What are the common and serious side effects of niacin. How does niacin interact with other medications. What precautions should be taken when using niacin for cholesterol management.

What is Niacin and How Does It Work?

Niacin, also known as vitamin B3, is a medication used to manage cholesterol levels and reduce the risk of cardiovascular disease. As an antilipemic agent, niacin works by:

• Lowering low-density lipoprotein (LDL) or “bad” cholesterol
• Reducing triglycerides in the blood
• Increasing high-density lipoprotein (HDL) or “good” cholesterol

Prescription niacin is available as generic and brand-name drugs, such as Niacor and Niaspan. It comes in oral tablet form and as extended-release tablets. When combined with a healthy diet, exercise, and weight management, niacin can be an effective tool in managing cholesterol levels and improving overall cardiovascular health.

Common Side Effects of Niacin

While niacin can be beneficial for many patients, it’s important to be aware of potential side effects. Some of the more common side effects include:

• Flushing (reddening and warming of the face)
• Diarrhea
• Nausea
• Vomiting
• Increased cough
• Itching

These side effects are often mild and may subside within a few days or weeks as your body adjusts to the medication. However, if these symptoms persist or become severe, it’s crucial to consult your healthcare provider.

Managing Niacin-Induced Flushing

Flushing is one of the most common side effects of niacin. Can this uncomfortable sensation be managed? Yes, there are several strategies to reduce niacin-induced flushing:

1. Take niacin with meals or a low-fat snack
2. Avoid hot drinks or alcohol when taking niacin
3. Start with a low dose and gradually increase as tolerated
4. Consider taking an aspirin 30 minutes before niacin (consult your doctor first)
5. Use extended-release formulations, which may cause less flushing

Serious Side Effects and Precautions

While less common, niacin can cause serious side effects that require immediate medical attention. These include:

Muscle Problems

Niacin may increase the risk of muscle breakdown, especially in certain populations. Who is at higher risk for niacin-related muscle problems?

• Seniors
• Patients taking statin drugs
• Individuals with diabetes
• Those with thyroid hormone deficiencies
• People with kidney disease

If you experience unexplained muscle soreness, pain, or weakness, it’s crucial to inform your healthcare provider immediately.

Liver Effects

Niacin can affect liver function, potentially causing abnormally high liver function test results. Your doctor will monitor your liver function while you’re taking this medication. Symptoms of liver problems may include:

• Tiredness or weakness
• Loss of appetite
• Upper stomach pain
• Dark-colored urine
• Yellowing of the skin or eyes (jaundice)

Is regular monitoring necessary when taking niacin? Yes, your healthcare provider should perform periodic liver function tests to ensure the medication isn’t causing liver damage.

Niacin Interactions with Other Medications

Niacin can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. It’s essential to inform your healthcare provider about all medications, vitamins, and supplements you’re taking.

Interactions with Cholesterol-Lowering Drugs

Certain cholesterol-lowering medications can interact with niacin:

• Statins: When combined with niacin, statins may increase the risk of muscle problems. Examples include atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• Bile acid sequestrants: These medications can reduce niacin absorption. To avoid this interaction, niacin should be taken 4-6 hours after bile acid sequestrants like cholestyramine, colestipol, and colesevelam.

How can patients manage these potential interactions? Always follow your doctor’s instructions regarding medication timing and dosage. If you’re taking both niacin and a statin, be particularly vigilant for signs of muscle problems and report any concerns to your healthcare provider promptly.

Proper Use and Dosage of Niacin

The appropriate dosage of niacin varies depending on the individual’s medical condition, response to treatment, and the specific formulation being used. Typically, doctors start with a low dose and gradually increase it to minimize side effects.

General Dosage Guidelines

• Immediate-release tablets: Usually started at 250 mg two to three times daily, gradually increased to 1-2 grams three times daily.
• Extended-release tablets: Often started at 500 mg once daily at bedtime, gradually increased to 2 grams once daily.

