Niacin

Niacin is also called vitamin B3. The two chemical forms are nicotinic acid and niacinamide, or nicotinamide. Niacin is water soluble. It converts food into energy by helping certain enzymes. It is a major component of the enzymes NAD and NADP, which are involved in cellular metabolism. Niacin plays a role in cell signaling and repairing DNA, as well as acts as an antioxidant.

The health benefits of niacin include:

• Lowers LDL cholesterol
• Increases HDL cholesterol
• Lowers triglycerides
• Prevents heart disease
• Boosts brain function
• Treats type 1 diabetes
• Improves skin function
• Reduces arthritis symptoms
• Treats pellagra

Everybody needs niacin, but some may not get enough from their diet alone. If you have a deficiency or if you have any other condition that may benefit from higher doses, your healthcare provider may recommend a niacin supplement. When taken as a supplement, niacin is found along with other B vitamins.

Brand: Niacin, B-3-50, Niacin SR, Niacor, Niaspan ER, Slo-Niacin

Generic: Nicotinic acid/Vitamin B3

Niacin is a cholesterol-lowering drug used to treat high bad cholesterol (LDL/ low-density lipoprotein) and triglyceride levels in the blood. At the same time, this medication increases the amount of good cholesterol, or HDL/ high-density lipoprotein, in the blood. Consequently, niacin reduces the chances of developing heart disease, pancreatitis, stroke, and heart attack. Higher amounts of niacin can lower cardiovascular risks and improve cholesterol levels. Studies have shown that niacin can lower triglycerides, lower bad LDL cholesterol, and boost levels of good HDL cholesterol. Statins, Crestor, Lescol, or Lipitor are often prescribed in combination with niacin for cholesterol control. Niacin at fairly high doses is effective, however, these doses could also pose risks, such as gastrointestinal problems, liver damage, and glucose intolerance. Hence, do not buy over-the-counter niacin supplements, and be sure to get advice from a healthcare provider regarding dosage. Niacin reduces atherosclerosis and lowers the risk of a second heart attack. It is approved by the FDA for pellagra, a condition that develops due to a niacin deficiency. For high cholesterol, niacin is taken by mouth. For other problems, such as migraine headaches, circulation problems, Meniere’s syndrome, other causes of dizziness, and to reduce diarrhea associated with cholera, niacin is used. For people who take illegal drugs, in order to prevent a positive urine drug screen, niacin is taken by mouth. It is also taken for schizophrenia, hallucinations due to drugs, Alzheimer’s disease, loss of thinking skills due to age, chronic brain syndrome, motion sickness, muscle spasms, alcohol dependence, blood swelling linked with skin lesions, and edema. Some people use it for acne, leprosy, to prevent premenstrual headache, improve digestion, protect against toxins and pollutants, reduce the effects of aging and arthritis, lower blood pressure, improve circulation, promote relaxation, improve orgasms, prevent cataracts, and for attention-deficit/hyperactivity disorder.

The rating scales as per the National Medicines Comprehensive Database are as follows: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate. Some of the ratings are as follows:

• Likely Effective for:

• • High cholesterol: Some FDA-approved niacin is used to treat high cholesterol, which comes in higher strengths of 500mg or greater. The dietary supplements come in strengths of 250mg or less, however, high cholesterol dietary supplements require high doses of niacin. Niacin is considered a second-line therapy for people who need to lower LDL cholesterol and for people with high levels of both cholesterol and triglycerides, it is considered a first line of therapy. When single-drug therapy is not enough, it is combined with other cholesterol-lowering drugs.
  • Pellagra: The FDA has approved the use of niacin for pellagra. However, sometimes niacinamide is preferred, since it does not cause flushing, which is a side effect of niacin.
• Possibly Effective for:
  • Osteoarthritis: Niacinamide has shown to improve joint flexibility and reduce swelling and pain. Some people who take niacinamide might be able to cut down on painkilling medications.
  • Alzheimer’s disease: People who take higher amounts of niacin and multivitamin sources are at a lower risk of getting Alzheimer’s disease compared to those who consume less niacin. But there is no such evidence that only niacin supplements help to prevent Alzheimer’s disease.
  • Atherosclerosis
  • Reducing the risk of a second heart attack
  • Diarrhea due to cholera
  • Type 1 and type 2 diabetes
  • Prevention and treatment of cataracts
• Insufficient Evidence for:
  • Cataracts: Nuclear cataracts are the most common type and can be reduced by taking niacin.
  • Erectile dysfunction: The penetration frequency and duration of erection seem to improve with extended-release niacin in men with erectile dysfunction.
  • Kidney failure: Research has suggested that niacin intake reduces phosphate levels and increases calcium levels in people with increased blood phosphate levels and end-stage kidney disease.
  • Acne
  • Alcohol dependence
  • Depression
  • Dizziness
  • Motion sickness
  • Schizophrenia
  • Migraine or premenstrual headache
  • Attention-deficit/hyperactivity disorder
  • Drug-induced hallucinations
  • Cholesterol

Niacin can increase HDL cholesterol by more than 30%. Cholesterol levels are measured in milligrams per deciliter or millimoles per liter. For men, HDL levels under 40mg/dl and for women, HDL levels under 50mg/dl increase the risk of heart disease. 

This medication is also used to treat a vitamin B3, or niacin, deficiency in the body.

Read your medication guide and follow your doctor’s prescription at all times.

• Take niacin orally after meals, one to three times a day per the doctor’s prescription. If this is taken once a day, take it after dinner or the evening meal.
• The dosage depends on your medical condition or treatment response. Do not adjust your dose without your doctor’s recommendation. Your doctor will usually prescribe you a low dose to start and then increase it gradually.
• Sometimes, it is taken at bed time with a low-fat snack. Follow the instructions given by the doctor.
• Take this medication with a full glass of cold or cool water; if you take it with a hot drink, it may increase the risk of flushing.
• Do not break, chew, or crush sustained-release forms of niacin to prevent releasing the contents all at once, as this may intensify the potential side effects. Swallow it whole. Too much of the drug may be released at one time if the pill is broken or opened. Extended-release tablets and capsules are of a higher strength than the regular ones, so be sure to take the correct type of dose of the tablet or capsule.
• Take niacin four to six hours before or after taking other anti-cholesterol agents (i.e., cholestyramine or colestipol) if you are prescribed any.
• Avoid activities that require mental alertness (i.e., driving or operating machinery) and get up slowly from a lying or sitting position, as this medication can cause dizziness.
• Avoid intake of alcohol and other hot beverages to prevent skin flushing. Likewise, you may take plain aspirin or non-steroidal anti-inflammatory drugs (i.e., ibuprofen) thirty minutes before your dose of niacin.
• Monitor your blood sugar level regularly and inform your doctor immediately if the results are high or low.
• Continue taking niacin on a regular schedule (at the same time of day). Do not stop taking this medication abruptly without consulting your doctor.
• Do not take this medication if you are allergic to niacin or if you have severe liver disease or a stomach ulcer.
• If you have stopped the medication for a period of time, talk with you doctor before starting it again. You might have to restart it at a lower dose.
• Store it away from moisture and heat.
• Your program might also include diet, exercise, weight control, and other medications. Food sources include yeast, fish, milk, meat, eggs, nuts, green vegetables, enriched breads, beans, and cereals. According to the National Institutes of Health, the human body can make niacin from the amino acid tryptophan.

Inform your doctor immediately if your condition becomes aggravated or does not improve.

Take a missed dose as soon as possible. However, make sure the time interval between the missed and the next dose is not too close. Otherwise, stick with the regular schedule and leave out the missed dose. Do not double dose to cover up a missed one. Record your missed dose and inform your doctor immediately if you have missed several.

