Skin flushing is one of the most unpleasant symptoms experienced by patients when they first start niacin therapy. Niacin, or nicotinic acid, is a water-soluble B vitamin that helps lower LDL (bad cholesterol) and raise HDL (good cholesterol). Fortunately many patients develop a tolerance to niacin with time.

To help minimize niacin flush, you should discuss the following tips with your doctor:

• Extended-release niacin may reduce skin flushing, however it may also worsen liver and stomach side effects.
• Start niacin at a low dose and go up gradually to help build tolerance.
• Take niacin with food.
• Avoid taking niacin with hot beverages.
• Take aspirin 30 minutes before taking niacin.
• Take an antihistamine, such as benadryl, prior to taking niacin.

In addition to skin flushing, niacin use is also associated with elevated blood sugar, liver toxicity, worsening of stomach ulcers and gout. Gastrointestinal side effects include nausea, diarrhea, vomiting, and indigestion. Although available over the counter and without a prescription, niacin use should only be directed under the care of your physician who can check your liver enzymes and monitor for any side effects.