Is it safe to adjust niacin dosage on your own? No, never change your niacin dosage without consulting your healthcare provider. Abrupt changes in dosage can lead to increased side effects or reduced effectiveness.

Niacin in Combination Therapy

Niacin is often used as part of a combination therapy to manage cholesterol levels effectively. This approach may involve using niacin alongside other cholesterol-lowering medications, such as statins or bile acid resins.

Benefits of Combination Therapy

Why might a doctor prescribe niacin in combination with other medications?

• Enhanced cholesterol-lowering effects
• Targeting multiple aspects of lipid metabolism
• Potential for lower doses of individual medications, reducing side effects
• Addressing different risk factors for cardiovascular disease

When considering combination therapy, healthcare providers carefully weigh the potential benefits against the increased risk of side effects and drug interactions.

Monitoring and Follow-up Care

Regular monitoring is crucial when taking niacin to ensure its effectiveness and detect any potential side effects early. Your healthcare provider will likely recommend:

• Regular blood tests to check cholesterol levels and liver function
• Periodic assessments of muscle symptoms
• Blood glucose monitoring, especially for patients with diabetes or at risk for diabetes
• Evaluations of overall cardiovascular health and risk factors

How often should patients on niacin have follow-up appointments? The frequency of follow-up care varies depending on individual factors, but typically includes:

1. Initial follow-up within 4-6 weeks of starting niacin
2. Subsequent visits every 3-6 months, or more frequently if needed
3. Annual comprehensive health assessments

Maintaining open communication with your healthcare provider and reporting any new symptoms or concerns promptly is essential for safe and effective niacin therapy.

Lifestyle Considerations While Taking Niacin

While niacin can be an effective medication for managing cholesterol levels, it works best when combined with a healthy lifestyle. Consider the following recommendations:

Diet and Nutrition

• Follow a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• Limit saturated and trans fats
• Reduce intake of simple sugars and refined carbohydrates
• Consider incorporating foods naturally high in niacin, such as poultry, fish, and nuts

Exercise and Physical Activity

Regular physical activity can enhance the cholesterol-lowering effects of niacin. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, along with muscle-strengthening activities at least twice a week.

Alcohol Consumption

Does alcohol interact with niacin? Yes, alcohol can increase the risk of liver problems and may exacerbate niacin-induced flushing. It’s best to limit or avoid alcohol while taking niacin. If you do consume alcohol, do so in moderation and not at the same time as taking your niacin dose.

Smoking Cessation

Quitting smoking can significantly improve cardiovascular health and enhance the benefits of niacin therapy. If you smoke, talk to your healthcare provider about smoking cessation strategies.

By combining niacin therapy with these lifestyle modifications, patients can maximize the medication’s benefits and improve their overall cardiovascular health.

Special Considerations for Specific Populations

Certain groups may require special attention when using niacin:

Elderly Patients

Older adults may be more sensitive to the effects of niacin and at higher risk for side effects. Careful monitoring and potentially lower starting doses may be necessary.

Patients with Diabetes

Niacin can affect blood glucose levels. Individuals with diabetes or at risk for diabetes should have their blood sugar monitored closely while taking niacin.

Pregnant and Breastfeeding Women

Is niacin safe during pregnancy and breastfeeding? The safety of high-dose niacin during pregnancy and lactation has not been well-established. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the risks and benefits of niacin therapy with their healthcare provider.

Patients with Liver or Kidney Disease

Individuals with pre-existing liver or kidney conditions may require more frequent monitoring and dose adjustments when taking niacin.

By considering these special populations and tailoring treatment plans accordingly, healthcare providers can help ensure the safe and effective use of niacin across diverse patient groups.

Side Effects, Dosage, Uses, and More

Highlights for niacin

1. Prescription niacin is available as a generic drug and as brand-name drugs. Brand names: Niacor, Niaspan.
2. Niacor comes as an oral tablet, and Niaspan comes as an oral extended-release tablet. Generic niacin comes in both forms.
3. Prescription niacin is used to reduce the levels of cholesterol and triglycerides (fatty substances) in your blood, and decrease your risk of a heart attack. It works along with diet, exercise, and weight loss.

