Appropriate management of dyslipidemia can significantly reduce cardiovascular morbidity and mortality. Niacin is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglycerides and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol level, making it ideal for a variety of dyslipidemias. Niacin may be used alone or in combination to improve lipid profile and reduce clinical events; however, tolerability issues have limited its wider use. Niacin is available in 3 formulations (immediate release, extended release, and long acting), and adverse effects are directly related to the specific formulation. This article reviews the use of niacin in a variety of dyslipidemias, the available niacin formulations, and provides guidance for improving patient tolerance and adherence.