Generic
Niacin (nicotinic acid)
5 brands available in the market
At a glance
Niacin (nicotinic acid) is a vitamin B3 derivative used to lower high triglyceride and cholesterol levels. It increases HDL (good cholesterol) and decreases LDL, VLDL and triglycerides.
Description
Nicotinic acid is a derivative of vitamin B3 and is incorporated into coenzymes NAD and NADP, which are involved in multiple cellular metabolic pathways. Nicotinic acid reduces total serum cholesterol, LDL, VLDL, and triglycerides, and increases HDL cholesterol. It appears to decrease hepatic synthesis of VLDL.
Indications
- Primary hypercholesterolemia
- Mixed dyslipidemia
- Very high serum triglyceride levels (Type IV and V hyperlipidemia)
- Reduction of recurrent nonfatal MI in patients with history of MI
Therapeutic class
Vitamin-B3 Preparations
Pharmacological class
Antilipemic Agent
Pharmacology
Nicotinic acid is a derivative of vitamin B3 incorporated into NAD and NADP coenzymes. It decreases hepatic synthesis of VLDL to reduce total cholesterol, LDL, VLDL and triglycerides, and increases HDL cholesterol.
Mechanism of action
Lowers cholesterol and triglyceride levels and increases HDL.
Dosage
Adult Dose (Oral):
- Treatment of pellagra: 300-500 mg daily in divided doses
- Hartnup disease: 50-200 mg daily
- Hyperlipidemias: Initial 250 mg in the evening, increase every 4-7 days, max 6 g/day
- Extended-release: 500 mg/day initially, up to 1-2 g/day
- Vasodilation: 100-150 mg 3-5 times daily
Pediatric Dose: Pellagra: 100-300 mg daily in divided doses
Administration
- Swallow tablet whole; do not chew, crush or break
- Take at the same time each day
- Best taken with food
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Flushing (warmth in face, ears, neck and trunk)
- Itching
- Erythema (skin redness)
- Tingling
- Nausea
- GI upset
- Jaundice
- Hypotension
- Tachycardia
- Increased blood glucose and uric acid
- Myalgia
Precautions & warnings
- Caution in liver disease; monitor liver function regularly
- Monitor blood glucose in diabetic patients
- Caution in unstable angina or acute phase of MI
- Caution in patients predisposed to gout
- Caution with anticoagulants; monitor prothrombin time
- Avoid alcohol, spicy foods, hot beverages or hot baths
Contraindications
- Hypersensitivity
- Significant or unexplained hepatic dysfunction
- Active peptic ulcer disease
- Arterial bleeding
Drug interactions
- Increased risk of myopathy and rhabdomyolysis with HMG-CoA reductase inhibitors
- Reduced bioavailability with colestyramine or colestipol
- Decreased metabolic clearance with aspirin
- May potentiate effects of ganglionic blocking agents and vasoactive drugs
Food interactions
Caution with alcohol; consult doctor.
Use in pregnancy
Use in Pregnancy: Niacin may be unsafe during pregnancy; animal studies show evidence of fetal harm.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Niacin is safe during breastfeeding; not significantly excreted in breast milk.
Pediatric use
Dose established for children (pellagra).
Geriatric use
Elderly may require dose adjustment.
Renal / hepatic impairment
Renal Impairment: Limited information; caution advised.
Hepatic Impairment: Not recommended in active liver disease; caution.
Overdose effects
Overdose: Nausea, dizziness, itching, vomiting, upset stomach, flushing; supportive measures.
Storage conditions
Store in a cool and dry place, protect from light and moisture; keep out of reach of children.
Chemical structure
Niacin (Nicotinic Acid)