The nurse plans which intervention to decrease the flushing reaction of niacin?

• A. Administer niacin with an antacid.
• B. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
• C. Apply cold compresses to the head and neck.
• D. Administer aspirin 30 minutes before nicotinic acid.

Answer: (D)

Premedication with aspirin before taking niacin reduces flushing because the flushing is driven by prostaglandin release that dilates skin blood vessels. Aspirin inhibits cyclooxygenase, lowering prostaglandin synthesis and thus bluntly preventing much of the flushing reaction. The other steps don’t target that mechanism: an antacid won’t stop prostaglandin-mediated vasodilation; diphenhydramine tackles histamine, which isn’t the main driver of niacin flushing; cold compresses only offer temporary relief after the flush has begun. So giving aspirin about 30 minutes before nicotinic acid is the preventive approach that best decreases the flushing. (Safety note: consider patient risk for GI bleeding or ulcers when using aspirin.)