Common Niacin Side Effects (Plus 9 Tips for Avoiding the Niacin Flush)

The most common of these side effects, the niacin flush, can cause such discomfort that many people stop taking niacin after only having tried it a few times.

niacin side effects

The B vitamin niacin prevents high cholesterol symptoms.

© Violety |

If you’ve been diagnosed with high cholesterol, chances are you have also been recommended to take a statin drug. While statin drugs may help lower your cholesterol, they also come with a vast array of serious side effects. Statins may cause diabetes, excessive tiredness, and muscle pain, and they may even block the benefits of exercise. So what do you do if you have high cholesterol and don’t want to take a statin drug? Fortunately, there is an all-natural and highly effective solution. The B vitamin niacin is one of the most reliable ways to lower LDL cholesterol and raise HDL cholesterol (read more about using niacin for cholesterol control here). There’s just one catch: people often experience niacin side effects such as those listed below. 

Common Niacin Side Effects

  • Upset stomach
  • The most common of the niacin side effects, flushing can cause such discomfort that many people stop taking niacin after only having tried it a few times. Fortunately, there are many ways to reduce flushing, or even how to prevent niacin flush, so that you can take full advantage of this incredible supplement.

What is a Niacin Flush?

Shortly after ingesting, people often experience a skin reaction to niacin. Although it may be alarming to experience for the first time, it is completely normal and it is not a sign of a serious adverse reaction. The skin flush typically starts in the face, where you will feel warm and itchy. Sometimes these symptoms can spread to the chest and arms and are often described as a “pins and needles” sort of discomfort. The niacin flush generally lasts less than an hour, and it usually only occurs during the first few weeks of treatment when the person is increasing their dosage.[1]

Approximately 25% to 40% of people stop using niacin because of the unpleasant flushing symptoms.[1] But don’t let the initial flushing reaction get in your way of taking advantage of the amazing niacin benefits for your health. Use these tools to reduce your flushing reaction during the first few weeks of treatment.

9 Tips for Reducing the Niacin Flush Symptoms

  1. Realize that the flush is temporary. First, it is important to remember that the flushing will go away and it isn’t serious. The symptoms themselves will last less than an hour, and flushing will only occur during the beginning of your treatment regime. Once you have built up to your recommended dose, flushing will subside and, in most cases, disappear completely. Give it time; toughing through the first few weeks is well worth it, because niacin is such a powerful tool for your health.
  1. Start with a low dose and increase your dosage slowly. The initial recommended dose is around 250 to 300 mg. Try 100 mg three times per day at first, and work your way up to as much as 1,000 or 2,000 mg. When you increase more slowly, your flushing symptoms will be less severe.[1] Once you reach your regular dose (only go high enough to maintain healthy cholesterol levels), keep it consistent. If you stop taking niacin and then restart, you may experience a flush again.
  1. Take it with meals. If you haven’t eaten for a while, niacin will be absorbed more quickly, which can make flushing worse.[1] Take your dose at meal times to be sure your aren’t taking it on an empty stomach. Also be sure to drink plenty of water.
  1. Wait until bedtime. If you take your niacin before bed, your flushing symptoms may occur while you are sleeping, which may help you to avoid feeling the flush.
  1. Avoid alcohol, spicy foods, hot beverages, hot baths, or hot showers close to or near your dosage time. These factors may all make flushing worse, so be sure to avoid them near the time you take your niacin.[1]
  1. Take quercetin with your niacin. Some studies show that taking quercetin, a flavanoid antioxidant, can help reducing flushing symptoms. Try taking 150 mg of quercetin before your niacin dose.[2,3]
  1. Use a low dose of aspirin with your niacin. If you can’t tolerate the flush, a low dose of aspirin can effectively reduce the intensity and duration of flushing. Try a low dose, around 80 to 160 mg. If that doesn’t work, try 325 mg.[1] Researchers suggest that aspirin only be used as a temporary “bridge” to help you during the first weeks of treatment when your dosage is being increased. Once you have reached your maximum, regular dosage, stop using the aspirin.[4]
  1. Try an extended release formulation, only if you have to. Most people take immediate-release niacin, which is the safest and most reliable formulation. But if you are having a particularly hard time with the niacin flush (and have already tried regular niacin for a few weeks), try an extended release formulation. These can help reduce flushing, but they are also associated with a higher risk for liver toxicity.[5] If you wish to try an extended release option, talk to your doctor, who can help you be sure to keep your liver safe.
  1. Do not choose a “no-flush” niacin product. While these specialized formulations of niacin may not produce a flushing reaction, they are also not effective and don’t have the same cardiovascular benefits as regular niacin.[1]

