Thursday, July 24, 2008

Simcor and Niacin Flushing

I recently started taking a new cholesterol medication called Simcor.  It is a combination of Zocor and Niaspan.  Niaspan is extended release niacin (which is one of the best ways to get your good cholesterol up, according to my doctor).  One of the side effects of high doses of niacin is something called "niacin flushing".  I have experienced this twice so far (I have taken the medication for 9 days now).  I wanted to look up more about it and thought I would share it here in case it helps anyone else.

My doctor advised me to take an aspirin or other anti-inflammatory 30 minutes before taking Simcor and then take Simcor when I go to bed. I have been taking ibruprofen (my anti-inflammatory of choice) every evening, but I also take a low dose aspirin regularly. I thought my doctor said "regular aspirin" but wondered if the low dose was enough. So last night I did not take my ibuprofen.  Mistake. 

I can't remember now what time it was that I woke up but I woke up feeling very hot. I realized right away what was happening. I had it happen once before, but it was not as bad that time. My skin felt tight, like it had been sunburned, and I could feel heat coming off my whole body. I could deal with that. The worst was that my skin was tingling and itching.  And if I scratched it, it was really painful.  I splashed some water on my face and arms but it didn't help much. I had some mosquito bites on the back of my leg behind the knee and one on my elbow and they started itching too.  I have a tea tree oil gel that has other soothing stuff in it too. I put that on my bug bites and got too much out so rubbed it over both my arms. It had somewhat of a cooling effect which was nice.  Then I just went back to bed and was able to go back to sleep after a few minutes.

I won't skip my anti-inflammatory again! 


Niacin is a water-soluble nutrient belonging to the vitamin B complex. It assists in metabolism of carbohydrates and fat. It is sometimes incorrectly referred to as vitamin B3.  It inhibits cholesterol synthesis.  And it opens the blood vessels wider.

Taking niacin supplements may also help with vertigo, tinnitus, PMS, headaches and osteoarthritis.  Tuna is one of the best sources of niacin.  Most processed grains are fortified with niacin. Meat and yeast are good sources.

High doses of niacin can help lower bad cholesterol and raise good cholesterol BUT YOU SHOULD NOT DO THIS EXCEPT UNDER SUPERVISION OF A PHYSICIAN.  It can lead to liver damage, worsen gout and raise blood sugar in diabetics. It shouldn't be taken by people on high blood pressure medication.


One of the most common side effects of taking high doses of niacin is "vasodilation", often called the niacin flush. It is very similar to hot flashes women experience during menopause. Flushing starts 2-4 hours after taking the medication and lasts 15-30 minutes. It is sometimes accompanied by a prickly or itching sensation. It is not dangerous but actually a sign of improved blood flow. It can also cause headaches, lightheadedness and low blood pressure.

Niacin causes flushing by stimulating a hormone called prostaglandin, which causes blood vessels to abruptly dilate and fill with blood. The flushing occurs because there is more blood near the surface of the body. As the blood flows in these areas, the cells of the small capilaries will be getting rid of their waste products and often produce histamine as part of this process, which causes an 'itchy' feeling.

To reduce flushing, you can:

  1. Take a regular-strength aspirin or ibuprofen 30 minutes before taking the medication
  2. Take the medication at bedtime (you'll be asleep and less likely to notice it).
  3. Take the medication after a low-fat snack (reduces the chance of stomach upset)
  4. Avoid alcohol, hot drinks, spicy foods, hot showers or baths and vigorous exercise a couple of hours before bedtime.

If you do have flushing, according to one doctor, drinking two 8-12 oz glasses of water breaks the flush within 3 minutes in the great majority of people. He recommends taking the medication at dinnertime so if you have the flush and have to drink water after, you should have time for your body to get rid of the excess water so sleep isn't disrupted.

The intensity of the niacin flush lessens and often disappears with chronic use.

Sources/More Info:
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  1. I just want to say thank you for such good information. I had the flush late at night and at first it scared me not knowing what was going on. After stumbling across your blog and reading it, I was comforted in knowing what was going on inside. Thank you. Anna

  2. Anonymous1:40 AM

    I took one baby aspirin 30 minutes before Simcor and still had flushing (doctor suggested baby aspirin 81mg). Scared the crud out of me so the next night I took two baby aspirins and I haven't noticed any more flushing.

  3. Thanks for the information. I stumbled across your blog after searching for information about flushing after taking Simcor. I have been on it for 4 months now and still flush 2-3 nights a week. Sometimes it is more painful that other nights. I usually forget to take the ibuprofen when I take the medication but I have found that taking it during flushing spell helps to ease the pain. I made the mistake of taking my Simcor this morning instead of last night. I looked like a lobster at church this morning and had to leave worship because of the pain. Not a pleasant experience.