Niacin interactions are as follows:

• Alcohol: Niacin may cause flushing and itchiness. When consumed with alcohol, it may make the flushing and itchiness worse. It may also increase the risk of liver damage.
• Allopurinol (Zyloprim): This is used to treat gout. If niacin is taken in larger doses, it could make gout worse by decreasing the effectiveness of allopurinol.
• Clonidine (Catapres): Clonidine lowers blood pressure, and so does niacin. Thus, taking both might cause one’s blood pressure to become very low.
• Medications for diabetes: Some medications for diabetes include glimepride (Amaryl), glyburide (DiaBeta, Glynase Pres Tab, Micronase), rosiglitazone (Avandia), Metformin (Glucophage), Chlorpropamide (Diabinese), and tolbutamide (Orinase). Niacin might decrease the effectiveness of these medications by increasing one’s blood sugar level.
• Medications used for lowering cholesterol: Bile acid sequestrants decrease the body’s ability to absorb niacin, which reduces its effectiveness. Hence, there should be a time gap of four to six hours between taking niacin and this medication.
• Probenecid and Sulfinpyrazone (Anturane): This is used to treat gout. Larger doses of niacin might make gout worse and decrease the effectiveness of the medication.
• Genfibrozil (Lopid): Taking niacin along with this medication may cause muscle damage.
• Aspirin: Often, aspirin is used along with niacin in order to reduce flushing, which is a side effect of niacin. However, high doses of aspirin may decrease the body’s ability to get rid of niacin, and the excess niacin will lead to side effects.

Niacin may interact with:

• Blood thinner medications (i.e., warfarin)
• Antihypertensive drugs (i.e., diltiazem and prazosin)
• Other medications that may cause flushing, such as nitrates
• Other products that contain either niacin or nicotinamide
• Fibrates, such as gemfibrozil and fenofibrate
• Atorvastatin
• Anticonvulsants
• Thyroid hormones and antibiotics, as well as supplements like ginkgo biloba
• Some antioxidants

It was previously thought that the levels of HDL would increase if niacin was added to statins, atorvastatin, and simvastatin — another cholesterol medication. But recent studies have shown that niacin provides little additional benefits compared to statins alone, and it also increases the risk of serious side effects.

Niacin is no longer recommended as a first-line cholesterol treatment. It is given only to those who can’t tolerate statins.

Some drugs may either lessen the beneficial effects or worsen the side effects of niacin. Likewise, niacin may make some drugs less efficient or intensify their side effects.

Inform your doctor of all drugs you are currently taking or using (prescribed and non-prescribed medications, including vitamins, minerals, and herbal products) to check for possible drug interactions with niacin.

Never alter the doses of other medications while on niacin, and neither stop nor start any medicine without the doctor’s recommendation.

Niacin interactions with herbs and supplements include:

• Beta–carotene: In people with coronary heart disease and low HDL levels, the combination of niacin and simvastin — a prescription drug — raises HDL cholesterol levels. However, taking niacin with combinations of antioxidants, such as beta-carotene, vitamin C, vitamin E, and selenium, blunts the rise in HDL.
• Chromium: Taking niacin along with chromium may lower blood sugar. Monitor your blood sugar level if you have diabetes and if you take chromium with niacin supplements.
• Herbs and supplements that lower blood pressure: Taking niacin along with other herbs and supplements that lower blood pressure may cause the blood pressure to become too low. These include andrographis, casein peptides, cat’s claw, coenzymes Q10, lycium, L-arginine, theanine, and stinging nettle.
• Herbs and supplements that may harm the liver: Taking niacin along with herbs and supplements that may harm the liver could increase the risk. These include androstenedione, borage leaf, comfrey, chaparral, dehydroepiandrosterone, kava, pennyroyal oil, and red yeast.
• Herbs and supplements that may slow blood clotting: Taking niacin with certain herbs may increase the risk of bleeding. These include angelica, clove, garlic, ginger, and Panax ginseng.
• Kombucha tea: The concern that kombucha tea decreases niacin absorption needs to be studied more.
• Tryptophan: In the body, some tryptophan can be converted into niacin. Taking niacin with tryptophan might increase the levels of niacin and thus its side effects.
• Zinc: Malnourished people with a niacin deficiency, such as chronic alcoholics, make extra niacin if they also take zinc. If niacin is taken along with zinc, there could be an increased risk of side effects, such as flushing and itching.

There are no known side effects aside from a possible allergic reaction in people who have a previous or unknown hypersensitivity to the drug. Potential reactions include:

• Niacin flush: This is the dilation of blood vessels. In addition to this, a person may experience tingling, pain, or a burning sensation
• Stomach irritation and nausea: This occurs when people take slow-release nicotinic acid.
• Liver damage: High doses of niacin over time may cause liver damage.
• Blood sugar control: In both short-term and long-term usage, large doses of niacin have been linked to impaired blood sugar control.
• Eye health: In addition to other negative effects, blurred vision is another side effect.
• Gout: It can increase the uric acid level in the body, leading to gout.

Watch out for signs of an allergic reaction, such as:

• Rash
• Itching
• Swelling
• Mild dizziness
• Sweating or chills
• Burping
• Leg cramps and muscle pain
• Insomnia

Serious side effects include:

• Skin flushing combined with dizziness
• Severe allergic reaction
• Fainting or light-headedness
• Fast pounding or uneven heart beat
• Grayish stool or dark-colored urine
• Shortness of breath
• Stomach pain
• Yellowing of the eyes or skin
• Flu-like symptoms

Since niacin can cause flushing, one’s healthcare provider will increase the dose slowly. In order to control flushing, the doctor might offer a time-release prescription formulation. Other side effects are stomach upset and diarrhea, which may fade over time. 

Niacin can increase the risk of liver problems, stomach ulcers, low blood pressure, heart rhythm changes, changes to glucose levels, and muscle damage. It can also increase the risk of infection, type 2 diabetes, stroke, and bleeding.

Before taking niacin, tell your healthcare provider if you have/are:

• Any allergies to any substances, foods, or medications, particularly to niacin, as it can make the allergy more severe due to the release of histamine.
• Medical history or a present condition, such as:
• Extremely low blood pressure: Niacin lowers blood pressure and might worsen the condition.
• Recent liver disease
• Current or history of stomach or intestinal ulcers
• Current bleeding problem
• Alcohol dependence
• Diabetes: Niacin may increase blood sugar levels.
• Gallbladder disease: Niacin may make the disease worse.
• Gout: Niacin, in larger amounts, may bring on gout.
• Heart disease: Niacin, in larger amounts, can increase the risk of irregular heartbeat.
• Kidney problems: Niacin may accumulate in the kidneys and worsen the problem.
• Stomach ulcers: These may become worse, so do not use niacin if you have ulcers.
• Low phosphate levels in the blood
• Crohn’s disease: People with this condition have low niacin levels and may require supplementation during flare-ups.
• Abnormally decreased activity of the thyroid (hypothyroidism): Niacin lowers the blood levels of thyroxin and may worsen the symptoms of thyroid disorder.  

• Pregnant, planning to become pregnant, or currently breastfeeding: Niacin can harm the unborn child and can pass through breast milk, which may harm the nursing child. The risks and benefits of using this medication during pregnancy must be discussed with your doctor.

• Surgery: During and after surgery, niacin may interfere with blood sugar control. Niacin should be stopped at least two weeks before surgery.

In developed countries and United States, niacin deficiency is rare. It is typically found in alcoholics. Symptoms include fatigue, canker sores, depression, vomiting, indigestion, and poor circulation. More severe deficiencies can cause pellagra. The symptoms of pellagra include inflamed or flaky skin, mental impairment, and diarrhea. Talk to your healthcare provider about the best dosage for you. Dietary reference intake (DRI) is the term used for the amount of niacin required from food and supplements. The DRIs vary with age and other factors:

• Children: Depending on their age, 2–16mg
• Men: 16mg daily
• Women: 14mg daily
• Pregnant women: 18mg daily
• Breastfeeding women: 17mg daily
• For adults of all ages: 35mg daily

People can also get the required amount by eating a healthy diet. If you have been prescribed niacin, you may want to take it with food. This will help prevent an upset stomach and reduce flushing.

Many doctors advise self-medicating and, in many cases, supplements aren’t needed. Plenty of niacin can be obtained through a healthy diet.

If you are a smoker, you have to stop smoking. Be sure to eat a healthy diet, and start an exercise program after consulting your doctor.