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This medication requires careful consideration due to several important safety concerns. It is crucial to understand the following warnings and contraindications and to discuss any questions or concerns with your healthcare provider.

• Rhabdomyolysis Risk: Rarely, using niacin ER alongside statin medications can lead to rhabdomyolysis, a severe condition involving muscle breakdown that can harm your kidneys and heart. This risk is higher for individuals aged 65 and older, or those with a history of diabetes, kidney issues, or low thyroid levels. Be vigilant for sudden muscle pain, weakness, or tenderness, particularly when initiating treatment or increasing your dose. Consult your healthcare provider if such symptoms occur.

• Liver Damage: Niacin ER has the potential to cause significant liver damage, especially if you transition from the immediate-release form to the sustained-release form at the same dosage. These forms are not interchangeable, and using them at equivalent doses can lead to excessive intake, increasing the risk of liver harm. Individuals who consume large amounts of alcohol or have a history of liver disease are at greater risk. Niacin ER should not be used by those with active liver disease. Regular liver function tests will be conducted by your healthcare provider. Immediate medical attention is required if you experience severe abdominal pain, nausea, vomiting, or yellowing of the skin or eyes.

• Contraindications: Do not use this medication if you have:

  • Active liver disease
  • Active peptic ulcer disease
  • Unexplained elevation in liver enzymes
  • Arterial bleeding

Please ensure to discuss any pre-existing health conditions or concerns with your healthcare provider before starting this medication to avoid potential complications.

When taking this medication, some people may experience common side effects, including flushing of the face and neck, warmth, headache, itching, burning, sweating, chills, or tingling, often occurring within 20 minutes and possibly lasting a few hours as the body adjusts. Dizziness, stomach upset, heartburn, nausea, vomiting, and diarrhea are also possible, with flushing affecting up to 69% of users, diarrhea up to 14%, and nausea up to 11%. These side effects are generally mild and should improve over time. To minimize dizziness and lightheadedness, especially if you are on blood pressure medication, rise slowly from sitting or lying positions.

While most users do not experience severe side effects, it's important to be aware of them. Seek immediate medical care if you notice symptoms such as persistent nausea or vomiting, fast or irregular heartbeat, severe headache, unusual joint pain, swelling of the legs or arms, vision problems, severe abdominal pain, black stools, easy bruising or bleeding, unexplained muscle pain, tenderness or weakness, changes in urine output, dark urine, vomit resembling coffee grounds, or yellowing of the eyes or skin. These may indicate serious conditions like liver damage or rhabdomyolysis.

Allergic reactions to this medication are rare but serious. If you experience a rash, itching or swelling—especially of the face, tongue, or throat—severe dizziness, or trouble breathing, seek immediate medical attention. If you notice any other side effects, even those not listed, consult your healthcare provider.

When taking Niacin ER, it's important to consult with your doctor or pharmacist about all medications and supplements you are using, including both prescription and nonprescription products, as well as vitamins and dietary supplements. This is crucial because some products, like those containing niacin or niacinamide, could raise the risk of side effects if combined with Niacin ER.

Niacin ER can also interact with certain medications. It is generally advised not to use this medicine with statins such as Atorvastatin, Cerivastatin, Lovastatin, Pitavastatin, Rosuvastatin, and Simvastatin unless necessary. If they are prescribed together, your doctor may adjust the doses or the frequency of use to minimize any potential risks.

Additionally, combining Niacin ER with Warfarin might increase the risk of side effects; however, your doctor might still recommend this combination if it provides the best treatment for you. Again, dosage adjustments may be made to ensure safety.

Moreover, Niacin ER can interfere with specific lab tests, such as those involving urine or blood catecholamines and copper-based urine glucose tests, possibly leading to inaccurate results. It is important that you inform all healthcare providers and lab personnel that you are using this medication.