At the high doses of niacin used to treat hyperlipidemia, side effects are common. These include cutaneous flushing (partially prevented by pretreatment with aspirin, 81–325 mg/day, and use of extended-release preparations) and gastric irritation. Elevation of liver enzymes, hyperglycemia, and gout are less common untoward effects.
et al. Assessment of the role of niacin in managing cardiovascular disease outcomes: a systematic review and meta-analysis. JAMA Netw Open. 2019 Apr 5;2(4):e192224.
et al. Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials. Heart. 2016 Feb;102(3):198–203.
AF. Niacin does not decrease mortality in patients with coronary artery disease or low HDL. Am Fam Physician. 2017 Jul 15;96(2):129.
et al. Niacin and heart disease prevention: engraving its tombstone is a mistake. J Clin Lipidol. 2017 Nov–Dec;11(6):1309–17.