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Clinician’s Corner: Niacin

As we journey through the water-soluble vitamins, lets focus on Niacin (Vitamin B-3) which is available both as an extended release prescription product, as well as over the counter in our vitamin aisles. Your Thompson Pharmacist will guide you through the maze of niacin products. Niacin (B-3) is one of the vitamins discovered by Casimir Funk. In the early 1900’s this condition was common in the southern United States due to diets being heavy in corn-based products.  Our diet today is well supplemented with niacin, so deficiency is rare.

NIACIN (Vitamin B-3)

Dietary sources: meat, fish, legumes, whole grains.  Grains are supplemented with micronutrients such as thiamin, riboflavin, niacin, iron and folic acid.

Deficiency states are rare, due to the presence in most of the foods we ear. Niacin deficiency causes Pellagra “translation: rough skin”. Primary symptoms involve the 3 D’s of Pellagra: Dermatitis, Diarrhea, Dementia.

Adverse effects:  flushing, GI upset, and may increase blood sugar levels. The “flushing” is similar to a hot flashes women experience after menopause.  This flushing can be blocked by taking an Aspirin 325mg tablet one hour before the dose of niacin. Acetaminophen (Tylenol) does NOT work.

Supplemental doses:  50mg, 100mg, 250mg & 500 mg (immediate release release)

  • No Flush niacin (inositol hexaniacinate) not as effective for cholesterol lowering
  • At doses over 1 gram per day, Niacin will increase the chances of muscle pain and wasting, especially if you take a statin.  Consult your Thompson Pharmacist
  • OTC-Niacin: The immediate-release niacin formulations are more likely to cause flushing, especially first dose. Long-acting niacin Slo-Niacin (long acting niacin) is more likely to cause liver problems.

Let’s discuss prescription Niacin extended release:

  • Niaspan® (Rx only) is an extended release prescription product that is used for cholesterol and blood fats, with minimal risk for liver dysfunction. Has fallen out of favor. Adding niacin to bump up HDL (good cholesterol) makes number look better, but does not improve outcomes.

Your Thompson Pharmacist wants you to know about niacin therapy:

  • Skin flushing- may be managed with Aspirin 325mg 1 hour before dose.
  • Take with food or light snack to decrease GI upset.
  • Swallow whole, with cold water.
  • Avoid sudden changes in posture. May cause dizziness.
  • Avoid alcohol and hot drinks during administration.
  • Increase blood glucose monitoring if diabetic.
  • Watch niacin content in multivitamin.

RECOMMENDATION: Niacin is associated with stomach upset, diarrhea, rash, muscle pain, and flushing with possibly more infections and GI bleeding.

The latest on Niacin: Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) study showed a form of vitamin B3 (niacinamide) showed a reduction in the risk of skin cancer of 23%. The thought is that niacinamide may help repair sun-damaged skin and prevent immune suppression in the skin after sun exposure. Always wear sunscreen and protective clothing.

“Urban Legend”: No scientific evidence indicates that taking niacin can alter a urine drug test result. It is of no value “flushing” marijuana from the body.