398) A 45 year old man with well-controlled diabetes presents to your office with complaints of troublesome flushing of his face and trunk for the past one week. Frequently, the flushing is severe and causes stinging sensations. His past medical history is significant for dyslipidemia with an isolated low HDL cholesterol for which he was started on Niacin one week ago. On examination, his blood pressure is 120/88 mm Hg. His face and trunk have flushed appearance. Reminder of physical examination is unremarkable. Which of the following is the most appropriate recommendation for him at this time?
A) Discontinue Niacin
B) Take Niacin with food
C) Diphenhydramine as needed
D) Take Aspirin before Niacin
E) Re-assure symptoms will bate in one week
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D) take Aspirin before Niacin
that will prevent the flushing side effect of Niacin.
B.take niacin with food
D,
B.
B) Take Niacin with food
B or D. They both look right..
D
D-take asprin before niacin
Answer D: Patients almost always have flushing associated with Niacin intake, reason being the receptor that causes the reduction in lipids is also the same receptor that causes flushing but by targeting COX through aspirin can reduce flushing symptoms big time. As COX is upstream of PGD2, NSAIDs have the ability to block production of PGD2, PGE2 and PGI2 the likely culprits.
Counseling should be done in terms of health benefits of niacin and for the next dose of niacin the patient should take aspirin 30 minutes before giving him an extended release niacin.
Peace,
mufy 😉