Which side effect is extremely common with nicotinic acid?

Which side effect is extremely common with nicotinic acid?

• A. Nausea
• B. Hot flashes
• C. Gas
• D. Hepatotoxicity

Answer: (B)

Niacin commonly causes flushing of the skin, a warm, red sensation on the face and neck that is driven by prostaglandin-mediated vasodilation in the skin. This reaction is dose dependent and occurs very frequently after taking the drug, often within minutes to an hour. Because of this, hot flashes are considered an extremely common side effect. You can lessen it by starting with a low dose and titrating up, taking niacin with meals, or taking a low-dose aspirin beforehand to inhibit prostaglandin synthesis and blunt the flush. Extended-release forms minimize flushing somewhat but carry a higher risk of hepatotoxicity at high doses. While nausea or GI upset and even gas can occur, they are not as consistently or characteristically seen as flushing with niacin, and serious hepatotoxicity is more about high-dose, long-term use rather than something that happens to most patients at standard dosing.