• Muscle effects: Niacin may increase your risk of muscle breakdown. Your risk is higher if you’re a senior, take a statin drug, or have diabetes, problems producing enough thyroid hormones, or kidney disease. Tell your doctor right away if you have unexplained muscle soreness, pain, or weakness.
• Liver effects: Niacin may cause your liver function lab test results to be abnormally high. Your doctor will monitor this while you’re taking this drug.

Prescription niacin comes as an oral tablet and an oral extended-release tablet. Other forms are available over the counter.

Prescription niacin is available as the brand-name drugs Niacor and Niaspan. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Niacin may be used as part of a combination therapy. This means you may need to take it with other medications. These may include bile acid resins and other cholesterol-lowering medications.

Why it’s used

Niacin should be used with diet, weight loss, and exercise to:

• reduce the risk of another heart attack in people who have had a heart attack and have high cholesterol.
• prevent buildup of cholesterol and fats along the walls of blood vessels in people with high cholesterol and heart disease.
• reduce the amount of triglycerides (fatty substances) in the blood in people with very high levels who are at risk of diseases affecting the pancreas.
• lower cholesterol levels.

How it works

Niacin belongs to a class of drugs called antilipemic agents. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Niacin works by lowering both your low-density lipoprotein (LDL) or “bad” cholesterol and other fatty substances (triglycerides) in your blood and raising your high-density lipoprotein (HDL) or “good” cholesterol. Niacin works with exercise and a healthy diet to improve your cholesterol levels.

Niacin oral tablet doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

Some of the more common side effects of niacin can include:

• reddening and warming of your face (flushing)
• diarrhea
• nausea
• vomiting
• increased cough
• itching

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Muscle problems. Symptoms can include:
• unexplained muscle weakness, tenderness, or pain
• Liver problems. Symptoms can include:
• tiredness or weakness
• loss of appetite
• upper stomach pain
• dark-colored urine
• yellowing of your skin or the whites of your eyes

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Niacin oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with niacin are listed below.

Cholesterol drugs

Certain cholesterol drugs called statins may increase your risk of muscle problems when taken with niacin. Examples of these drugs include:

• atorvastatin
• fluvastatin
• lovastatin
• pitavastatin
• pravastatin
• rosuvastatin
• simvastatin

Other cholesterol medications called bile acid sequestrants can reduce the absorption of niacin. You should take niacin 4–6 hours after taking a bile acid sequestrant. Examples of these drugs include:

• cholestyramine
• colestipol
• colesevelam

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Niacin can cause a severe allergic reaction. Symptoms can include:

• trouble breathing or swallowing
• swelling of your face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• skin rash
• hives
• itching

Call 911 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

The use of drinks that contain alcohol can increase your risk of reddening and warming of your face (flushing) and itching caused by niacin. Your body also processes alcohol and niacin in similar ways. If you drink alcohol, talk to your doctor. You may need to avoid drinking alcohol around the time that you take niacin.

Warnings for people with certain health conditions

For people with liver disease: You shouldn’t take niacin if you have liver disease or abnormally high liver function blood tests. This drug can make your liver disease worse.

For people with kidney disease: Ask your doctor whether niacin is safe for you to take. Niacin is processed by your kidneys. If you have kidney disease, the levels of niacin in your blood can get too high. This could cause you to have more side effects.

For people with diabetes: Niacin can increase your blood sugar levels. If your blood sugar is too high, your doctor may change your dosage of niacin or take you off of the medication.

For people with gout: Niacin can increase your uric acid levels, which may worsen your gout. Your doctor may take you off of niacin if your gout worsens while taking the drug.

For people with active peptic ulcer disease: You shouldn’t take niacin if you have active peptic ulcer disease. This drug can increase the amount of acid in your stomach. This may aggravate your ulcer.

