Editing Niacin (section)

====Flushing====
[[Flushing (physiology)|Flushing]] &ndash; a short-term [[vasodilation|dilatation]] of skin [[arteriole]]s, causing reddish skin color &ndash; usually lasts for about 15 to 30 minutes, although sometimes can persist for weeks. Typically, the face is affected, but the reaction can extend to neck and upper chest. The cause is blood vessel dilation<ref name=lpi/><ref name="NIH Fact Sheet" /> due to elevation in prostaglandin GD<sub>2</sub> ([[PGD2]]) and [[serotonin]].<ref name="ReferenceA"/><ref>{{cite journal | vauthors = Benyó Z, Gille A, Kero J, Csiky M, Suchánková MC, Nüsing RM, Moers A, Pfeffer K, Offermanns S | title = GPR109A (PUMA-G/HM74A) mediates nicotinic acid-induced flushing | journal = The Journal of Clinical Investigation | volume = 115 | issue = 12 | pages = 3634–40 | date = December 2005 | pmid = 16322797 | pmc = 1297235 | doi = 10.1172/JCI23626 }}</ref><ref>{{cite journal | vauthors = Benyó Z, Gille A, Bennett CL, Clausen BE, Offermanns S | s2cid = 30199951 | title = Nicotinic acid-induced flushing is mediated by activation of epidermal langerhans cells | journal = Molecular Pharmacology | volume = 70 | issue = 6 | pages = 1844–9 | date = December 2006 | pmid = 17008386 | doi = 10.1124/mol.106.030833 }}</ref><ref>{{cite journal | vauthors = Maciejewski-Lenoir D, Richman JG, Hakak Y, Gaidarov I, Behan DP, Connolly DT | title = Langerhans cells release prostaglandin D2 in response to nicotinic acid | journal = The Journal of Investigative Dermatology | volume = 126 | issue = 12 | pages = 2637–46 | date = December 2006 | pmid = 17008871 | doi = 10.1038/sj.jid.5700586 | doi-access = free }}</ref> Flushing was often thought to involve histamine, but histamine has been shown not to be involved in the reaction.<ref name="ReferenceA">{{cite journal | vauthors = Papaliodis D, Boucher W, Kempuraj D, Michaelian M, Wolfberg A, House M, Theoharides TC | s2cid = 5609632 | title = Niacin-induced "flush" involves release of prostaglandin D2 from mast cells and serotonin from platelets: evidence from human cells in vitro and an animal model | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 327 | issue = 3 | pages = 665–72 | date = December 2008 | pmid = 18784348 | doi = 10.1124/jpet.108.141333 }}</ref> Flushing is sometimes accompanied by a prickly or [[itching]] sensation, in particular, in areas covered by clothing.<ref name="NIH Fact Sheet" />

Prevention of flushing requires altering or blocking the prostaglandin-mediated pathway.<ref name="NIH Fact Sheet" /><ref name="kamanna">{{cite journal | vauthors = Kamanna VS, Kashyap ML | title = Mechanism of action of niacin | journal = The American Journal of Cardiology | volume = 101 | issue = 8A | pages = 20B–26B | date = April 2008 | pmid = 18375237 | doi = 10.1016/j.amjcard.2008.02.029 }}</ref> [[Aspirin]] taken half an hour before the niacin prevents flushing, as does [[ibuprofen]]. Taking niacin with meals also helps reduce this side effect.<ref name="NIH Fact Sheet" /> Acquired tolerance will also help reduce flushing; after several weeks of a consistent dose, most people no longer experience flushing.<ref name="NIH Fact Sheet" /> Slow- or "sustained"-release forms of niacin have been developed to lessen these side effects.<ref name=autogenerated1>{{cite book |author=Katzung, Bertram G. |title=Basic and clinical pharmacology |publisher=McGraw-Hill Medical Publishing Division |location=New York |year=2006 |isbn=978-0-07-145153-6 }}</ref><ref>{{cite journal | title = Options for therapeutic intervention: How effective are the different agents? | journal = European Heart Journal Supplements | volume = 8 | pages = F47–F53 | doi = 10.1093/eurheartj/sul041 | vauthors = Barter P | date = October 2006 | issue = F| doi-access = free }}</ref>