  4. It's been 24 -48 hours since I last took Simcor and I'm still flushing. Does anyone know if that's normal?

  5. I took my last simcor about 40 hours ago but I'm still felling the "flushing". Is that normal? How long does it last?

  6. Anonymous7:44 PM

    I have been taking Simcor for three months and have had a total of three really bad flushing experiences. I have taken the medication as prescribed, at night, with ibupropen 30 minutes before taking it, and a low fat snack. The past two nights were really bad. I've notified my doctor that I will not ever take it again!

  7. Anonymous10:59 PM

    I was on Simcor for almost two months. I had a light facial flush a couple of times the first month. After taking it for almost two months, I woke up about 5 AM burning from head to foot, my skin all looked sunburned. The itching was almost unbearable. That episode lasted about 1 1/2 hours. It was the most miserable time in my life.
    I had rather die with heart related problems a little earlier than to put up with the hot flashes and their effect.

  8. Thank you for your blog regarding flushing. I woke up in the middle of the night with a red hot burning feeling on my face, arms and upper chest area. My doctor had not warned me about flushing and I had not read the warning information that came with the samples I was given. I called my daughter and then rushed out to a 24 hour pharmacy to by Benadryl. The flushing is starting to end. I'm calling my Dr. to tell her I'm giving Simcor two thumbs down. I'm not taking it again!

  9. Anonymous2:10 AM

    I started Simcor six days ago. Tonight I woke up with a weird tingling sensation. Sure enough it was flushing. The sensation grew stronger and I felt heat radiating through my skin. I agree with others that I was afraid because of the pain. I drank a glass of water and took a baby aspirin. After a couple of minutes the symptoms eased. As I write this, I am still having waves of tingling spread over me. Thanks to this site I knew what to expect. I plan to sleep with two bottles of water by my bed from now on. Thank you.

  10. An update: I have continued to take Simcor over the past 15 months or so. At some point, my dosage was changed so as to increase the amount of niacin. Over time, the frequency of the flushing slowed down and now it's rare that it happens (or at least rare that I wake up when it's happening). If I take my medicine too early in the evening I'm more likely to feel it, so I take it just before bedtime. I continue to take it because it has made a huge difference in my cholesterol numbers and has been the only way I've been able to get the good cholesterol (HDL) up. I am very pleased with it. It is worth the occasional discomfort.

    I always take it with ibuprofen. If I do wake up and feel it, I try to just go right back to sleep without scratching or dwelling on it. If it's really bad and I can't sleep I'll get up and drink some water.

  11. Anonymous1:53 PM

    Hello i'm 66 years old and have high cholesterol and my doctor put me on simcor and now im haveing hot flashes and itching so he tells me to take a benatrol but i say i can't keep talking this all of the time. I just want to no what to do, i no my doctor will say keeping taking simcor need as answer thank you

  12. I am not a medical professional and would urge you to discuss this with your physician. Ask if he has other suggestions for you. The only advice I have is already in this blog entry. Best of luck to you.

  13. Anonymous8:13 PM

    I have taken niaspan or simcor for more than 5 years. I have learned that eating 3 or 4 ounces of fat free ham or turkey when I take my niacin medication just before going to sleep at night keeps me from waking up flushing. If I overeat or eat dinner late, it seems to delay the flushing so much that when I wake at my normal time, I am still flushing.

  14. Anonymous1:56 PM

    Has anyone noticed, that while on Simcor, they're having a reaction in the sun? Although I've had some flushing, the rash when I've been in the sun is so much worse. It's like raised, red bumps that have appeared on my arms and chest area...Also, what is the usual dosage? I've been on it since March, 2010 because my caratoid artery was beginning to clog.

  15. According to what I've read online, the usual starting dosage is 500/20 mg (500 mg of niacin and 20 mg of Zocor). The maintenance dosage is 1000/20 (what I take) to 2000/20.

    I have not experienced the rash you describe.

  16. My doctor just put me on Simcor and I am really nervous. I already had night sweats and the past 2 nights have been the worst ever. My doctor didn't say anything about taking an aspirin or ibuprofen. I am currently taking the 500/20 and will increase to the 1000/20 in a couple of weeks.

  17. Anonymous12:05 AM

    I keep reading that the flushing only lasts for a few minutes at a time, but I have noticed mine, once they start hang on for a couple hours then lessen for a short time only to start up again for a few more hours.
    I will try the aspirin/ibuprofen trick, but was wondering if anyone else experiences the longer lasting flushing as I do.
    I thought when I started this that flushing just meant a few heated moments here and there...wasn't expecting this. Thanks for your input

  18. Anonymous2:09 AM

    Eating raw garlic will help to reduce cholestrol but it has its own side effects.