Warnings for other groups

For pregnant women: Niacin is a category C pregnancy drug. This means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to your pregnancy.

For women who are breastfeeding: Niacin passes into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of the drug to be higher than normal. If you’re a senior, you may need a lower dosage or a different dosage schedule.

For children: Niacin hasn’t been studied in children. It shouldn’t be used in children younger than 16 years.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Niacin

• Form: oral extended-release tablet
• Strengths: 500 mg, 750 mg, 1000 mg
• Form: oral tablet
• Strengths: 500 mg

Brand: Niaspan

• Form: oral extended-release tablet
• Strengths: 500 mg, 750 mg, 1000 mg

Brand: Niacor

• Form: oral tablet
• Strengths: 500 mg

Dosage for lowering cholesterol and triglyceride levels and reducing risk of a heart attack

Adult dosage (ages 18–64 years)

• Extended-release tablet: The starting dosage is 500 mg taken by mouth once per day at bedtime. After 4 weeks, your doctor may increase your dosage by up to 500 mg. The standard maintenance dosage is 1,000–2,000 mg taken once daily at bedtime.
• Oral tablet: The initial dosage is 250 mg (one-half of the 500-mg tablet) taken by mouth once per day following your evening meal. Your doctor may gradually increase your dosage to a maximum of 6 grams (6,000 mg) per day. The standard dosage is 1–2 grams (1,000–2,000 mg) taken 2–3 times per day.

Child dosage (ages 16–17 years)

• Extended-release tablet: The starting dosage is 500 mg taken by mouth once per day at bedtime. After 4 weeks, your doctor may increase your child’s dosage by up to 500 mg. The standard maintenance dosage is 1,000–2,000 mg taken once daily at bedtime.
• Oral tablet: The initial dosage is 250 mg (one-half of the 500-mg tablet) taken by mouth once per day following the evening meal. Your doctor may gradually increase your child’s dosage to a maximum of 6 grams (6000 mg) per day. The standard dosage is 1–2 grams (1,000–2,000 mg) taken 2–3 times per day.

Child dosage (ages 0–15 years)

This medication hasn’t been studied in children and shouldn’t be used in children younger than 16 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dose or a different medication schedule. This can help keep levels of this drug from building up too much in your body.

Dosage warnings

• To reduce your risk of side effects:
• Take the extended-release form of niacin at bedtime.
• Ask your doctor about taking aspirin. Taking up to 325 mg of aspirin about 30 minutes before taking niacin can reduce flushing (reddening and warming of your face).
• The extended-release form of niacin shouldn’t be substituted for equal doses of regular niacin. This may cause severe liver disease. If your doctor switches you from regular to extended-release niacin, you’ll start on a low dose. Your doctor will slowly increase it if needed.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Niacin is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: If you don’t take niacin, your cholesterol levels may not be controlled. High cholesterol levels put you at a higher risk for heart attack and stroke.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. You may have the following symptoms:

• flushing (reddening and warming of your face)
• dizziness
• fast heart rate
• shortness of breath
• fainting

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You won’t feel niacin working, but your doctor will check your cholesterol levels to see how well niacin is working. Your doctor may adjust your dose depending on your cholesterol levels.

Keep these considerations in mind if your doctor prescribes niacin for you.

General

• Niacin should be taken with food.
• The extended-release form of niacin should be taken at bedtime.
• Niacin shouldn’t be crushed or cut.

Storage

• Store niacin at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep the container of niacin closed tightly. Protect it from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You’ll need to have certain blood tests done while you take niacin. This monitoring may be done using three tests:

• Lipid panel. Your doctor does this test to check your cholesterol levels. To get an accurate reading, you’ll be asked fast (not eat) for a certain number of hours before having your blood drawn. Your doctor may adjust your dose of niacin based on the results of this test.
• Blood sugar (glucose) test. Your doctor may check your blood sugar level with this test. If your blood sugar is too high, your doctor may take you off of niacin.
• Liver function tests. Your doctor will do blood tests to check how well your liver is working. If your liver isn’t working well, your doctor may have you stop taking this drug.

