Aspirin and NSAIDs inhibit multiple pathways to niacin flushing
Increased synthesis of several prostaglandins cause the niacin flush
- Studies show niacin causes increased levels of vasodilatory prostaglandins: PGI2, PGE2, and PGD21,2,3
- Aspirin and NSAIDs inhibit early in prostaglandin synthesis
- Effectively inhibit multiple key prostaglandin pathways that lead to flushing4,5
Clinical experience with niacin extended-release treatment suggests that flushing may be accompanied by symptoms of dizziness, tachycardia, palpitations, shortness of breath, sweating, chills, and/or edema, which in rare cases may lead to syncope.
References
1. Morrow JD, Parsons WG III, Roberts LJ II. Release of markedly increased quantities of prostaglandin D2 in vivo in humans following the administration of nicotinic acid. Prostaglandins. 1989;38:263-274.
2. Benyó Z, Gille A, Kero J, et al. GPR109A (PUMA-G/HM74A) mediates nicotinic acid–induced flushing. J Clin Invest. 2005;115:3634-3640.
3. Gille A, Bodor ET, Ahmed K, Offermanns S. Nicotinic acid: pharmacological effects and mechanisms of action. Ann Rev Pharmacol Toxicol. 2008;48:4.1-4.28.
4. Dunn RT, Ford MA, Rindone JP, Kwiecinski FA. Low-dose aspirin and ibuprofen reduce the cutaneous reactions following niacin administration. Am J Ther. 1995;2:478-480.
5. Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med. 1997;12:591-596.
6. Duvall WL, Vorchheimer DA, Fuster V. Thrombogenesis and antithrombotic therapy. In: Fuster V, Alexander RW, O’Rourke RA, eds. Hurst’s The Heart. 11th ed. New York, NY: McGraw-Hill Medical Publishing Division; 2004:1361-1418.
7. Olsson AG, Carlson LA, Änggard E, Ciabattoni G. Prostacyclin production augmented in the short term by nicotinic acid. Lancet. 1983;565-566.
8. Cheng K, Wu TJ, Wu KK, et al. Antagonism of the prostaglandin D2 receptor 1 suppresses nicotinic acid-induced vasodilation in mice and humans. Proc Natl Acad Sci. 2006;103:6682-6687.
9. Eklund B, Kaijser L, Nowak J, et al. Prostaglandins contribute to the vasodilation induced by nicotinic acid. Prostaglandins. 1979;17:821-830.
10. Tang Y, Zhou L, Gunnet JW, et al. Enhancement of arachidonic acid signaling pathway by nicotinic acid receptor HM74A. Biochem Biophys Res Commun. 2006;345:29-37.
11. Oberwittler H, Baccara-Dinet M. Clinical evidence for use of acetyl salicylic acid in control of flushing related to nicotinic acid treatment. J Clin Pract. 2006;60:707-715.
12. Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101:1206-1218.
