Yes

Antilipemic Agent (Miscellaneous); Vitamin, Water Soluble

Adjunctive treatment of hyperlipidemias; peripheral vascular disease and circulatory disorders; treatment of pellagra; dietary supplement

A (C if used in doses greater than RDA suggested doses)

Hypersensitivity to niacin or niacinamide; liver disease; active peptic ulcer; severe hypotension; arterial hemorrhage

Use caution in heavy ethanol users, unstable angina or CAD (risk of arrhythmias at high doses), diabetes (interfere with glucose control), renal disease, active gallbladder disease (can exacerbate), gout, or allergies. Avoid large pharmacological amounts in patients with a history of liver disease. Flushing is common and can be attenuated with a gradual increase in dose. Monitor liver function tests.

1% to 10%:

Cardiovascular: Generalized flushing

Central nervous system: Headache

Gastrointestinal: Bloating, flatulence, nausea

Hepatic: Abnormalities of hepatic function tests, jaundice

Neuromuscular & skeletal: Paresthesia in extremities

Miscellaneous: Increased sebaceous gland activity, sensation of warmth

<1% (Limited to important or life-threatening symptoms): Tachycardia, syncope, vasovagal attacks, dizziness, rash, liver damage (dose-related incidence), blurred vision, wheezing

Symptoms of acute overdose include flushing, GI distress, pruritus; chronic excessive use has been associated with hepatitis

Antihistamines may relieve niacin-induced histamine release; otherwise treatment is symptomatic

Oral hypoglycemics: Effect may be decreased by niacin.

Sulfinpyrazone and probenecid; niacin may inhibit uricosuric effects.

Aspirin decreases adverse effect of flushing.

Lovastatin (and possibly other HMG CoA reductase inhibitors): Increased risk of toxicity (myopathy).

Adrenergic blocking agents additive vasodilating effect and postural hypotension.

Component of two coenzymes which is necessary for tissue respiration, lipid metabolism, and glycogenolysis; inhibits the synthesis of very low density lipoproteins

Peak serum concentrations: Oral: Within 45 minutes

Metabolism: Depending upon the dose, niacin converts to niacinamide; following this conversion, niacinamide is 30% metabolized in the liver

Half-life: 45 minutes

Elimination: In urine; with larger doses, a greater percentage is excreted unchanged in urine

Administer I.M., I.V., or S.C. only if oral route is unavailable and use only for vitamin deficiencies (not for hyperlipidemia)

Pellagra: 50-100 mg/dose 3 times/day

Recommended daily allowances:

0-0.5 years: 5 mg/day

0.5-1 year: 6 mg/day

1-3 years: 9 mg/day

4-6 years: 12 mg/day

7-10 years: 13 mg/day

Children and Adolescents: Oral: Recommended daily allowances:

Male:

11-14 years: 17 mg/day

15-18 years: 20 mg/day

19-24 years: 19 mg/day

Female: 11-24 years: 15 mg/day

Adults: Oral:

Recommended daily allowances:

Male: 25-50 years: 19 mg/day; >51 years: 15 mg/day

Female: 25-50 years: 15 mg/day; >51 years: 13 mg/day

Hyperlipidemia: 1.5-6 g/day in 3 divided doses with or after meals using a dosage titration schedule

Pellagra: 50-100 mg 3-4 times/day, maximum: 500 mg/day

Niacin deficiency: 10-20 mg/day, maximum: 100 mg/day

Should be administered after meals

Blood glucose, liver function tests (with large doses or prolonged therapy), serum cholesterol

False elevations in some fluorometric determinations of urinary catecholamines; false-positive urine glucose (Benedict's reagent)

Niacin is a very effective agent in the treatment of hyperlipidemia. Niacin lowers LDL cholesterol and triglycerides and increases HDL cholesterol. An important problem with niacin is the flushing and the need for frequent daily dosing. Adverse effects of niacin (itching, tingling, headache) may be attenuated by increasing the dose slowly or by taking aspirin or an NSAID 30 minutes to 1 hour prior to niacin dosing. Sustained release niacin may decrease the incidence of flushing and circumvent the need for multiple daily dosing. Sustained release niacin may not increase HDL cholesterol or decrease triglycerides as well as immediate release niacin.

May rarely cause dizziness

None reported

No information available to require special precautions

No effects or complications reported

May experience transient cutaneous flushing and sensation of warmth, especially of face and upper body; itching or tingling, and headache may occur, these adverse effects may be decreased by increasing the dose slowly or by taking aspirin or a NSAID 30 minutes to 1 hour prior to taking niacin; may cause GI upset, take with food; if dizziness occurs, avoid sudden changes in posture; report any persistent nausea, vomiting, abdominal pain, dark urine, or pale stools to the physician; do not crush sustained release capsule

Monitor closely for signs of hepatotoxicity and myositis; avoid sudden changes in posture

Capsule, timed release: 125 mg, 250 mg, 300 mg, 400 mg, 500 mg

Elixir: 50 mg/5 mL (473 mL, 4000 mL)

Injection: 100 mg/mL (30 mL)

Tablet: 25 mg, 50 mg, 100 mg, 250 mg, 500 mg

Extended release: 500 mg, 750 mg, 1000 mg

Timed release: 150 mg, 250 mg, 500 mg, 750 mg

Brown WV, "Niacin for Lipid Disorders. Indications, Effectiveness, and Safety," Postgrad Med, 1995, 98(2):185-9, 192-3.

Colletti RB, Neufeld EJ, Roff NK, et al, "Niacin Treatment of Hypercholesterolemia in Children." Pediatrics, 1993, 92(1):78-82.

Dalton TA and Berry RS, "Hepatotoxicity Associated With Sustained-Release Niacin," Am J Med, 1992, 93(1):102-4.

Dunn RT, Ford MA, Rindone JP, et al, "Low-Dose Aspirin and Ibuprofen Reduce the Cutaneous Reactions Following Niacin Administration," Am J Therapeut, 1995, 2:478-80.

Lasagna L, "Over-the-Counter Niacin," JAMA, 1994, 271(9):709-10.

McKenney JM, Proctor JD, Harris S, et al, "A Comparison of the Efficacy and Toxic Effects of Sustained- vs Immediate-Release Niacin in Hypercholesterolemic Patients," JAMA, 1994, 271(9):672-7.

Schwab RA and Bachhuber BH, "Delirium and Lactic Acidosis Caused by Ethanol and Niacin Coingestion," Am J Emerg Med, 1991, 9(4):363-5.

"Summary of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II)," JAMA, 1993, 269(23):3015-23.