Question 154

Question:

A 56-year-old male is found to have elevated LDL and low HDL levels on his lipid panel. You begin treatment with niacin. A month later, the patient returns with complaints of frequent flushing and lightheadedness. This complication could have been avoided by also prescribing which of the following medications?

Correct Answer: B.  Aspirin

Aspirin, which inhibits cyclooxygenase, can reduce prostaglandin levels thereby preventing flushing.
Niacin is an effective treatment for patients with hyperlipidemia. It acts by inhibiting lipolysis and thereby decreasing the levels of LDL. An added benefit of niacin is that it can also elevate HDL levels. One of the side effects of niacin is flushing which is thought to be mediated by prostaglandins. Aspirin, which inhibits cyclooxygenase, can reduce prostaglandin levels thereby preventing flushing. Other notable side effects of niacin include: hyperglycemia, hyperuricemia and increased incidence of peptic ulcers.
Amlodipine is a calcium channel blocker that also causes flushing as a side effect. Therefore, this would not be warranted in this patient.
Loratidine is a 2nd generation H1 antagonist that is often used to reduce the symptoms associated with allergies. This patient is not experiencing an allergic reaction.
Octreotide is a somatostatin analog that is used in the treatment of carcinoid syndrome. While flushing is one of the symptoms of carcinoid syndrome, this is a rare entity and not as likely given the other history in the question stem.
Propranolol is a non-selective beta blocker. One of the side effects of beta blockers is hyperlipidemia and this would therefore not be a desirable drug to use in this patient.