Flushing, with niacin

Another treatment for cholesterol is niacin. The use of niacin predates the statins. Niacin is also known as nicotinic acid or vitamin B3. The name, niacin comes from nicotinic ac id and vitamin and was coined to avoid confusion and so that people would not think that the vitamin contained nicotine or that tobacco products contained vitamins. Niacin inhibits lipoprotein synthesis by preventing the secretion of very low density lipoprotein from the liver. Very low density lipoprotein is a precursor of low density lipoproteins (LDL). However there are several adverse side effects with niacin including flushing, warm skin, itching rash, constipation, nausea, hearthum, and problems with liver function. Because of these side effects, niacin is often used in a controlled release form [17] and even in this form is unsuitable for many patients. 

Most of them are generally classified as poisons. Exceptions to this rule are known. A notable one is 4-dimethyl aminopyridine (DMAP) (24), which is widely used in industry as a superior acylation catalyst (27). Quaternary salts of pyridines are usually toxic, and in particular paraquat (20) exposure can have fatal consequences. Some chloropyridines, especially polychlorinated ones, should be handled with extra care because of their potential mutagenic effects. Vinylpyridines are corrosive to the skin, and can act as a sensitizer for some susceptible individuals. Niacin (27), niacinamide (26), and some pyridinecarbaldehydes can cause skin flushing. 

Nicotinic acid (niacin) Yes Reduces LDL Reduces VLDL Raises HDL IV Ik with fibrates severe IV with fibrates Cutaneous flush, GI distress, liver dysfunction, hyperglycemia, hyperuricemia... 

Other evidence consistent with this is that in bipolar disorder there is excessive flushing in response to niacin (Hudson et al., 1997 Ward et al., 1998). This is consistent with overactivity of CPLA2 but without any associated abnormality in FACE such as seems to occur in schizophrenia and that reduces the availability of AA for niacin-mediated signal transduction. However, there is no evidence from the enzyme-linked immunosorbent assay (ELISA) assay that, in bipolar disorder, there is any elevation of CPLA2 protein levels in red cells (MacDonald et al., 2000). If CPLA2 is elevated in bipolar disorder, it seems more likely to be related to increased activity of the enzyme, possibly as a result of an activating factor such as one of the S-100 group of protein, rather than to an increased amount of enzyme. 

Niacin TLDL and VLDL Synthesis 4-Triglyceride and cholesterol 4VLDL, 4LDL, fHDL Problems with patient acceptance good in combination with bile acid resins extended-release niacin causes less flushing and is less hepatotoxic than sustained-release niacin... 

Niacin Pellagra dermatitis, dementia, glossitis. Urinary niacin Flushing and Gl distress can be seen with... 

Nicotinic acid (niacin) was first shown to lower serum cholesterol levels over 40 years ago (1955). This activity is not related to its vitamin functions (nicotinamide does not share its action). At daily doses of 3 g niacin s hypocholesterolemic effects are about equivalent to clofibrate. In addition to lowering triglycerides, it can also raise HDL levels. Unfortunately, at these high doses nicotinic acid can produce intense flushes and itching, resulting in poor patient compliance. Circumventing the problem with potential pro-drugs such as nicotinyl alcohol, fructose tetranicotinate, and others were not very successful. 

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