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The most common side effects of niacin are: stomach upset, flushing, headache, reduced blood pressure upon standing (orthostatic hypotension), vomiting, diarrhea, itching and ; tingling sensations of the extremities. Flushing may be reduced by taking 325 mg of aspirin 30 minutes before the niacin and by increasing the dose of niacin slowly.
It is not clear how niacin causes its effects on cholesterol and triglyceride levels, but it may be by reducing the production of proteins that transport cholesterol and triglycerides in the blood. Niacin is available in immediate and slow-release forms (Niaspan, Slo-Niacin).