Be sure to not let some uncomfortable niacin side effects get in the way of your using niacin effectively for cholesterol control. Use these strategies to help reduce or stop niacin flush, and try to stick it out even through the initial discomfort. It will be well worth it to keep your heart healthy with this all-natural remedy.

If you’re taking niacin for its other health benefits, such as skin health, eye health, and type 1 diabetes, consider trying niacinamide as an alternative. Check out our article, “Niacinamide, a Gentler Form of Niacin, Has Positive Benefits on Skin, Eyes and More.”

Share Your Experience with Niacin Side Effects

Have you ever experienced these niacin side effects? Do you have tips for niacin flush treatment? Share your experience on how to reduce niacin flush in the comments section below.

Originally published in 2015, this post has been updated.

[1] Am J Cardiol. 2008 Apr 17;101(8A):14B-19B.

[2] Int J Immunopathol Pharmacol. 2008 Jul-Sep;21(3):509-14.

[3] Br J Pharmacol. 2008 Apr;153(7):1382-7.

[4] Mayo Clin Proc. 2010 Apr;85(4):365-79.

[5] Int J Pharm. 2015 May 15;490(1-2):55-64.

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  • I have tried niacin several times to try reduce high cholesterol. Can’t take statins. I have found taking with inositol and food I am finally able to take niacin with very little flush. This is so important as I also endure hot flashes due to menopause

  • I had a severe response when I doubled my niacin dose last night: nearly passing out when the facial flushing started, followed by nausea, then 5 hours of intense itching from scalp to toes, made worse if I scratched. I took 2 Benedryl and a 325mg aspirin while my husband ran to the health food store for Quercetin (500 mg). I finally tried soaking in a cool tub, which helped tremendously, although I shivered pretty intensely from the cold. The itching started up again as soon as my body started to warm up. I finally took a pain pill. Dont know if that’s what finally did it, or it just started to dissipate on its own, but I fell asleep and woke this morning feeling fine (albeit exhausted).

  • I just started taking Niacin and my skin feels like it is on fire. I can’t take statins at all. I had near death experience with them. I hope this flush gets better with time.

  • Been taking 500 mg. slow release niacin for like 8-10 years now. Sitting here right now with a strong niacin flush, which happens several times a week. When do you suppose I’ll finally get acclimated? I came to this site, looking for something I haven’t tried yet to help this. My cholesterol is still 230. I take half a pill with breakfast, and half with supper. Even after exactly the same breakfast, sometimes I get a flush, sometimes not. If a slow release tablet still does this to me, would a regular pill be any better? Or worse?

  • Not knowing the side effects of niacin, I started off at 500 mg. I started feeling the flush about 20 minutes later. Started in my face and eventually made it all the way down to my feet. One of the most uncomfortable experiences of my life! I was extremely hot and then the warmth turned to itching. After some consulting, I tried a different brand from “Nature’s Bounty” because it offered 250 mg pills. I eventually worked my way up to 500 mg. So when I had finished the Nature’s Bounty 250 mg pills, I went back to the original bottle of the 500 mg and immediately started feeling the flush again! It must be this particular brand, but I’m sitting here absolutely pissed! I have to go to work, but I’m so hot and itchy, I just want to sit here and complain about it for a little while longer! Writing this reply is at least taking my mind off of the itching. Much like one of the comments above, my last flush lasted multiple hours. I hope this one isn’t as bad. Anyway…anyone who’s reading this while also simultaneously experiencing a horrible niacin flush, I FEEL YOUR PAIN!! It sucks, right?! Rest assured, don’t freak out too much, it does pass. I’m off to take a cold shower, I remember that helping last time. And I f you haven’t started scratching yet…DON’T! Fight through it! Mind over matter! Stay strong! Scratching makes it WAY worse! Good luck!

