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"   What is it used for?  Lowering high blood cholesterol levels (primary hypercholesterolaemia). Correcting high levels of &amp;#039;bad fats&amp;#039; (ie LDL cholesterol and triglycerides) and low levels of &amp;#039;good fats&amp;#039; (ie HDL cholesterol) in the blood (mixed dyslipidaemia).  Nicotinic acid is normally used when another type of cholesterol-lowering medicine called a statin (for example simvastatin, atorvastatin), together with a low cholesterol diet and increased exercise, has not lowered LDL cholesterol sufficiently. Nicotinic acid is taken in combination with the statin medicine to produce an additional effect on cholesterol levels. It may also be used on its own in people who cannot take statin medicines.    How does it work? Niaspan prolonged release tablets contain the active ingredient nicotinic acid (also known as niacin), which is a member of the B group of vitamins.  Nicotinic acid is normally consumed in the diet, as well as being made by the body, and has various effects. However, Niaspan contains nicotinic acid in much larger doses than those normally obtained by the body and it produces effects unrelated to its role as a vitamin. Large doses of nicotinic acid are used to lower blood levels of cholesterol and other &amp;#039;bad fats&amp;#039; that are associated with heart disease. For the sake of simplicity, there are two sorts of cholesterol; a &amp;#039;bad&amp;#039; sort called low density lipoprotein (LDL) and a &amp;#039;good&amp;#039; sort called high density lipoprotein (HDL). LDL is deposited in the arteries and increases the risk of heart disease by clogging and narrowing the arteries (atherosclerosis), while HDL actually protects the arteries against this. Nicotinic acid works by improving the balance of &amp;#039;good&amp;#039; and &amp;#039;bad&amp;#039; fats in the blood. The way it works is not completely understood. It reduces blood levels of LDL cholesterol and other &amp;#039;bad fats&amp;#039; called triglycerides by decreasing their production by the liver. It also increases the blood level of HDL cholesterol. This results in lowered levels of &amp;#039;bad fats&amp;#039; and raised levels of &amp;#039;good fats&amp;#039;.  Altering the balance of good and bad fats in the blood has an important role in preventing coronary heart disease, because it reduces the risk of excess cholesterol being deposited in the major blood vessels of the heart (atherosclerosis). Any blockage in these blood vessels limits the amount of blood and therefore oxygen being carried to the heart muscle. This can cause chest pain (angina) and in severe cases can result in a heart attack (myocardial infarction) or stroke. Nicotinic acid can cause the blood vessels to dilate (widen) and this can cause side effects such as flushing or feeling itchy. Niaspan prolonged release tablets are designed to release the nicotinic acid slowly and continuously over a few hours to help minimise these sorts of side effects. The tablets must be swallowed whole and not crushed, broken or chewed to avoid damaging the prolonged release action. They should be taken at bedtime, after a low-fat snack such as an apple, low fat yoghurt or slice of bread.  It is important to continue to follow a cholesterol-lowering diet and exercise regime while taking nicotinic acid. Ask your doctor for advice.    Warning!  Niaspan tablets should be swallowed whole with water and not broken, crushed or chewed.  You should should continue to follow a cholesterol-lowering diet during treatment with this medicine. Discuss this with your doctor.  When you begin treatment with this medicine your dose will be started low and gradually increased over a period of a few weeks. You should follow the instructions given by your doctor carefully, as this gradual dose escalation is to reduce the chance of experiencing side effects such as flushing and itching. You can also minimise these side effects by taking each dose with a low-fat snack and avoiding hot drinks and alcohol around the time of each dose. If you do experience side effects such as flushing these will usually improve over time.  If for any reason you stop taking this medicine for an extended period of time, you will need to re-introduce it slowly, increasing the dose gradually as before, when you start taking it again. Ask your doctor or pharmacist for advice. You should have blood tests to monitor your liver function (liver function tests) regularly throughout treatment with this medicine. If you experience any symptoms that may suggest a liver problem, for example, persistent nausea and vomiting, abdominal pain, or the development of jaundice (a yellow colouring to the skin and the whites of the eyes), you should consult your doctor so that your liver can be checked.     Use with caution in  Kidney disease. History of liver disease. People who drink large amounts of alcohol.  Diabetes.  Angina not well controlled by medical treatment (unstable angina). People in the acute phase of a heart attack. History of gout. History of gall bladder disease. History of jaundice. History of peptic ulcer.    Not to be used in  Severely decreased liver function.  Active peptic ulcer. Bleeding from an artery.  Breastfeeding. The manufacturer has not studied the safety and efficacy of this medicine in children and adolescents. It is not recommended for children and adolescents.   This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.  The safety of this medicine in pregnancy has not been established. It is is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.  This medicine passes into breast milk and could have adverse effects on a nursing infant. It should not be used by mothers who are breastfeeding. Seek medical advice from your doctor.     Label warnings  Take this medication with or after food. This medication is to be swallowed whole, not chewed.    Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.  Flushing (warmth, redness, itching, tingling). Disturbances of the gut such as nausea, vomiting, indigestion, diarrhoea or abdominal pain. Skin reactions such as rash and itch. Headache. Dizziness. Awareness of your heart beat (heart palpitations). Increased heart rate (tachycardia). Shortness of breath (dyspnoea). Sweating. Feeling of weakness (asthenia). Swelling of the ankles due to fluid retention. Decreased blood pressure. Fainting. Difficulty sleeping (insomnia). Nervousness. Inflammation of the lining of the nose (rhinitis) causing a blocked or runny nose. Muscle disorders, eg pain, weakness, cramps. Liver disorders. Gout. Increased skin pigmentation.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.   How can this medicine affect other medicines? It is important to tell your doctor what medicines you are taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.  Niaspan should not be used in combination with other nicotinic acid preparations. Check with your doctor or pharmacist before taking high dose multivitamins or vitamin B supplements in combination with this medicine.  There may be an increased risk of side effects on the muscles if this medicine is taken in combination with a cholesterol-lowering medicine known as a statin. These include atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin. If you are taking this medicine in combination with a statin you should inform your doctor immediately if you experience any muscular symptoms, for example muscle pain, tenderness, cramps, or weakness, particularly if accompanied by a fever or feeling generally unwell. This medicine may raise blood glucose levels and may therefore reduce the effectiveness of medicines used to treat diabetes. People with diabetes should carefully monitor their blood sugar while taking this medicine. Dose adjustments of antidiabetic medicines may be needed. Seek further advice from your doctor. The anti-blood-clotting effect of anticoagulants such as warfarin may be increased by this medicine. For this reason, if you are taking an anticoagulant your doctor may want to check your blood-clotting time (INR) when you start or stop treatment with this medicine.  This medicine might increase the effects of medicines used to lower high blood pressure. If you are being treated for high blood pressure you should let your doctor know if you feel dizzy or lightheaded after starting treatment with this medicine. If you are taking other medicines that dilate the blood vessels and cause flushing, for example nitrates such as glyceryl trinitrate, you may find that this medicine increases the flushing.   Other medicines containing the same active ingredient There are currently no other medicines available in the UK that contain only nicotinic acid at a dose for treating high cholesterol levels. Last updated 01.02.2006 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/heart-and-blood/a8588/niaspan-discontinued-in-the-uk-june-2011/>