From the Guidelines
To prevent niacin-induced flushing, taking aspirin 30 minutes before niacin is the most effective approach, as recommended by the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1. This approach can significantly reduce the intensity and duration of flushing.
- A dose of 325 mg of aspirin can be used for this purpose.
- Other methods to minimize flushing include:
- Starting with a low dose of niacin (such as 100-250 mg) and gradually increasing it over several weeks to allow the body to develop tolerance.
- Taking niacin with food to reduce gastrointestinal upset.
- Avoiding hot beverages or alcohol when taking niacin, as these can exacerbate flushing.
- Using extended-release formulations of niacin, which may cause less flushing than immediate-release formulations. The flushing occurs because niacin causes prostaglandin release, which dilates blood vessels in the skin.
- Aspirin blocks this prostaglandin production, thereby reducing the flushing response. Most people develop tolerance to the flushing effect within a few weeks of consistent niacin use, even if it's initially uncomfortable. If you're taking prescription niacin, always consult your healthcare provider before adding aspirin or changing your regimen, as noted in the guideline 1.
From the FDA Drug Label
Flushing of the skin appears frequently and can be minimized by pretreatment with aspirin or non-steroidal anti-inflammatory drugs. Tolerance to this flushing develops rapidly over the course of several weeks. Flushing, pruritus, and gastrointestinal distress are also greatly reduced by slowly increasing the dose of nicotinic acid and avoiding administration on an empty stomach
The niacin-induced flushing can be prevented or minimized by:
- Pretreatment with aspirin or non-steroidal anti-inflammatory drugs
- Slowly increasing the dose of nicotinic acid
- Avoiding administration on an empty stomach 2
From the Research
Niacin-Induced Flushing Prevention
To prevent niacin-induced flushing, several strategies can be employed:
- Taking niacin with meals or at bedtime with a low-fat snack can help minimize flushing 3
- Avoiding exacerbating factors such as alcohol or hot beverages is also recommended 3, 4
- Taking aspirin 30 minutes before niacin dosing can reduce the incidence and severity of flushing 3, 5, 6
- Using extended-release niacin formulations can also decrease flushing compared to immediate-release niacin 5, 4
- Regular consistent dosing and patient education on factors that can minimize flushing can enhance the tolerability of niacin 4
Aspirin Regimens for Flushing Reduction
Different aspirin regimens have been studied for their effectiveness in reducing niacin-induced flushing:
- Taking 325 mg of aspirin 30 minutes before niacin dosing has been shown to reduce flushing by 30-50% 3, 6
- Simultaneous administration of swallowed aspirin and niacin can reduce moderate-to-severe flushing events by a mean of 36.1% 7
- Orally dissolved aspirin taken at the same time as niacin can also decrease flushing in subjects who experienced moderate-to-severe flushing symptoms despite taking swallowed aspirin 7