Good or bad idea to take Niaspan while recovering from a CABG (triple bypass)?

I am a 40 year old male just a little over two weeks post op from a triple bypass performed after I had suffered a heart attack. (I had a MI while deployed to Iraq, was evaced to Germany where they performed the surgery and was then flown back to the US for recovery. I am now seeing my fourth cardiologist in 3 weeks).

Today, my new doctor prescribed Niaspan (extended release Niacin 500mg) to help increase HDLs. After looking at the side effects of this medication I am not willing to take it but I am interested to hear if anyone else out there has had a CABG and then been placed on this drug in short order after the surgery and how they may have handled it. My initial reaction is to tell the doc that I will wait until I am a little more recovered from the surgery (2 or 3 months at least) before I risk the side effects of this drug.

I have read several reviews of the drug from people who have used it and the vast majority were unpleasant. The thing I noticed though was that none of the reviews seemed to come from people who were post op from a CABG so I would be extremely interested to hear any feedback from someone in who has used it post op.

Thanks to everyone for sharing their experiences here. It has helped to read these posts.

Cheers...rob

From what I've read, I see no problems taking niacin (Niaspan) soon after CABG ... It has no clinical effects that will impact the integrity of the grafts.

One of the primary goals with Niacin is to help lower your LDL and increase your HDL. And you need to that almost immediately after surgery. The splices where the grafts are connected are "damage points" and sites where cholesterol (LDL) plaques will form fairly easily especially in the early days of healing. The HDL needs to be increased to scavenge any LDL from deposited plaques. This will help at the damage points and also help stabilize the clogged arteries that were bypassed.

So, there's good reason to take a statin, or a statin with a niacin supplement. Now with both of these medicines, watch the side effect symptoms, and in particular muscle pain.

I was on very high dose Lipitor and by a year, my urine was consistently rich coloured and I was starting to get muscle pain in legs and arms. Doctor first wanted to try Crestor instead. That was almost instantly worse than Lipitor. So, my doctor agreed to cut my Lipitor dose in half. It had little impact on my lipids, but it eliminated the muscle pain.

With Niacin (Niaspan) the risk of muscle pain is even higher, so watch for muscle pain and if you get that and dark urine (a symptom of possible muscle breakdown)go to your doctor to get new recommenations ... which may simply be a reduced dose.

So, I'd take it and see how it works out. If it caused problems at any time or if after a year I was still reluctant, I'd push back and get it off the menu. At the start though you want to give your grafts as much help as you can get, because you want to go as long as you can on these grafts and not have to go for another graft set soon (after all, you've only got 2 legs to scavenge grafts from and one is probably now used!)

The other thing that is important is to keep up a good level of exercise and low fat/salt diet.

The first few months are probably the most frustrating part of the recovery, but after about 3 months you'll start to feel more normal as your chest heals. By 12 months you'll feel better than for years.

I'm surprised though that they flew you out of Germany after the bypass surgery for at least 3 months. My doctor wouldn't have me look at an airplane for 3 months, and then from 3 to 6, only short distance flights, and transatlantic in an emergency. (Sick closest relatives, or funeral). After 6 I was good to go and flew Ottawa to London. Even that was uncomfortable in terms of shaking up my chest cavity.

The chest felt "loose" inside for about 9 months ... very much so for the first 3.

Ask your doctor if there's a "cardiac rehab" program available from a hospital near you. It really helped me get on the diet and exercise program and destressing too.

Thanks Stuart, That was very informative.

I am already on Lipitor now but understand what you are saying with regards to the combination of Lipitor and Niaspan. I do have one other concern I will address with my doctor and that is taking a regular aspirin prior to taking the Niaspan. I have read that helps to reduce the flushing symptoms but I am still unsure on the dosage and timing of taking it prior to the Niaspan.

I will discuss again with my doctor prior to starting this med as I want to make sure we have addressed it.

