes before niacin to reduce flushing, but this should only be done under medical supervision 1.
• Always consult with a healthcare provider before starting niacin supplements, especially at higher doses used for managing cholesterol levels 1.

Important Considerations

• The use of niacin should be carefully considered due to its potential side effects, including flushing, hepatotoxicity, hyperuricemia, and hyperglycemia 1.
• The benefits and risks of niacin therapy should be weighed carefully, particularly in patients with pre-existing cardiovascular disease or those taking statin therapy 1.

From the FDA Drug Label

Flushing is the most common side effect of niacin extended-release tablet(s). The most common side effects of niacin extended-release tablet(s) include: flushing Flushing happens when tiny blood vessels near the surface of the skin (especially on the face, neck, chest and/or back) open wider Symptoms of flushing may include any or all of the following: warmth redness itching tingling of the skin

The vitamin that gives flushing is Niacin 2, 2, 2.

• Flushing is a common side effect of Niacin therapy.
• Niacin extended-release tablet(s) may cause flushing, which can be minimized by taking the medication at bedtime after a low-fat snack.
• Patients should be advised to inform other healthcare professionals prescribing a new medication that they are taking Niacin extended-release.

From the Research

Vitamin Associated with Flushing

• Niacin, also known as vitamin B3, is the vitamin that gives flushing 3, 4, 5, 6.

Mechanisms of Flushing

• The flushing response is mediated by the activation of the capsaicin receptor TRPV1, a polymodal cellular sensor that mediates the flushing response on consumption of spicy food 5.
• Niacin binds with G protein-coupled receptor (GPR) 109A on cutaneous Langerhans cells and causes vasodilation with flushing in the head and neck area 6.

Strategies for Reducing Flushing

• Moderate doses of prostaglandin inhibitors can reduce the cutaneous flushing response from niacin administration 3.
• Other strategies for reducing flushing include regular consistent dosing, the use of extended-release formulations, patient education, dosing with meals or at bedtime, and the avoidance of alcohol, hot beverages, spicy foods, and hot baths or showers close to or after dosing 3.