Niacin Niacinamide (nicotinic acid or 3-pyridinecarboxylic acid)

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Niacin Brand Names

Niacor | Niaspan | Nicomide-T | Slo-Niacin

What is Niacin

Niacin (nicotinic acid or 3-pyridinecarboxylic acid) is a B-complex vitamin.

Good dietary sources of niacin are animal proteins, beans, green vegetables, liver, mushrooms, peanuts, whole wheat, and unpolished rice. Niacin is also present in cereal grains but is largely bound to plant proteins, and thus is poorly absorbed after ingestion.

Niacin is one of the substances used in the enrichment of refined flour, and our dietary intake of pre-formed niacin comes primarily from enriched grains. However, the body’s niacin requirement is also met by the biosynthesis of niacin from tryptophan, an amino acid.

For example, milk and eggs do not contain niacin, but do contain large amounts of tryptophan from which niacin is derived.

Each 60 mg of excess tryptophan (after protein synthesis) is converted to approximately 1 mg of niacin. Synthesis of the vitamin from tryptophan in proteins supplies roughly half the niacin requirement in man.

Iron-deficiency or inadequate pyridoxine or riboflavin status will decrease the conversion of tryptophan to niacin and may contribute to deficiency, due to an interdependence of coenzymes in the niacin production pathway.

A late and serious manifestation of niacin deficiency is pellagra, a clinical symptom complex principally affecting the GI tract, skin, and CNS, producing symptoms of diarrhea, dermatitis, and dementia, respectively.

Pellagra may result from a niacin- and protein-deficient diet, isoniazid therapy, or certain diseases that result in poor utilization of tryptophan.

Pellagra was the only vitamin-deficiency disease to ever reach epidemic proportions in the US; pellagra is rare today in industrialized countries due to the enrichment of refined flours.

Indications

  1. atherosclerosis
  2. hyperlipoproteinemia
  3. hypertriglyceridemia
  4. myocardial infarction prophylaxis
  5. nutritional supplementation
  6. pellagra
  7. peripheral vascular disease (PVD)
  8. tinnitus

For the treatment of clinical manifestations of pellagra

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. angina
  4. angioedema
  5. asthenia
  6. atrial fibrillation
  7. blurred vision
  8. bullous rash
  9. chills
  10. cough
  11. diabetes mellitus
  12. diaphoresis
  13. diarrhea
  14. dizziness
  15. dyspepsia
  16. dyspnea
  17. edema
  18. elevated hepatic enzymes
  19. eructation
  20. fatigue
  21. flatulence
  22. flushing
  23. gout
  24. headache
  25. hepatic failure
  26. hepatic necrosis
  27. hepatitis
  28. hyperglycemia
  29. hyperuricemia
  30. hypophosphatemia
  31. hypotension
  32. insomnia
  33. jaundice
  34. laryngeal edema
  35. laryngospasm
  36. macular edema
  37. maculopapular rash
  38. muscle cramps
  39. myalgia
  40. myasthenia
  41. myopathy
  42. nausea
  43. orthostatic hypotension
  44. palpitations
  45. paresthesias
  46. peptic ulcer
  47. peripheral edema
  48. peripheral vasodilation
  49. pruritus
  50. rash
  51. renal tubular obstruction
  52. rhabdomyolysis
  53. sinus tachycardia
  54. skin hyperpigmentation
  55. syncope
  56. thrombocytopenia
  57. urticaria
  58. vesicular rash
  59. vomiting
  60. weakness
  61. xerosis

Monitoring Parameters

  • blood glucose
  • LFTs
  • serum uric acid

Contraindications

  • acute myocardial infarction
  • alcoholism
  • angina
  • anticoagulant therapy
  • bleeding
  • breast-feeding
  • children
  • coagulopathy
  • diabetes mellitus
  • driving or operating machinery
  • gallbladder disease
  • geriatric
  • gout
  • hepatic disease
  • hypophosphatemia
  • hypotension
  • infants
  • neonates
  • orthostatic hypotension
  • peptic ulcer disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • rhabdomyolysis
  • surgery
  • thrombocytopenia

Patients who have a known hypersensitivity to niacin or any product component should not be given the drug.

Interactions

  • Acarbose
  • Acetohexamide
  • Albiglutide
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alpha-blockers
  • Alpha-glucosidase Inhibitors
  • Amlodipine; Atorvastatin
  • Angiotensin II receptor antagonists
  • Angiotensin-converting enzyme inhibitors
  • Aspirin, ASA; Pravastatin
  • Atorvastatin
  • Atorvastatin; Ezetimibe
  • Beta-blockers
  • Bile acid sequestrants
  • Calcium-channel blockers
  • Canagliflozin
  • Canagliflozin; Metformin
  • Carbamazepine
  • Central-acting adrenergic agents
  • Cerivastatin
  • Chlorpropamide
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Dulaglutide
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Eplerenone
  • Epoprostenol
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Ethanol
  • Exenatide
  • Ezetimibe; Simvastatin
  • Fluvastatin
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide
  • Glipizide; Metformin
  • Glyburide
  • Glyburide; Metformin
  • Iloprost
  • Incretin Mimetics
  • Insulin Degludec; Liraglutide
  • Insulin Glargine; Lixisenatide
  • Insulins
  • Linagliptin
  • Linagliptin; Metformin
  • Liraglutide
  • Lixisenatide
  • Loop diuretics
  • Lovastatin
  • Lovastatin; Niacin
  • Mecamylamine
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Miglitol
  • Nateglinide
  • Niacin; Simvastatin
  • Pitavastatin
  • Potassium-sparing diuretics
  • Pramlintide
  • Pravastatin
  • Red Yeast Rice
  • Repaglinide
  • Reserpine
  • Rosuvastatin
  • Saxagliptin
  • Semaglutide
  • Simvastatin
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sulfonylureas
  • Telbivudine
  • Thiazide diuretics
  • Thiazolidinediones
  • Tolazamide
  • Tolbutamide
  • Treprostinil
  • Vasodilators
  • Warfarin

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