    Seriously…I’m trying to think of something else to write…this is definitely preoccupying my mind. How bout them Dodgers? Okay, okay…I’ll leave.

  • I get thru the flush. Just avoid going out in public. But haven’t tried the aspirin trick. Has anyone tried that and had success??

  • I tried Vitamin B3 (300) for the first time today. After about 20 minutes, I got hot and dizzy. I got a cold cloth and put it on the back of my neck. My ears started to ring and I had a hard time breathing. Next thing I knew I was on the floor. I stayed there long enough to crawl into bed. Four hours later, I finally feel better, but I won’t take it again.

  • Niacin flush is not a problem for me…….nausea & irritated stomach are my side effects…have severe gerd. esophagitis & gastritis……anyone have a suggestion? statins NOT an option.

  • My doctor prescribed 1000 mg of niacin due to genetic CVD markers in my blood. Started me off with 500 mg for a week then 1000 mg and a year later increased it to 1500 mg and now satisfied with the results on my blood tests. The flushing was horrendous the first couple of days. But I discovered taking it just before bedtime with an 80 mg baby asprin. I never felt another flush until my increase to 1500 mg a year later and it settled back down again after my first week or so of the increase. Apple Sauce or Yogurt with it helps with the nausea. I’ve been on Niacin for 7 years now. Still take the 80 mg baby asprin for clotting purposes but I no longer need food with it I just take the meds before bed and I sleep through the flushing, Stick with it… you’re heart will be thankful.

  • Started niacin as an alternative to statin. I had to convince my doc of this option. Built up to 1000mg over a couple weeks and have been taking it since October ’17. I don’t normally experience the flush. I take plain tablets right before bed and I drink a ton of water. I’ve found being properly hydrated keeps the flush away for me. I just have to increase my sodium intake now as the was the only thing wonky on my last blood analysis. Did everything that needed to be done for my cholesterol. If you can deal with the flush it’s a safe and cheap alternative to big pharma and statins.

  • I have been taking 500mg twice a day for several days. There is no flush at night but the one in the morning causes an uncomfortable flush. I take it with a piece of toast and some V8. There has been NO change in the morning flush over the years. Since I already take a low dose aspirin before bed, I will try switching it to the morning.

  • Had terrible problems with painful long lasting flushes (1500 mg a day). Finally hit upon grinding the tablets with a mortar and pestle. Then I sprinkle my meals a little at a time with the ground powder in each of my meals. Have eliminated the problem. Haven’t found granular niacin where I could figure out doses by the ½ tsp.

  • I just started taking niacin yesterday. I did not know I would get this flush. Today, the symptoms are worse than my 2 doses from yesterday. I do not mind the redness and itchy feeling, but my nostrils feel like they are closing up and I fear being unable to breathe. Has anyone experienced anaphylaxis with this flush? Is there any method to stop this feeling of not being able to breathe deeply? The symptoms start 15 minutes after I take my dose, and lasts for about one hour. I am taking 200mg.
    Thank you.?

  • Started yesterday with 500 mg Niacin. Flush started 30 minutes after taking. I powered through hot, itch flush for almost an hour. But I felt slightly flushed all day. Today it’s the same but after reading the comments, I realized I took it on an empty stomach and not with a full glass of water. Will try again tomorrow with food and well hydrated. Yikes!!

  • Have taken Naicin for a week and a half the itching and discomfort so bad u have not taken now for a week and still suffering with the itchy skin please advise what is the problem

  • I’ve been told by a professional supplement company that eating applesauce with the niacin helps reduce the flush and take it at night. I’m trying that tonight. I’ll try to get back to tell you how it went.

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