Quick answer

Ask your pharmacist or doctor before combining. Two official sources describe the concern. The prescription niacin label says niacin may add to the effects of ganglionic blocking agents and vasoactive drugs, such as nitrates, calcium channel blockers and adrenergic blockers, causing a drop in blood pressure on standing. NIH says flushing from nicotinic acid can come with dizziness.^1,2

Key facts

The prescription niacin label says niacin may potentiate the effects of ganglionic blocking agents and vasoactive drugs, resulting in postural hypotension, a drop in blood pressure on standing.¹
Its precautions call for caution in people with unstable angina or a recent heart attack who also take vasoactive drugs such as nitrates, calcium channel blockers or adrenergic blocking agents.¹
The patient leaflet says to tell your doctor about blood pressure medicines, and to get up slowly if flushing wakes you at night, especially if you feel dizzy or faint or take blood pressure medicines.¹
NIH says flushing from nicotinic acid can come with dizziness or a drop in blood pressure, and that 1,000 mg a day or more can cause low blood pressure that makes falls more likely.^2,3
The label is for one prescription product, and none of the sources say how much supplemental niacin matters for people on blood pressure medicines.^1,2

Ask your pharmacist or doctor first

The prescription niacin label says niacin may add to the effects of ganglionic blocking agents and vasoactive drugs, such as nitrates, calcium channel blockers and adrenergic blockers, and cause a drop in blood pressure on standing. Its leaflet tells people who take blood pressure medicines to get up slowly if flushing wakes them at night.¹

On the medicine's label

What does the niacin label say about blood pressure medicines?

The prescription label for extended-release niacin has a heading on antihypertensive therapy. It says niacin may potentiate the effects of ganglionic blocking agents and vasoactive drugs, resulting in postural hypotension. That means a drop in blood pressure when you stand up, which can cause dizziness or fainting.¹

In its precautions the label adds that caution is needed in people with unstable angina or in the acute phase of a heart attack who are also receiving vasoactive drugs such as nitrates, calcium channel blockers or adrenergic blocking agents.¹

The patient information tells people to say whether they take blood pressure medicines and, if flushing wakes them at night, to get up slowly, especially if they feel dizzy or faint or take blood pressure medicines. MedlinePlus gives similar advice about getting up slowly when flushing wakes you.^1,4

What does NIH say about niacin and low blood pressure on its own?

Flushing can come with headache, rash, dizziness or a drop in blood pressure.^2,3

At 1,000 mg a day or more, nicotinic acid can cause low blood pressure that makes falls more likely, extreme tiredness, high blood sugar, nausea, heartburn, stomach pain, and blurred vision or fluid buildup in the eye.^2,3

These are effects of niacin by itself. The label's concern is that a blood pressure medicine could add to them. None of the sources measures how much the combination changes blood pressure.^1,2

Does the label cover niacin supplements or only the prescription tablet?

The label covers one prescription product, extended-release nicotinic acid. NIH's sheets cover supplements and describe flushing from nicotinic acid at much lower amounts than the prescription doses. Whether the label's blood pressure wording carries over to an over-the-counter niacin supplement is not stated by any source on this page.^1,2

The label does say that vitamins or other supplements containing large amounts of niacin or nicotinamide may add to its side effects, and asks patients to tell their physician about them. If you take both a prescription and a supplement, tell your pharmacist about both.¹

Is niacin good for high blood pressure?

The sources checked for this page do not describe niacin as a way to lower blood pressure. The prescription label is about lowering cholesterol and triglycerides alongside diet, and MedlinePlus describes the same use. NIH describes low blood pressure as a side effect of high doses of nicotinic acid, not as a goal.^1,2,4

The label's list of contraindications does not name high blood pressure, but its warning about blood pressure medicines is the reason anyone who takes them should ask first. Whether niacin suits a person who has high blood pressure is a question for their doctor, who also knows which medicines they take.¹

Which blood pressure medicines do the sources name?

MedlinePlus describes the commonly used groups as ACE inhibitors and angiotensin II receptor blockers, beta blockers, calcium channel blockers and diuretics. The niacin label names calcium channel blockers, nitrates and adrenergic blocking agents, and uses the broader terms ganglionic blocking agents and vasoactive drugs.^1,5

It does not name ACE inhibitors, angiotensin II receptor blockers or diuretics. That is not a finding either way for those groups, so ask your pharmacist about the one you take.

What to ask your pharmacist about niacin and blood pressure medicine

Is the niacin I take a prescription product or a supplement, and which form is it?
Could my blood pressure medicine and niacin together make me dizzy when I stand up?
What should I do about flushing that wakes me at night?
Should my blood pressure be checked if I start, stop or change my niacin?

Questions people ask

Can you take niacin with blood pressure medicine?

Ask your pharmacist or doctor first. The prescription niacin label says niacin may add to the effects of some blood pressure drugs and cause a drop in blood pressure on standing.¹

Is niacin good for high blood pressure?

The sources on this page do not describe niacin as a way to lower blood pressure. NIH lists low blood pressure as an effect of high doses of nicotinic acid, so ask your doctor.^1,2

Can I take niacin if I have high blood pressure?

Ask your doctor, who knows what you take. The niacin label's contraindications do not name high blood pressure, but its warning about blood pressure medicines is the reason to ask first.¹

Does niacin and high blood pressure medication cause dizziness?

The label's wording is postural hypotension, a drop in blood pressure on standing. Its leaflet says to get up slowly when flushing wakes you if you feel dizzy or take blood pressure medicines.¹

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Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.