Nicotinic acid side effects

Nicotinic acid is effective in lowering cholesterol levels, but it too has numerous side effects including GI disturbances, flushing of the skin, abnormal liver function (elevated semm liver enzymes), hypeiglycemia, and hyperaricemia. Required large doses make it intolerable for most patients. 

Rhabdomyolysis is the destruction of skeletal muscle tissues and may be associated with lipid-regulating drugs such as the fibrates and the statins. The risk of this side-effect is increased in patients with renal impairment and with hypothyroidism. Rhabdomyolysis may also occur with nicotinic acid, the antipsychotic aripiprazole, and the anaesthetic propofol. 

Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995 99(4) 378-85. 

Nicotinic acid has a broad lipid-lowering ability, but its clinical use is limited due to its unpleasant side effects. Derivatives of this drug that are not available in the United States appear to have fewer adverse effects. 

Nicotine hydroxamic acid is a urease inhibitor which reduces ammonia formation in the intestine. This substance has no systemic side effects. In a controlled double-blind study, it proved to be superior to treatment with neomycin (C. Hirayama et at, 1982). 

Flunixin meglumine, a nicotinic acid derivative, is a potent analgesic commonly used to control severe intestinal pain or colic in the horse. In this setting, it has effects comparable to opioid analgesics without inducing the unwanted side-effects commonly observed with opiates in horses, such as CNS excitation and ileus (Boothe 1995). In addition, flunixin meglumine has been shown in several experimental models to produce antien-dotoxic effects at doses lower than those used for anti-inflammatory effects (Jackman et al 1994, Moore et al 1986, Templeton et al 1987). 

Elevated uric acid level is a common side effect of nicotinic acid therapy. Thus, gout would be exacerbated. 

The nomenclature for nicotinic acid formulations can be confusing. Nicotinic acid is available over the counter in an immediate-release (crystalline), and slow-release or timed-release form. A shorter acting, timed-release preparation referred to as intermediate release or extended release nicotinic acid is available by prescription. Due to the potential for side effects, medical supervision is recommended for the use of nicotinic acid as a cholesterol-lowering agent. 

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