    Note:- Take Raw Garlic if it suites to your body.

  19. Anonymous10:34 AM

    I have been on Simcor about a year and it does what it promises. The intolerable part is the itching. The low dose aspirin takes care of the flushing and taking it just before bed is the way to go. I started on 2000 MGs of Niacin (2 Simcor and 2 Niaspan) but after a month I could not tolerate the extra Niacin. So my doc cut me back to just the Simcor. I had a really bad itching spell last night and there really isn;t much that cuts that. When I get them I take Benedryl but I think it just makes me sleep rather than actually making it go away. This morning I called my Doc and told him I've had enough. Let's see what med he puts me on next.


  20. Anonymous11:46 AM

    Thank you for this information. I am not on Simcor, but just recently started taking Niacin as an additional supplement because I heard good things about it, and figured since its "natural" it couldn't hurt me. Well, a little while ago the "Niacin flush" started for the first time and I freaked out!!!! I was about to rush to the ER because I had no idea what this was from, but started doing internet research and "Niacin flush" kept coming up. Your blog, by far, had the most helpful information. God bless you. I am still very uncomfortable but at least I am not scared to death. Hoping that this will go away within an hour and then I think I will just live without a Niacin supplement. Again, THANK YOU!

  21. Anonymous11:57 PM

    My doctor advised me to take a regular aspirin an hour before taking the Simcor. The first time I experienced Flushing I thought I was dying, never thought anything could be so painful. I told my doctor exactly what flushing was and he was surprised at how bad it was said none of his other patients had complained. Now that I know what it is its still horrible but I've learned what it is and how to deal with it. It will wake me up and I immediately chew up a regular aspirin and drink lots of water and then just lay back down and try to do relaxation breathing and finally fall back to sleep. I have only had it 2 times during the day. I have been on Simcor for approx. 4 years and it is the only thing that has worked for my triglycerides and HDL. So I will work through the flushing episodes. I find it easier to deal with by knowing what to expect its still happens and usually lasts an hour or two. I'm just glad to know I'm not the only one and wish I had known what to expect before. For me knowing takes away the fear aspect and makes it easier to handle. Thanks for your blog, so others can know exactly what flushing can be.

  22. Roger7:34 PM

    I had been taking Simcor for about a week at bedtime and never had a side effect at all. So I thought I'd try taking it in the morning with the other medicines I take. After about 2 days I got the flushing which I didn't mind so much but the itching lasted almost an hour. So I went back to taking it at night. No more side effects. Then I read the above that said that "histamine" was released as part of the process. As it turns out I take an antihistamine just before bed to help me sleep. Apparently it also helps me to avoid side effects of the Simcor. Thought maybe it might help someone else as well.

  23. Anonymous12:17 PM

    My first experience with Simcor flushing scared the heck out of me. I awakened around 4:00 a.m. and I was on extreme fire from head to toe. The only thing I could compare it to was standing too close to a bonfire and not being able to take a step back. The flush lasted about 15 minutes. I did not experience any itching. I have occasional hot flashes from menepause, but this flushing was 100 fold stronger.

    After reading all of the above, I understand better. I have been taking a low does aspirin before the Simcor. I will take a regular dose now; actually I prefer an advil.

    I will hang in there a bit longer before switching because I know Simcor really does assist with high cholesterol.

  24. Anonymous4:17 PM

    Cinnamon. I've been on Simcor for a couple of years and don't mind the flushing, but I have found that if I consume about a tablespoon of cinnamon in my oatmeal for breakfast and take my Simcor in the morning with the rest of my pills, I do not have problems with flushing. If I eat a different breakfast without cinnamon, I may flush in early afternoon especially if I drink something warm like tea or hot chocolate.

  25. Anonymous11:32 AM

    I have taken Niaspan for years and have had varying degrees of flushing or that hot pins and needles efect. I have found in my case I do not eat anything for an hour or two after taking the medication this has helped control the intensity of the flushing from none to very little this is especially true at night.

  26. I have been on Simcor (1000/40)for the past 16 months, and have experienced the flushing at least 10 - 15 times. I take it before bedtime with my other "statins" as directed by my cardioligist. As has been said previously, it works to keep my cholostorols in check.

    Lately, the flushing has become severe, waking me up with a feeling that acid has been poured over various parts of my body. I usually get up, and wipe myself with a cold compress to help relieve the feelings. I do not get the itching sensations that other have described, just the unbearable burning.

    I have found that eating pickles (I love pickles ) in the evening greatly enhances that chance that i will flash that night. As you can imagine, I have stopped eating the pickles and other potassium containing foods in the evenings. This seems to have slowed the flushing. I do not have a clue as to why.

  27. Anonymous10:13 AM

    One more side effect. I now must use viagra for sex. I'm not happy about that.