vitamin B3 (common name): Adult Dosing

Dosage forms: 50,100,250,500; 125,250,400,500,750,1000 ER

hypercholesterolemia

immediate-release form

Dose: 1.5-3 g/day PO div bid-tid; Start: 250 mg PO qd, incr. 250 mg/day q4-7 days until 2 g/day then incr. 250-500 mg/day q2-4wk; Max: 4.5 g/day; Info: give w/ food; 325 mg aspirin 30min before dose may reduce flushing

extended-release form

Dose: 1-2 g ER PO qhs; Start: 500 mg ER PO qhs x4wk, then incr. 500 mg/day q4wk based on effect/tolerance; Max: 2 g/day ER; Info: give w/ food; aspirin 325 mg 30min before dose may reduce flushing; do not cut/crush/chew ER form

nutritional supplementation

1 cap/tab PO qd

pellagra

300-500 mg/day PO div bid-qid

Max: 500 mg/day

renal dosing

not defined

renal impairment: caution advised

hepatic dosing

see below

liver dz hx: caution advised; unexplained elev. LFTs/active liver dz: contraindicated

vitamin B3 (common name): Peds Dosing

This information is currently unavailable or not applicable for this drug.

vitamin B3 (common name): Contraindications/Cautions

• hypersens. to drug/class/compon.
• liver dz, active
• elevated LFTs, unexplained
• active peptic ulcer
• arterial bleeding
• caution if liver dz hx
• caution if biliary dz hx
• caution if PUD hx
• caution if alcohol abuse
• caution if diabetes mellitus
• caution if gout
• caution if unstable angina
• caution if acute MI
• caution if impaired renal fxn
• caution if hypophosphatemia
• caution if surgery

vitamin B3 (common name): Drug Interactions

Avoid/Use Alternative

• amlodipine/atorvastatin

• aspirin, buffered/pravastatin

• atorvastatin

• ethanol

• ezetimibe/simvastatin

• fluvastatin

• lovastatin

• niacin/lovastatin

• niacin/simvastatin

• pravastatin

• rosuvastatin

• simvastatin

• telbivudine

Monitor/Modify Tx

• bile acid binding resins

• diazoxide

• hypoglycemics, other

• insulins

• metformin/sulfonylurea combos

• sitagliptin

• sulfonylureas

• thiazolidinediones

• uricosurics

• warfarin

Caution Advised

• alpha blockers, non-selective

• alpha blockers, selective

• amlodipine/A2R blocker combos

• beta blocker/thiazide combos

• beta blockers, systemic

• bosentan

• CCBs, dihydropyridines

• CCBs, others

• central alpha 2 agonists

• epoprostenol

• fenoldopam

• hydralazine

• hydralazine/hydrochlorothiazide

• iloprost inhaled

• mecamylamine

• minoxidil

• nesiritide

• nitrates

• nitrites/sodium thiosulfate

• nitroprusside

• phenoxybenzamine

• phentolamine

• reserpine

• sildenafil

• tadalafil

• tizanidine

• treprostinil

• vardenafil

vitamin B3 (common name): Adverse Reactions

Serious Reactions

• hepatotoxicity
• hepatic necrosis, fulminant
• peptic ulcer
• arrhythmias
• hypersensitivity rxn
• anaphylaxis (rare)

Common Reactions

• flushing
• pruritus
• hyperpigmentation
• hypotension, orthostatic
• dyspepsia
• vomiting
• diarrhea
• peptic ulceration
• jaundice
• abnormal LFTs
• dry skin
• decreased glucose tolerance
• hyperuricemia
• gout
• toxic amblyopia
• headache
• macular edema

vitamin B3 (common name): Safety Monitoring

Pregnancy: C

Lactation: Safety Unknown

Monitoring Parameters: LFTs at baseline, 6-8wk after reach 1500 mg/d, 6-8wk after reach max dose, then q12mo; fasting glucose, uric acid at baseline, 6-8wk after start tx, then q12mo

Noninterchangeable Forms: do not substitute for equivalent dose extended-release niacin; if switching from extended-release niacin start low dose, titrate to effect

vitamin B3 (common name): Pharmacology

Metabolism: liver; CYP450: unknown

Excretion: urine 88% (12% unchanged); Half-life: 20-45min

Class: Cholesterol Lowering

Mechanism Of Action
participates in tissue respiration oxidation-reduction reactions; decreases hepatic LDL and VLDL production; inhibits adipose tissue lipolysis; decreases hepatic triglyceride esterification; increases lipoprotein lipase activity

vitamin B3 (common name): Manufacturer/Pricing

Manufacturer: generic DEA/FDA: OTC/Rx

vitamin B3 (common name): Patient Education

• Generic Name: niacin (nicotinic acid)

• Pronounced: NYE a sin (NIK oh TIN ik AS id)

• Brand Names: B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Nico-400, Nicobid Tempules, Nicolar, Slo-Niacin

What is the most important information I should know about niacin?

