• Inform patient that cutaneous flushing and a sensation of warmth, especially in the face, neck, and ears; itching or tingling; and headache may occur within the first 2 hr after taking the drug. These effects are usually transient and subside with continued therapy. If flushing is distressing or persistent, aspirin 300 mg given 30 min before each dose or slow upward titration of dose may decrease flushing.

» Advise patient to change positions slowly to minimize orthostatic hypotension.

» Instruct patients taking long-term OTC extended-release niacin to report signs of hepatotoxicity (darkening of urine, light gray–colored stool, loss of appetite, severe stomach pain, yellow eyes or skin) to health care professional.

» Emphasize the importance of follow-up examinations to evaluate progress.

• Vitamin Deficiency: Encourage patient to comply with dietary recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the four basic food groups.

» Foods high in niacin include meats, eggs, milk, and dairy products; little is lost during ordinary cooking.

» Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses for treatment of various medical conditions is unproved and may cause side effects.

• Hyperlipidemia: Advise patient that this medication should be used in conjunction with dietary restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.