Time Release Niacin 500 mg by Ortho Molecular Products

This is for adults using niacin for cholesterol specifically: raising HDL-C (the “good” cholesterol), lowering triglycerides, or reducing Lp(a) [lipoprotein(a), a genetic risk marker]. It’s reasonable if you can’t tolerate statins or have low HDL-C with elevated triglycerides. Expect HDL-C to rise and triglycerides to fall within 4 to 8 weeks. If you’re already on a statin, outcome trials didn’t show added heart-attack reduction, so add niacin only with a plan and labs.

Nicotinic acid (the active form of niacin for lipids) lowers how much fat your liver exports in VLDL particles (the form your liver packages fat into for transport), which pulls down triglycerides. It also slows breakdown of apoA-I (the main HDL protein), so HDL-C rises. Many see triglycerides drop 20–30% and HDL-C rise 15–30%. Niacin also lowers Lp(a) in many patients. Flush-free forms like inositol hexanicotinate don’t deliver these lipid effects.

The suggested use is 1 tablet with meals, three times daily. That totals 1,500 mg/day, which is a therapeutic dose for lipid effects. Take with food to blunt flushing and nausea. Recheck a fasting lipid panel, Lp(a) if relevant, and liver enzymes (ALT, AST) after 4 to 12 weeks. If you need a lower starting dose, begin with one tablet daily and step up weekly as tolerated.

Niacin can strain the liver more when combined with alcohol or other liver-metabolized drugs; schedule liver tests (ALT, AST) and ask about timing if you take acetaminophen regularly. With statins, muscle symptoms are more likely, and trials didn’t show extra event prevention. It can nudge fasting glucose and A1c up, so monitor if you have diabetes. Uric acid can rise, which matters if you have gout.

Avoid high-dose niacin if you have active liver disease, heavy alcohol use, uncontrolled diabetes, recurrent gout, or a history of peptic ulcers. Pregnancy and breastfeeding: avoid high-dose therapy. For NAD+ or energy goals, niacinamide (nicotinamide) is the form used, but it won’t improve cholesterol. If flushing is your only barrier, this time release format reduces it; severe itching or dark urine means stop and get labs.