Your diet

Your doctor may recommend that you eat a cholesterol-lowering diet while you take niacin.

You shouldn’t eat spicy foods while taking niacin. This can reduce your risk of flushing (reddening and warming of your face).

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Niacin Toxicity – StatPearls – NCBI Bookshelf

Continuing Education Activity

Niacin is a medication used in the management and treatment of hyperlipidemia. It is in the vitamin supplement class of drugs. This activity reviews the toxic reactions commonly associated with nicotinic acid use. It will highlight the pathological mechanisms of action, along with the evaluation and treatment of poisoning from this drug, that the health care team will need to understand when managing this condition.

Objectives:

• Identify the etiology of niacin toxicity in its different formulations.

• Review the evaluation of niacin toxicity.

• Outline the treatment and management options available for niacin toxicity.

• Describe interprofessional team strategies for improving care coordination and communication to advance and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

At a time when so many people are taking large amounts of supplements, niacin toxicity is something of which to be aware. Niacin, also known as vitamin B3, is required in regular amounts, usually acquired through diet. Niacin, in its forms of nicotinic acid and nicotinamide, is mainly metabolized in the liver. The primary use of nicotinamide today is to treat nutritional niacin deficiency. For many years, the main clinical use of nicotinic acid was the treatment of hyperlipidemia. This approach changed as statin drugs became the mainstay therapy. Recent trials suggest no significant improvement by adding niacin to statin treatments. [1][2] This review will focus on the various clinical manifestations and complications of niacin toxicity.  

Etiology

Much less common now than in the past, niacin deficiency was the cause of pellagra. Other observed reactions of niacin deficiency are an increased risk of developing diabetes in non-diabetic patients and increased fasting glycemic levels in people with diabetes.[3][4][5] However, at higher doses, niacin can cause more serious reactions. These include but are not limited to, hypotension, hepatotoxicity, and multiple organ failure.[6] 

Energy drinks can contain large quantities of vitamins, including niacin. There have been isolated reports of acute hepatitis involving ingestion, which appear to be the result of high amounts of niacin from energy drinks.[7] Another trend that has resulted in toxicity is using niacin to help pass a pre-employment drug test, following the online theory that niacin speeds up metabolism to help eliminate toxins. 

Epidemiology

The incidence of niacin poisoning is reflected in the most recent report (2018) of the American Association of Poison Control Center’s National Poison Data System.   Of the approximately 792 single exposures, there were no documented gender differences, and the most common age groups fell into a bimodal distribution, with 248 patients aged five years or less, and 397 patients aged 20 years or older. There were 405 unintentional exposures and 150 intentional exposures; 232 adverse reactions were documented, and 227 cases received treatment in the hospital. The morbidity breakdown of the outcomes was as follows: 71 individuals experienced no problems, 255 had minor toxicity, 61 sustained moderate toxicity, one had a significant reaction, and no one died.[8]

Pathophysiology

The well-known side effect related to niacin is flushing, most commonly in the face, arms, and chest, which typically occurs within 30 minutes of ingestion and abates after 60 minutes.[9] This vasodilation from niacin appears to be caused by niacin interacting with a G-protein-coupled receptor 109A on Langerhans cells in the epidermis, which results in activation of prostaglandins. [10][11] This effect can occur at prescribed doses of immediate-release (IR) niacin and is known to affect patient compliance negatively.

