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Niacin Flush or Vasodilatation

Niacin usually causes a flush a few minutes after it is taken. A few people will flush with 25 milligrams, more with 50, and most with 100 milligrams. The flush begins in the forehead and works its way down the body, rarely affecting the toes. The higher the initial dose, the greater is the initial flush, but if any dose causes a maximum flush, a larger dose taken later will not cause any greater flush. The capillaries are dilated and the blood flow through the organs is increased. There is an internal increase in blood flow as well as in the skin that may last up to several hours. Patients must be warned this will happen. If not, they may be very surprised and even shocked. Patients can be started on lower doses until they have adjusted to the lower intensity flush; then the dose may be increased gradually.

Each time the niacin is taken the flush is repeated, but to a much lesser degree and in most cases after a week or so it is almost all gone or is a minor nuisance at worst. However, some people do not tolerate the flush and they will have to discontinue the niacin. If the niacin routine is interrupted for several days and then resumed the same sequence of flushing will occur, but the initial flush will usually not be as strong as the original one was. The intensity of the flush is minimized by taking the pills after meals and by taking them regularly three times daily. I have been taking it for fifty years and at the maximum have very minor flushes. It is a dry flush, not like the wet menopausal flush, or the flush suffered by male hormone blockers used in treating prostate cancer.

Niacinamide does not cause flushing, except in about 1 percent of the subjects in whom it will cause a very unpleasant flush, and for these people it can not be used. Probably they convert the niacinamide too rapidly into niacin.

Vasodilatation is sometimes very helpful. Many patients, particularly arthritics, have reported that they feel much better when their joints are warmed up by the flush, and some will stop taking niacin for a few days in order to once more experience the flush, but for most people the sensation is not pleasant. It is tolerable if the patient knows what to expect and is properly prepared for it by the physician. Bill Parsons wrote that only physicians who KNOW niacin should use it.

Non flush and slow release preparations, which are also no-flush, are available. The best known no-flush product is inositol hexaniacinate, which is an ester of inositol, a vitamin, and niacin.

Other uncommon side effects are increased gastric acidity, probably because niacin does stimulate secretion of gastric juice, and increased brown pigmentation of certain areas of the skin, usually the flexor surfaces; this is not acanthosis nigricans, a very serious condition, even though it has been erroneously labeled as such. This is never a problem for patients if they are told the truth, but is a problem for some doctors who are not familiar with it. Acanthosis nigricans is a very serious, almost cancer-like condition. Parsons correctly called the increased skin pigmentation a skin change which resembles acanthosis nigricans. The similarity is only in color, not in pathology. The browning effect of niacin on a very few subjects is entirely different. It is transient, usually lasting only a few months, and when it clears the skin is perfectly normal; like an old tan, it washes off if the skin is rubbed when moist. It never recurs even with continued use. I think it is due to the deposition of melanin-containing indoles from tyrosine and adrenalin. It occurs most commonly in schizophrenic patients and is part of the healing process.

http://www.orthomolecularvitamincentre.com/niacinflush.php 

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