Niacin (prescription extended-release)
Prescription extended-release niacin lowers LDL and triglycerides and raises HDL. In pooled trials, median LDL reductions were 7% at 1,000 mg, 13% at 1,500 mg, and 16% at 2,000 mg nightly, but adding it to intensive statin therapy did not improve cardiovascular outcomes in AIM-HIGH. Study results
How much does niacin lower LDL cholesterol?
Prescription extended-release niacin lowered LDL cholesterol by a median of 7% at 1,000 mg, 13% at 1,500 mg, and 16% at 2,000 mg nightly in pooled placebo-controlled studies. Read the evidence.
| Dose and treatment context | LDL result |
|---|---|
| 1,000 mg nightly | 7% |
| 1,500 mg nightly | 13% |
| 2,000 mg nightly | 16% |
These are changes from baseline after at least four weeks at each dose. The results apply to prescription extended-release niacin, not every supplement sold as niacin.
Individual responses vary. LDL and ApoB measure different things; these LDL percentages should not be used as ApoB estimates. Compare ApoB-lowering treatments.
How is niacin taken?
Prescription extended-release niacin is started at a low dose and increased gradually. It is taken at bedtime after a low-fat snack. Immediate-release, sustained-release supplements, and prescription extended-release products are not interchangeable dose for dose. Prescribing information.
How does niacin compare with other medications?
Niacin improves several lipid numbers, but that does not guarantee better cardiovascular outcomes. Ezetimibe and Bempedoic-acid have more relevant add-on outcome evidence for many LDL-treatment decisions.
Which medications can be combined with niacin?
Adding niacin to a statin can increase muscle-related adverse effects and did not improve outcomes in AIM-HIGH. Alcohol and hot beverages around dosing can worsen flushing; glucose-lowering and blood-pressure medicines may also need review.
How much does niacin cost?
Cost Plus Drugs lists niacin 500mg, 30 extended-release tablets, at $7.55 before shipping ($12.80 with standard shipping). Prices were checked October 6, 2026; the quantity is not necessarily a month’s supply.
Cost Plus Drugs
Niacin 500mg, 30 extended-release tablets: $7.55 including the dispensing fee, or $12.80 with standard shipping.
GoodRx
Compare local coupon prices for the same 500mg strength and 30 extended-release tablets. The pharmacy, ZIP code, and coupon can change the price; this is a live comparison, not a second fixed quote.
Compare the cash price with your plan’s out-of-pocket quote for the same strength and quantity. Coupon purchases may not count toward your insurance deductible.
Does insurance cover niacin?
Coverage for niacin varies by plan and formulation. These named formularies and medical policies were checked October 6, 2026; your plan’s rules and cost sharing may differ.
| Insurer | Coverage policy |
|---|---|
| UnitedHealthcare | Prescription extended-release niacin is Tier 2, with no prior authorization, step therapy, or quantity limit listed. Commercial PDL, September 2026. |
| Aetna | Extended-release 500, 750, and 1,000 mg tablets are preferred generic; Niacor is nonformulary. Advanced Control, October 2026. |
| Cigna | Cigna lists niacin at Tier 1 with possible home delivery. Confirm the exact prescription formulation; the formulary’s entry does not identify every release type. California Standard 4-Tier (DMHC), July 2026. |
| Anthem | Anthem lists niacin at Tier 1 with step therapy. The 500 mg strength is limited to one tablet daily; 750 and 1,000 mg to two daily. California Individual Select, October 2026. |
| Blue Shield of California | Blue Shield of California lists niacin at Tier 1; 500 mg is limited to four tablets daily and 750 or 1,000 mg to two daily. Standard Formulary. |
| BCBS of Texas | Extended-release niacin is nonpreferred generic, with no listed prior-authorization or step-therapy marker. Performance Annual, 2026. |
What are the side effects of niacin?
Flushing and itching are common. Important risks include liver injury, increased blood glucose, elevated uric acid or gout, and gastrointestinal symptoms. Active liver disease, active peptic ulcer disease, and arterial bleeding are contraindications. Full safety information.
Does niacin reduce heart attacks or strokes?
AIM-HIGH found no additional cardiovascular benefit from adding extended-release niacin to intensive statin therapy despite improvements in HDL and triglycerides. Niacin should therefore not be chosen simply to raise a low HDL number. Read the supporting evidence.
Is niacin right for you?
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