In any case, extended-release niacin appears to offer an additional valuable option for decreasing the pathogenic effect of phosphate, whether or not renal function is impaired. Extended-release niacin is relatively inexpensive, available over the counter, and does not need to be taken with each phosphate-rich meal (unlike phosphate binders). On the negative side, niacin can provoke the annoying flushing response, has the potential to increase uric acid and serum glucose, and may increase risk for atrial fibrillation. But it can be discontinued if side effects are unacceptable, and extended-release preparations are well tolerated by a high proportion of patients.