II. Background
- Niacin (Nicotinic Acid, Niacinamide, Vitamin B3) is a B Vitamin
- As a component of NADH and NADPH, is involved in many in vivo reactions
- Niacin may be ingested or synthesized from Tryptophan (Essential Amino Acid)
- Food sources of Niacin
- Wheat germ
- Liver
- Fish
- Peanuts
-
Niacin Deficiency (Pellagra)
- Sythesized from Tryptophan and deficiency may be seen in limited diets (e.g. corn) in which Tryptophan is absent
- Pellagra presents with Diarrhea, Dermatitis and Dementia (3D's)
III. Indications
- Older indications that should be reconsidered in light of AIM-High Study (Niacin did not appear effective in these cases)
- Low HDL Cholesterol
- Combination therapy with Statin for Hyperlipidemia
- Indications that are reasonable as of 2013
- Hypertriglyceridemia
- Hyperlipidemia Management in patients intolerant to Statins
IV. Effects: Lipids
- HDL increased (15-35%)
- No other agent raises HDL as much as Niacin
- However Niacin related HDL increase did not effect outcomes in 2011 AIM-HIGH study (prematurely stopped)
- Triglycerides decreased (20-50%)
-
LDL Cholesterol decreased (10-25%)
- Significantly lowers LDL only at high dose
- Not a first-line agent for lowering LDL
V. Efficacy
- Does not affect all cause mortality
- Statin with Niacin did not show benefit beyond Statin alone in AIM-HIGH study (2011)
- Studies since the 1980s to today have suggested coronary disease risk reduction, but benefit may be aside from affect on HDL Cholesterol
VI. Adverse effects
- Flushing
- Pruritus
- Skin irritation of neck and face
- Gastrointestinal upset (Dyspepsia, Diarrhea)
- Blurred Vision
- Fatigue
- Glucose intollerance
- Hyperuricemia and gout
- Peptic Ulcer Disease exacerbation
- Hepatic toxicity with sustained release forms
-
Diabetes Mellitus (when Niacin is combined with a Statin)
- Increases risk of developing diabetes or worsening diabetes control
- (2014) N Engl J Med 2014 371:203-12 [PubMed]
VII. Adverse Effects: Compliance and tolerance
VIII. Contraindications
- Absolute
- Relative
- Type II Diabetes Mellitus
- Severe gout
- Hyperuricemia
IX. Preparations: Niacin
- Crystalline Niacin
- Niaspan (preferred)
- Safest of Niacins (only 4% GI side effects)
- More expensive than crystalline Niacin
- Example protocol for initiating doses
- References
- McBride (2003) New Therapeutics Lecture, Cable, WI
- Agents to avoid
- Avoid flush-free or no-flush Niacin
- Avoid Slow Niacin (Sustained Release)
- Decreased Safety due to hepatotoxicity
X. Preparations: Niacin combined with other agents
- Advicor: Niaspan (500-1000 mg) and Lovastatin (20-40 mg)
- Simcor: Niaspan (500-1000 mg) and Simvastatin (20 mg)
- Cordaptive: Niacin (extended release) with Laropiprant (to reduce Flushing)
Images: Related links to external sites (from Bing)
Related Studies
| niacin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NIACIN ER 1,000 MG TABLET | Generic | $0.30 each |
| NIACIN ER 500 MG TABLET | Generic | $0.17 each |
| NIACIN ER 750 MG TABLET | Generic | $0.40 each |
Ontology: Niacin (C0027996)
| Definition (NCI_NCI-GLOSS) | A nutrient in the vitamin B complex that the body needs in small amounts to function and stay healthy. Niacin helps some enzymes work properly and helps skin, nerves, and the digestive tract stay healthy. Niacin is found in many plant and animal products. It is water-soluble (can dissolve in water) and must be taken in every day. Not enough niacin can cause a disease called pellagra (a condition marked by skin, nerve, and digestive disorders). A form of niacin is being studied in the prevention of skin and other types of cancer. Niacin may help to lower blood cholesterol. |
| Definition (NCI) | A water-soluble vitamin belonging to the vitamin B family, which occurs in many animal and plant tissues, with antihyperlipidemic activity. Niacin is converted to its active form niacinamide, which is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and its phosphate form, NADP. These coenzymes play an important role in tissue respiration and in glycogen, lipid, amino acid, protein, and purine metabolism. Although the exact mechanism of action by which niacin lowers cholesterol is not fully understood, it may act by inhibiting the synthesis of very low density lipoproteins (VLDL), inhibiting the release of free fatty acids from adipose tissue, increasing lipoprotein lipase activity, and reducing the hepatic synthesis of VLDL-C and LDL-C. |
| Definition (NCI_CRCH) | Water-soluble vitamin that is a cosubstrate or coenzyme with numerous dehydrogenases for the transfer of the hydride ion. (DRI) |
| Definition (MSH) | A water-soluble vitamin of the B complex occurring in various animal and plant tissues. It is required by the body for the formation of coenzymes NAD and NADP. It has PELLAGRA-curative, vasodilating, and antilipemic properties. |
| Definition (CSP) | nicotinic acid (3-pyridinecarboxylic acid) and its derivatives; a water soluble B vitamin which is the precursor of NAD and NADP. |
| Definition (PDQ) | A water-soluble vitamin belonging to the vitamin B family, which occurs in many animal and plant tissues, with antihyperlipidemic activity. Niacin is converted to its active form niacinamide, which is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and its phosphate form, NADP. These coenzymes play an important role in tissue respiration and in glycogen, lipid, amino acid, protein, and purine metabolism. Although the exact mechanism of action by which niacin lowers cholesterol is not fully understood, it may act by inhibiting the synthesis of very low density lipoproteins (VLDL), inhibiting the release of free fatty acids from adipose tissue, increasing lipoprotein lipase activity, and reducing the hepatic synthesis of VLDL-C and LDL-C. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38351&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38351&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C689" NCI Thesaurus) |
| Concepts | Organic Chemical (T109) , Vitamin (T127) , Pharmacologic Substance (T121) |
| MSH | D009525 |
| SnomedCT | 419923002, 55013001, 273943001, 63639004 |
| LNC | LP14887-1, MTHU002113 |
| English | 3 Pyridinecarboxylic Acid, 3-Pyridinecarboxylic Acid, Acid, 3-Pyridinecarboxylic, Acid, Nicotinic, Nicotinic Acid, 3-Pyridinecarboxylic acid, Niacin, niacin, vitamins niacin, vitamins nicotinic acid, nicotinic acid (medication), niacin (medication), NIACIN, Niacin [Chemical/Ingredient], nicotinic acid, Niacin (substance), Vitamin B-3, Nicotinamide, Nicotinic Acid Amide, Antipellagra factor, Nicotinic acid, Niacin preparation, Nicotinic acid preparation, Nicotinic acid product, Niacin preparation (product), Nicotinic acid (substance), Niacin (substance) [Ambiguous], Niacin preparation (substance), NICOTINIC ACID |
| Swedish | Nikotinsyra |
| Czech | niacin, kyselina nikotinová, vitamin B3 |
| Finnish | Nikotiinihappo |
| Russian | NIKOTINOVAIA KISLOTA, NIATSIN, НИАЦИН, НИКОТИНОВАЯ КИСЛОТА |
| Japanese | 3-ピリジンカルボン酸, ニアシン, ニコチン酸, ピリジン-3-カルボン酸, ナイアシン |
| Spanish | niacina (producto), preparado con ácido nicotínico, preparado con niacina (producto), preparado con niacina, niacina (sustancia), factor antipelagra, niacina (concepto no activo), niacina, preparado de niacina (sustancia), ácido nicotínico (sustancia), ácido nicotínico, Niacina, Ácido Nicotínico |
| Polish | Kwas nikotynowy, Niacyna |
| Croatian | NIJACIN |
| French | Acide nicotinique, Nicotinique, acide |
| German | Niacin, Nikotinsäure |
| Italian | Niacina |
| Portuguese | Ácido Nicotínico, Niacina |
Ontology: Niacinamide (C0028027)
| Definition (NCI_NCI-GLOSS) | A nutrient in the vitamin B complex that the body needs in small amounts to function and stay healthy. Niacinamide helps some enzymes make energy in the cell. It is found in many plant and animal products. It is water-soluble (can dissolve in water) and must be taken in daily. It is being studied to increase the effect of radiation therapy on tumor cells. |
| Definition (NCI) | The active form of vitamin B3 and a component of the coenzyme nicotinamide adenine dinucleotide (NAD). Niacinamide acts as a chemo- and radio-sensitizing agent by enhancing tumor blood flow, thereby reducing tumor hypoxia. This agent also inhibits poly(ADP-ribose) polymerases, enzymes involved in the rejoining of DNA strand breaks induced by radiation or chemotherapy. |
| Definition (MSH) | An important compound functioning as a component of the coenzyme NAD. Its primary significance is in the prevention and/or cure of blacktongue and PELLAGRA. Most animals cannot manufacture this compound in amounts sufficient to prevent nutritional deficiency and it therefore must be supplemented through dietary intake. |
| Definition (CSP) | B complex vitamin used in the prophylaxis and treatment of pellagra; functions as a component of the coenzyme NAD (Nicotinamide-Adenine Dinucleotide). |
| Definition (PDQ) | The active form of vitamin B3 and a component of the coenzyme nicotinamide adenine dinucleotide (NAD). Niacinamide acts as a chemo- and radio-sensitizing agent by enhancing tumor blood flow, thereby reducing tumor hypoxia. This agent also inhibits poly(ADP-ribose) polymerases, enzymes involved in the rejoining of DNA strand breaks induced by radiation or chemotherapy. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42044&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42044&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C2327" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) , Vitamin (T127) |
| MSH | D009536 |
| SnomedCT | 61650007, 332374008, 58527004, 259657008, 86431009, 173196005, 55013001 |
| LNC | LP16218-7, MTHU007481 |
| English | Vitamin B3, Niacinamide, Nicotinamide, Vitamin PP, 3-Pyridinecarboxamide, Nicotinamide [skin], 3 Pyridinecarboxamide, Nicotylamide, Nicotinic Acid Amide, Pellagra-Preventing Factor, Nicotinamidum, VITAMIN B A 03, vitamin B3, vitamin PP, Nicotinamide preparation, niacinamide (medication), vitamins niacinamide, niacinamide, Niacinamide [Chemical/Ingredient], NIACINAMIDE, b3 vitamins, vitamin b3, vitamin b 3, b3 vitamin, vitamin pp, B3, Vitamin, B 3, Vitamin, Vitamin B 3, nicotinamide, Niacinamide [skin], Niacinamide (substance), Niacinamide [skin] (product), Vitamin B<sub>3</sub>, Vitamin B>3<, Nicotinic acid amide, Niacinamide preparation, Niacinamide preparation (product), Nicotinamide (substance), Niacinamide [Ambiguous], Niacinamide preparation (substance), Nicotinamide [skin] (substance), Nicotinamide product, Nicotinamide [skin] (product), Niacinamide product, VITAMIN B3, NIACIN (AS NIACINAMIDE) |
| Swedish | Niacinamid |
| Spanish | nicotinamida (uso dermatológico) (producto), nicotinamida (uso dermatológico), preparado con nicotinamida (producto), preparado con niacinamida, nicotinamida (producto), preparado con nicotinamida, niacinamida (uso dermatológico) (producto), niacinamida (uso dermatológico), niacinamida (sustancia), Vitamina B3, vitamina B<sub>3</sub>, vitamina B3, vitamina B>3<, nicotinamida (piel) (producto), nicotinamida (piel), nicotinamida (sustancia), preparado de nicotinamida (sustancia), nicotinamida, niacinamida, Nicotinamida, Niacinamida, Vitamina B 3, Vitamina PP |
| Czech | vitamin B 3, vitamin PP, niacinamid, nikotinamid |
| Finnish | Nikotinamidi |
| Russian | NIATSINAMID, NIKOTINAMID, VITAMIN RR, VITAMIN B3, ВИТАМИН B3, ВИТАМИН РР, НИАЦИНАМИД, НИКОТИНАМИД |
| Japanese | ニコチンアミド, ニコチン酸アミド, ニコチナマイド, ナイアシンアミド, ビタミンB3, ビタミンPP |
| German | VITAMIN B A 03, Niacinamid, Nicotinamid, Vitamin PP, Vitamin B3 |
| Polish | Witamina B3, Witamina PP, Nikotynamid, Niacynamid |
| Croatian | Not Translated[Niacinamide] |
| Portuguese | Vitamina B3, Nicotinamida, Niacinamida, Vitamina B 3, Vitamina PP |
| French | Nicotinamide |
| Italian | Niacinammide |
