Clinical evidence for use of acetyl salicylic acid in control of flushing related to nicotinic acid treatment

Abstract

Nicotinic acid (NA) is highly effective and widely used in the management of dyslipidaemia. For many patients, the side effect of flushing of the face and upper body leads to discontinuation. Flushing with NA is mediated by prostaglandins, and as acetyl salicylic acid (ASA, 'aspirin') is a highly effective inhibitor of prostaglandin synthesis, there is a rationale for its use to prevent or reduce the severity of NA-related flushing. This literature survey identified four studies specifically exploring the utility of ASA in preventing NA-related flushing in healthy volunteers. Twenty-three NA studies, where ASA was mandatory or optional within the protocol, and four studies, where background ASA therapy was reported in most participants, were also identified. Although the incidence of flushing in studies using ASA was often high, discontinuation rates due to flushing were low (mean 7.7%). This figure compares favourably with discontinuation rates with NA commonly reported in the literature (up to approximately 40%). There is good supportive evidence for the use of ASA in reducing the severity of NA-related flushing.

International Union of Basic and Clinical Pharmacology. LXXXII: Nomenclature and Classification of Hydroxy-carboxylic Acid Receptors (GPR81, GPR109A, and GPR109B)

“…Combinations with Antiflushing Drugs. Acetylsalicylic acid can be combined with nicotinic acid to reduce flushing (Oberwittler and Baccara-Dinet, 2006). The rationale is that the compound inhibits prostaglandin synthesis, including the formation of prostaglandin D 2 .…”

A intrigante bioquímica da niacina - uma revisão crítica

“…21,24 De modo geral, os efeitos adversos relacionados à ação vasodilatadora desaparecem com o uso continuado do ácido niacínico e podem ser minimizados com a ingestão de baixas doses de ácido acetilsalicílico ou ibuprofeno. 25,26 Os mecanismos moleculares envolvidos no surgimento de alguns dos efeitos adversos serão discutidos no tópico ação farmacológica. A ingestão de doses farmacológicas de niacina poderia aumentar dramaticamente as reações de ADP-ribosilação e a expressão de genes envolvidos no metabolismo do NAD + .…”

Targeting mulitple dyslipidemias with fixed combinations – focus on extended release niacin and simvastatin

“…Regular, consistent dosing over days, weeks, and months reduces frequency and severity of fl ushing, accompanied by lesser increases of prostaglandin D 2 after niacin ingestion (Stern et al 1991). Administering aspirin or other inhibitors of cyclooxygenase 30 min to 1 h before niacin intake can substantially reduce fl ushing (Oberwittler et al 2006). An aspirin dose of 325 mg is commonly advised; an 81-mg dose may not be enough.…”

“…First, niacin therapy needs to be initiated at a low dose and then slowly titrated upward to achieve the treatment goal. Second, patients may take aspirin 325 mg or another non-steroidal anti-infl ammatory drug 30 min before the niacin dose to reduce prostaglandin-mediated fl ushing (Oberwittler et al 2006). Third, physicians should advise patients to avoid spicy foods, hot beverages, and hot showers shortly after taking niacin.…”