11 replies to this topic

[randian]

I got the impression from various sources that your flush should get easier/less extreme over time. After taking 500mg of niacin daily for several months the flushing has not waned in severity. Why could this be?

[Dolph]

Taking 500 mg once(!) daily won't cut it. The 24 hours in between doses are enough to keep the flush going strong. It normaly diasappears within days with tid dosing, although I wouldn't necessarily recommend that.

Edited by Dolph, 22 August 2014 - 12:58 PM.

[Turnbuckle]

Taking 500 mg once(!) daily won't cut it. The 24 hours in between doses are enough to keep the flush going strong. It normaly diasappears within days with tid dosing, although I wouldn't necessarily recommend that.

 

 

This is likely correct. I take 2 grams at once, every other day. I used to take it every day but I wasn't getting the flush I wanted. With two days I get some flush, and I suspect that time will vary by the user.

[randian]

Taking 500 mg once(!) daily won't cut it. The 24 hours in between doses are enough to keep the flush going strong. It normaly diasappears within days with tid dosing, although I wouldn't necessarily recommend that.

What is tid dosing?

 

I need to take it more like twice a day to get rid of the flush?

Edited by randian, 22 August 2014 - 07:53 PM.

[Dolph]

tid means three times daily.
Yes, basically it means exactly that. Please keep in mind that frequent dosing with niacin increases risk of toxicity. I don't say that it would be high with tid dosing of 500mg, quite to the contrary, but one shouldn't mess around with niacin without solid knowledge abnut the substance.

[randian]

tid means three times daily.
Yes, basically it means exactly that. Please keep in mind that frequent dosing with niacin increases risk of toxicity. I don't say that it would be high with tid dosing of 500mg, quite to the contrary, but one shouldn't mess around with niacin without solid knowledge about the substance.

I thought it was only the extended release version that fried your liver, not the "instant" release stuff.

[Dolph]

Well, yes. But some people manage to take the immediate release stuff often enough to get into trouble! As a rule of thumb, tid is the most often one should take it. I personally and some others wouldn't recommend more than bid.

[niner]

This is a little OT, but what exactly is the problem with extended release niacin?  An awful lot of people take it, including me.  I chose it on the basis of a cardiologist's clinical experience that it's better at reducing lp(a) than I.R. niacin.  (I have high lp(a), a bad thing...)  How does it harm the liver?

[Dolph]

http://www.mayoclini...(12)61180-X/pdf

[niner]

Thanks, Dolph.  In a couple large trials where ER niacin was used in conjunction with statins and laropiprant (anti-flushing agent), it had somewhat more adverse events than the cohort without niacin, but laropiprant (not to mention the statins) clouds the issue.  I'm only taking a gram a day, (500mg after breakfast and dinner) and aside from an increase in fasting blood sugar, haven't noticed other sides.  That paper's report of liver changes in the absence of symptoms and with normal microscopy is a worry.

[gt35r]

This is interesting. Though I do not use Niacin, I feel the same way with beta-alanine; the flushing effect won't subside much (if at all) even after a month of use. 

[Dolph]

Thanks, Dolph.  In a couple large trials where ER niacin was used in conjunction with statins and laropiprant (anti-flushing agent), it had somewhat more adverse events than the cohort without niacin, but laropiprant (not to mention the statins) clouds the issue.

Yes, it's a pitty niacin monotherapy hasn't been tested more thoroughly back in the day than in the CDP, which was underpowered in every respect. AIM-HIGH and HPS2-THRIVE are probably the last nail in the coffin for big studies with niacin. And I agree they are both confounded in several aspects.

I'm only taking a gram a day, (500mg after breakfast and dinner) and aside from an increase in fasting blood sugar, haven't noticed other sides.

I take between 1 and 2 grams of immediate release niacin and the only thing I can report is very dry skin, which seems to be the most common side effect only outrivaled by the flush. I can deal with that and don't consider it to be a dealbreaker, but even think it improved my persisting facial acne.

That paper's report of liver changes in the absence of symptoms and with normal microscopy is a worry.

Well, the liver changes they reported are at the cell-level and so subtle they had to use electron microscopy to detect them. This is not a standard procedure by any means. I would be curious what they would find if they did that routinously with other drugs, too. In the meantime I'm not overly worried as long as my liver clinically stays fine. AIM-HIGH and HPS-THRIVE2 were large trials that didn't find liver troubles aside from asymptomatic transaminase increases. Maybe the increased arterial bleedings in HPS-THRIVE2 were related to liver damage but my personal guess would be that prostaglindins in one way or another were involved in that...