Niacin can also cause serious hepatoxicity that ranges from a mild elevation of liver enzymes to acute liver failure. The hepatocellular injury pattern is more common than the cholestatic damage pattern. Clinical manifestations are jaundice, itching, fatigue, nausea, and vomiting. Early in the course of liver injury, transaminase levels can elevate significantly but may normalize with the removal of the offending agent. The thought is that there is a direct toxic effect similar to acute hepatic necrosis. Biopsy has revealed centrilobular necrosis. The severity of toxicity seems to be dose-dependent and more commonly involves sustained-release (SR) preparations.[12]  

Niacin associated hepatotoxicity is generally related to ingestions of around 3 grams per day.  In contrast, the more common symptom of flushing can occur at doses as low as 30 mg per day. Niacin is broken down in the liver via two pathways. One pathway has a low binding capability but can handle a lot of nicotinic acid substrate as it conjugates it with lysine into nicotinuric acid, which triggers the prostaglandin mediated flushing. The other pathway binds stronger to the substrate that it encounters. It is easily overwhelmed, and its by-products build up to damage the liver. This route processes the sustained release form.[13] The observed microvascular steatosis of liver damage is probably a reflection of mitochondrial injury with a resulting prothrombin time elevation, increased ammonia level, and normal bilirubin value.

History and Physical

Common complaints include flushing, itching, nausea, headache, vomiting, light-headedness, and epigastric pain.  The patient may or may not volunteer that they are taking supplemental products containing niacin, and the clinician should specifically query the patient about these substances. The patient may be hypotensive on the exam; the skin may or may not be flushed, they may have hepatomegaly and/or be jaundice, and they can have altered mentation. The presentation could lead the provider to assess that the patient is having anaphylaxis or an allergic reaction.[14]

Evaluation

A 12-lead electrocardiogram should be performed to look for QT-prolongation, QRS-widening, or any arrhythmias. Blood gas and a chemistry panel should be ordered, in addition to a complete blood count, liver panel, and prothrombin time.  As with any other potentially toxic ingestion, the physician should screen for co-ingested substances. While a specific nicotinic acid level can be ordered, the results will not come back in time to alter management, and should not be relied on to make the diagnosis. There is rarely an imaging study that would have any utility in the diagnosis of niacin toxicity. Finally, it is important to remember that a diagnosis of niacin toxicity should be one of exclusion.  

Treatment / Management

The emergency department assessment begins with rapid assessment and stabilization of the airway, breathing, and circulation, in addition to finger-stick glucose, oxygen saturation, and core temperature. Re-warming for hypothermia, dextrose infusion for hypoglycemia, in addition to intravenous crystalloid volume replacement may be necessary.  In rare cases, a bicarbonate drip may be indicated, or vasopressor support. Some severe cases have required transfusion of fresh frozen plasma or packed red blood cells. In patients who develop severe hepatotoxicity, consultation with gastroenterology is necessary for consideration of N-acetylcysteine (NAC) therapy and possible liver transplant. While the flushing can be alarming to the patient, it is self-limiting and does not require medication, although it would be responsive to the anti-prostaglandin properties of non-steroidal anti-inflammatory drugs such as aspirin or ketorolac. Nevertheless, in most cases, discontinuation of the niacin product, along with reassurance and follow-up, will be the only treatment indicated. 

Differential Diagnosis

The approach to the consideration of other possibilities when screening for niacin toxicity is to consider other conditions that present with flushing, with or without associated gastrointestinal symptoms[15]:  

• If the flushing is associated with angioedema, the clinician should consider anaphylaxis.  This response is triggered by an Ig mediated effect on mast cells, basophils, and eosinophils, which releases inflammatory mediators.  Epinephrine counteracts this cascade.  

• Panic attack, dumping syndrome, rosacea, thyroid storm, or hyperthyroidism

• Food or preservative allergies

• Medications, like metronidazole, can precipitate disulfiram reactions.  

• Scombroid poisoning, which is histamine-mediated

• Cardiac medications (adenosine, beta-blockers, calcium-channel blockers)

• Parenteral antimicrobials (ceftriaxone, vancomycin, amphotericin-B)

• Phosphodiesterase inhibitors (erectile dysfunction drugs)

• Black widow envenomation

• Anticholinergic medications and plants (e.g., jimsonweed and deadly nightshade) can cause anticholinergic toxicity, which can present with flushing as one of its symptoms.  Through its mechanism of action, physostigmine acts to reverse the poisoning by promoting cholinergic stimulation.   