Do not take this medication if you are allergic to niacin, or if you have severe liver disease, a stomach ulcer, or active bleeding.

Niacin can cause certain side effects, such as flushing (warmth, itching, redness, or tingly feeling under your skin). These effects can be made worse if you drink alcohol or hot beverages shortly after you take niacin. These effects should disappear over time as you keep taking the medication.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid taking colestipol (Colestid) or cholestyramine (Locholest, Prevalite, Questran) at the same time you take niacin. If you take either of these other medications, take them at least 4 to 6 hours before or after you take niacin.

Niacin is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.

What is niacin?

Niacin, also called nicotinic acid, is a B vitamin (vitamin B3). It occurs naturally in plants and animals, and is also added to many foods as a vitamin supplement. Niacin is also present in many multiple vitamins and nutritional supplements.

Niacin is used to treat and prevent a lack of natural niacin in the body, and to lower cholesterol and triglycerides (types of fat) in the blood. It is also used to lower the risk of heart attack in people with high cholesterol who have already had a heart attack. Niacin is sometimes used to treat coronary artery disease (also called atherosclerosis).

Niacin may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking niacin ?

Do not take this medication if you are allergic to niacin, or if you have severe liver disease, a stomach ulcer, or active bleeding.

Before taking niacin, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• heart disease or uncontrolled angina (chest pain);
• a stomach ulcer;
• diabetes;
• gout; or
• a muscle disorder such as myasthenia gravis.

If you have any of these conditions, you may not be able to use niacin, or you may need dosage adjustments or special tests during treatment.

FDA pregnancy category C. Niacin may be harmful to an unborn baby when the medication is taken at doses to treat high cholesterol or other conditions. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Niacin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take niacin ?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Niacin is sometimes taken at bedtime with a low-fat snack. Follow your doctor's instructions.

Niacin can cause certain side effects, such as flushing (warmth, itching, redness, or tingly feeling under your skin). These effects can be made worse if you drink alcohol or hot beverages shortly after you take niacin. These effects should disappear over time as you keep taking the medication.

Take niacin with a full glass of cold or cool water. Taking the medication with a hot drink may increase your risk of side effects such as flushing.

Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

Niacin extended-release tablets and capsules contain higher strengths of the medicine than the regular niacin tablets. Take only the dose that is correct for the type of niacin tablet or capsule you are using.

Niacin can cause you to have unusual results with certain medical tests (urine tests). Tell any doctor who treats you that you are using niacin.

If you stop taking niacin for any length of time, talk with your doctor before starting the medication again. You may need to restart the medication at a lower dose.

Niacin is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled appointments.

Store niacin at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Be sure to take the missed dose with food if you normally take your niacin dose with a meal or snack.

If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, dizziness, itching, vomiting, upset stomach, and flushing.

What should I avoid while taking niacin ?

Avoid drinking hot beverages shortly after taking niacin. Hot drinks can worsen niacin's flushing effect (warmth, itching, redness, or tingly feeling under your skin).

Avoid drinking alcohol while taking niacin. Alcohol may increase your risk of liver damage, and can also worsen the flushing effects of niacin.

Avoid taking colestipol (Colestid) or cholestyramine (Locholest, Prevalite, Questran) at the same time you take niacin. If you take either of these other medications, take them at least 4 to 6 hours before or after you take niacin.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

What are the possible side effects of niacin ?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling light-headed, fainting;
• fast, pounding, or uneven heart beats;
• feeling short of breath;
• swelling;
• jaundice (yellowing of your skin or eyes); or
• muscle pain, tenderness, or weakness with fever or flu symptoms and dark colored urine.

If you are diabetic, tell your doctor about any changes in your blood sugar levels.

Less serious side effects of niacin include:

• mild dizziness;
• warmth, redness, or tingly feeling under your skin;
• itching, dry skin;
• sweating or chills;
• nausea, diarrhea, belching, gas;
• muscle pain, leg cramps; or
• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect niacin ?

Tell your doctor about all other cholesterol-lowering drugs you are taking with niacin, especially atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), or simvastatin (Zocor).

Before taking niacin, tell your doctor if you are also using any of the following drugs:

• a blood thinner such as warfarin (Coumadin);
• multivitamins or mineral supplements that contain niacin;
• blood pressure or heart medications such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan); or
• heart medications such as doxazosin (Cardura), isosorbide (Dilatrate, Imdur, Isordil, Monoket, Sorbitrate), nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat), prazosin (Minipress), or terazosin (Hytrin).

This list is not complete and there may be other drugs that can interact with niacin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about niacin.

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

vitamin B3 (common name): Pill Pictures

This information is currently unavailable or not applicable for this drug.