Thanks again stuart for your quick reply...cheers!...rob

My HDL was high enough that they didn't bother with niacin, although it's still a little low ... need to get to more exercise!

As to ASA and aspirin ... most of the studies show a dosage of about 325 mg as effective for reducing flushing, taking effect about 60-120 minutes after administration,

Has your doctor recommended that you take aspirin already as a way to reduce clotting? My doctor has me taking 325 mg once per day. I'm looking to adjust that to 160 mg twice daily.

On the question of being on aspirin:

Yes I am taking an 81mg aspirin now once a day. I am also on 150 mg of Indocin for a pre-existing ankylosing spondylitis condition (auto-immune/RA type condition). That is why I am a little concerned about upping aspirin dosages without consulting the doctor first. I may need to stop indocin to tolerate the increased aspirin to tolerate the Niaspan.

I think my HDL was in the mid 30s (35 I think but not for sure) so that is not great but I am making progress on other areas. I have lost 20 pounds, quit smoking, and I am starting my cardiac rehab next week hopefully.

Sorry I missed your question about flying earlier. I am in the military and it was kind of a matter of necessity to fly me back to my home base for recovery. The Army tries to minimize the number of long term care patients they have in Germany. We can do it but if you are capable of flying they will move you. I had to fly back through the military medevac system and had a doctor and several flight nurses and medics on the aircraft and I was monitored the whole time.

Funny you talk about your chest being "loose" and not tolerating the jostling, that was the worst part of flying back. If I am resting I generally don't need pain meds but once I am up and moving around I can't go for long before I need something to take the edge off.The back/ shoulder pain is also still bad. I did not expect that and oddly no one explained it to me in Germany. It wasn't until I got back to the States that a nurse explained it to me.

Thanks again for sharing your experience. This is very helpful and informative to be able to discuss this with someone who has been through it. Cheers...rob

Wow, what a bummer ... AS is no picnic and then heart disease and CABG!

At least the things I take for other conditions don't cause potential cardiac problems.

Definitely consult your doctor about balancing the meds or even evaluating if it's the right combination for you. And you may be better off talking with the rheumatologist rather than the cardiologist. One thing I discovered early on was that the cardiologist is very focused on cardiology ... he knows cardiac drugs, like Beta Blockers, Calcium Channel blockers, ACE Inhibitors, Angiotensin II convertors etc. He knows a enough about statins, BUT not much about the interactions with drugs outside his normal range.

Rheumatologists are often the doctors of last resort so tend to know a lot about all kinds of things. Your GP probably has a better knowledge of your drug cocktail than the cardiologist!

From what I've been reading, knowing the heart condition, I'd be really concerned about the indocin, since like many NSAIDs, they have an impact on the heart.

Assuming everybody's happy with your EKG while taking indocin, I'd not be too worried about up to 325 mg of enteric coated aspirin (never the plain aspirin which along with the indocin can crap out your stomach!

So, if you're taking Niaspan say 2 times a day, I'd suspect that 1 or 2 low dose tab an hour before each niaspan dose would be as good as it gets. I get the impression that this combination would be OK from what I've been reading. The aspirin and indocin do interact to some extent but it neither improves nor reduces its the indocin's effectiveness.

One of those "we know what happens, but can't explain it and can't understand why it doesn't change things"!

Since you were flying with med staff on board that makes a huge difference ...

Sounds like the back/shoulder pain could be reactive ... i.e. when you had the attack the muscles in your back and shoulder stressed and haven't properly relaxed. Some massage would probably help there.

That "loose" feeling for me was never painful ... it just felt uncomfortably weird. The only "pain" I had with the two MI's I had in the one day was as if I'd been hit in the chest with a bat. No pains anywhere else, no shortness of breath. No feeling of my chest being compressed. The first time it passed in about a minute, and the second in about 3 minutes. The first one I thought was odd and said "I dunno what that was, but if it happens again, I'm calling 911" It did, I did, 1 angiogram with a high risk of death prognosis that evening (You will die tonight if you don't have surgery and a 40% chance if you do!) and emergency surgery overnight.

Anyway, talk about your drug situation with all your doctors and get them to decide what's best for you ... I hope that bit of info I've given you can help give you something to beat your docs into submission!

Very interesting about the Indocin and the reactions. Solid advice about I probably need to go see my Rheumatologist and GP shortly because the fact is I am not all that comfortable with my cardiologist but being in the Army it can be tricky to be able to switch docs even if one os available. Talking to the other docs may be a better recourse though.

I guess bottom line on the Niaspan, I understand it has potential upsides but they seem small relative to the negative side effects. I am sure I don't have to tell you that this has been a pretty traumatic event, I am still not sleeping well and then to add what is nicely phrased as "flushing" onto an already poor sleep cycle. I guess I would rather see a little more evidence that it is needed to justify the cost benefit. With the other things I already have going on I would like to see if they are working before jumping on the Niaspan grenade

Either way, I will have the conversation with the doc on Wednseday reference my medicinal cocktail and whether I should take the 325 mg dose aspirin.

Your description of the chest feeling is spot on. Still early for me though so trying to balance getting in my exercise with getting up and doing stuff. At least my energy is good and admittedly getting up and doing stuff takes my mind off of all the negative things swirling in my head since my MI.

My MI was significantly painful, enough to make me give up smoking, cold-turkey, with no cravings whatsoever so far. I had the Elephant on my chest pain. nothing down the arms just in the center of the chest.
It took them three days to get me cathetered and diagnosed with the need for CABG. They assumed that being so young they would be dealing with a single blockage they could fix with a stint and of course found a second blockage just before a Y in my artery. Hence the Triple.

They took an artery (radial) from my left arm. Not the leg. German doctor who performed the surgery is the head professor of Cadiac surgery at Homburg University Medical center and did great work. I was lucky I had been stationed in germany in the early 90's and still speak a fair amount of German. I was kind of the pet American patient for awhile. It actually took some getting used to when I got transferred back to the American hospital to get used to speaking English again

I ramble on. Again, thanks for everything! Will be sure to stay in touch and keep this updated...cheers...rob

Yup, military docs are a decided complication.

Yeah, the early weeks are the nuisance until the sternum finally glues back together.

I understand your concern over the Niaspan ... The issues with a statin like Lipitor don't include the feeling of flushes.

I sure understand the trauma of what you've been through and especially at an even younger age than me! As to not sleeping, yup, that's a definite problem to healing and something to talk about with your GP ... perhaps a counsellor will help and some anti depressant like Trazadone (Desyrel) which at low dose is good for sleeping through the night? The worst problem I had was waking in the middle of the night.

As my upper body strength returned, my overall mental well being improved with it.

Remember too that more and more people are surviving as the years are going by with better and better techniques and meds. I'm on a betablocker that slows my heart to about 60 bpm most of the time ... and it's hard work to get it over 80! I'm on an ACE inhibitor to reduce BP. My BP rarely goes up to 120/70! Most of the time it sits at about 105/65! One day it actually went down to 90/50 with a pulse of 48 ... I'd forgotten to eat lunch and went hypoglycemic!

The goal is to keep the stress off the bypasses.

I think that knowing what's happening should take a lot of stress off you. Your survival should be excellent.

I was dealt with at the University of Ottawa Heart Institute in Ottawa Canada ... a world class place. The cardiologist is Canadian but has close family in Germany!

If there's anything we can do to give you some reassurance do ask!

Gutes Glück, wenn Sie Ihre Doktoren sehen!

Thanks for that Stuart. As usual, sound counsel.

Tschuss!...rob

Take a full aspirin (325mg) 30 minutes prior to taking the Niaspan...take the Niaspan with a low fat snack (e.g. Babybel lite cheese)...so far, on the before regimen, I have avoided the flush...I'm also taking 80mg of Lipitor and 10 mg of Zetia.

Thanks for that...I will give that a try when I start taking it. Thanks...rob