Niacin (B3; nicotinic acid)

A to Z Drug Facts

Niacin (B3; nicotinic acid)

  Action
  Indications
  Contraindications
  Route/Dosage
  Interactions
  Lab Test Interferences
  Adverse Reactions
  Precautions
Patient Care Considerations
  Administration/Storage
  Assessment/Interventions
  Patient/Family Education


(NYE-uh-sin)
Niacor, Nicotinex, Slo-Niacin
Class: Vitamin/Antihyperlipidemic

 Action Necessary for lipid metabolism, tissue respiration and glycogenolysis. At pharmacologic doses, it reduces total cholesterol, LDL cholesterol, and triglycerides while increasing HDL cholesterol. Also causes peripheral vasodilation, especially cutaneous vessels.

 Indications Prevention and treatment of niacin deficiency or pellagra; treatment of hyperlipidemia (types IV and V); adjunct to diet for the reduction of elevated total and LDL levels in patients with primary hypercholesterolemia when the response to diet and other nonpharmacologic measures alone has been adequate. unlabeled use(s): Treatment of peripheral vascular disease, vascular spasm, migraine, headache, Meniere disease.

 Contraindications Significant liver disease; active peptic ulcer; severe hypotension; arterial hemorrhaging.

 Route/Dosage

Pellagra

ADULTS: PO Up to 500 mg daily in divided doses. Slow IV/SC/IM When oral route is not possible.

Dietary Supplementation

ADULTS: PO RDA is 15 to 20 mg/day for adult males and 13 to 15 mg/day for adult females. Increase niacin to 17 to 20 mg/day during pregnancy and lactation. CHILDREN: PO RDA is 5 to 20 mg/day.

Hyperlipidemia

ADULTS: PO 1 to 2 g tid, with or after meals. Titrate doses gradually. Lower doses may be effective if using sustained-release products.

 Interactions

Adrenergic-blocking agent: May potentiate hypotensive effect. HMG-CoA reductase inhibitors: Increased risk of myopathy and rhabdomyolysis.

 Lab Test Interferences May produce fluorescent substances, which may cause false elevation in some fluorometric measurements of urinary catecholamines. May produce false-positive reaction with cupric sulfate solution used for urinary glucose determination.

 Adverse Reactions

CV: Hypotension; tachycardia. CNS: Dizziness; syncope; headache. DERM: Flushing; pruritus; burning or tingling sensation; rash; hyperpigmentation (acanthosis nigricans); dry skin. EENT: Blurred vision; xerostomia. GI: Nausea; bloating; flatulence; hunger; vomiting; heartburn; diarrhea; activation of peptic ulcer; abdominal pain; dyspepsia. HEPA: Jaundice; liver damage; abnormal liver function test results. OTHER: Hyperuricemia; hyperglycemia; decreased glucose tolerance test results; toxic amblyopia; atrial fibrillation and other cardiac arrhythmias; cystoid macular edema; orthostasis.

 Precautions

Pregnancy: Category A. (Category C if used in doses above RDA.) Lactation: Actively excreted in breast milk. Children: Safety and efficacy not established for doses exceeding nutritional requirements. Extended-release preparations not recommended for children. Special-risk patients: Use drug with caution when administering to patients with gallbladder disease, history of jaundice, diabetes mellitus, gout, peptic ulcer, or allergy. Also, patients allergic to aspirin may be allergic to this product. Flushing: Commonly appears with oral therapy. Aspirin (325 mg) 30 min to 1 hr before niacin may decrease flushing. Long-acting dosage form: Increases risk of jaundice and hepatitis. Avoid use if possible. Heart disease: People who have recurrent chest pain (angina) or who recently suffered a heart attack should take niacin only under the supervision of a physician. Tartrazine sensitivity: Products containing FD&C yellow #5 may cause asthma in susceptible patients.


PATIENT CARE CONSIDERATIONS


 Administration/Storage

 Assessment/Interventions

OVERDOSAGE: SIGNS & SYMPTOMS
  Nausea, dizziness, pruritus, vomiting, tachycardia, GI distress, hypotension, flushing

 Patient/Family Education

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Copyright
© 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts