Preventing or Reducing the Flush
Fortunately, there are several steps that can be taken to greatly reduce and possibly eliminate the niacin flush. Most importantly, never start with a high dose of niacin. Instead, start with a very low dose and very gradually work your way up to a higher dose. Even with careful dosing, you might experience a little flushing, although this tends to go away over time. If you stop taking niacin for a while, you must start back at the lower dose, or you will flush severely.
Taking aspirin (non-coated) 30 minutes before a dose of niacin also helps prevent the niacin flush. Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen seem to work as well. However, it is a good idea to check with your healthcare provider before taking aspirin or an NSAID, as they can cause stomach bleeding or other problems in certain people.
Don't drink alcohol or hot beverages near the time you take niacin (or when you expect the flush), as this can set off an attack of flushing. Taking niacin with or after a meal or snack might also reduce flushing (and helps reduce stomach upset from niacin).
Lastly, consider the extended-release niacin product (Niaspan), which can be taken just once a day at bedtime. It is possible that you may sleep through any flushing that occurs.
No-Flush Niacin: Too Good to Be True?
In many causes, no-flush niacin products are indeed too good to be true. They might not cause flushing, but they might not work either. If you take niacin for cholesterol, make sure the niacin product you take contains nicotinic acid, not niacinamide (also known as nicotinamide). Niacinamide (another form of niacin) does not cause flushing, but it does not have any effect on cholesterol.
The non-prescription, sustained-release niacin products (also known as slow-release, controlled-release, or timed-release) are often claimed to produce less flushing. While this may be true for some people, these products appear to carry a higher risk for liver damage, compared to immediate-release niacin or the extended-release prescription niacin (Niaspan).
Lastly, there are several different "no-flush" niacin products that contain inositol nicotinate, a compound which consists of six molecules of nicotinic acid attached to a molecule of inositol. The idea behind this compound is that the body slowly breaks it down into niacin (and inositol) slowly, helping to reduce flushing. Inositol nicotinate products are usually sold as "flush-free" or "no-flush" niacin. While it is true that these products theoretically create little or no flushing, it is not clear if they have the same properties as nicotinic acid for improving cholesterol. Critics claim that these products do not increase the level of niacin in the blood enough to have an effect on cholesterol.