• Seratonin syndrome can present with flushing, in addition to delirium, hyperreflexia, hyperthermia, and tachycardia. This reaction is due to excessive stimulation of 5-HT2A/5HT1A receptors. A nonselective serotonin antagonist like cyproheptadine may help treat this, along with benzodiazepines.

In cases involving liver damage, the extensive differential for elevated liver function tests would be applicable. The clinician must consider:

• Drugs like amiodarone, isoniazid, and methotrexate

• Over-the-counter medications like acetaminophen

• Hepatotoxic species of mushrooms like Amanita phalloides (i.e., “death cap”)

• Alcohol misuse

Prognosis

Flushing is self-limited and usually requires no treatment.  Most patients, even those who sustain significant elevations of liver function tests, do very well so long as they discontinue the niacin, especially the SR formulations.

Complications

The flushing, headache, lightheadedness, itching, nausea, and vomiting are self-limited as long as the patient stops the supplement. Hypotension, coagulopathy, and metabolic acidosis improve with supportive therapy. Complications of niacin toxicity are limited to liver injury in rare cases. Occasionally, this can progress to fulminant hepatic failure necessitating transplantation or resulting in death.[16]

Deterrence and Patient Education

It is essential to ask the patient about over-the-counter medications and supplements. One would use the history to explore the specific type of vitamin compounds, especially if there is a slow-release preparation. It is important to find out what is motivating the patient to take the supplement, especially if they found the information on the internet. 

Pearls and Other Issues

The clinician must keep in mind that niacin toxicity is a diagnosis of exclusion. Many other conditions can cause liver damage, including other dangerous ingestions. The current clinical context is such that niacin is now less common in the treatment of hyperlipidemia, so it would less likely appear as prescribed patient medication. It would more likely be a supplement. 

Enhancing Healthcare Team Outcomes

The clinician has many resources available to help detect potentially dangerous supplements that patients are taking. Consult a toxicologist when needed, or Poison Control Centers are available around the clock to provide support. 

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Wilson PWF, Polonsky TS, Miedema MD, Khera A, Kosinski AS, Kuvin JT. Systematic Review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Jun 25;73(24):3210-3227. [PubMed: 30423394]

2.

Dunbar RL, Goel H. Niacin Alternatives for Dyslipidemia: Fool’s Gold or Gold Mine? Part I: Alternative Niacin Regimens. Curr Atheroscler Rep. 2016 Feb;18(2):11. [PMC free article: PMC4753247] [PubMed: 26876225]

3.

Goldie C, Taylor AJ, Nguyen P, McCoy C, Zhao XQ, Preiss D. Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials. Heart. 2016 Feb;102(3):198-203. [PMC free article: PMC4752613] [PubMed: 26370223]

4.

Meyer-Ficca M, Kirkland JB. Niacin. Adv Nutr. 2016 May;7(3):556-8. [PMC free article: PMC4863271] [PubMed: 27184282]

5.

Florentin M, Liberopoulos EN, Kei A, Mikhailidis DP, Elisaf MS. Pleiotropic effects of nicotinic acid: beyond high density lipoprotein cholesterol elevation. Curr Vasc Pharmacol. 2011 Jul 01;9(4):385-400. [PubMed: 21314635]

6.

Mularski RA, Grazer RE, Santoni L, Strother JS, Bizovi KE. Treatment advice on the internet leads to a life-threatening adverse reaction: hypotension associated with Niacin overdose. Clin Toxicol (Phila). 2006;44(1):81-4. [PubMed: 16496499]

7.

Robin S, Buchanan R, Poole R. Energy drinks and adolescents – A hepatic health hazard? J Hepatol. 2018 Apr;68(4):856-857. [PubMed: 29175287]

8.

Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, Hashem HA, Ryan ML. 2018 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019 Dec;57(12):1220-1413. [PubMed: 31752545]

9.

Kamanna VS, Ganji SH, Kashyap ML. The mechanism and mitigation of niacin-induced flushing. Int J Clin Pract. 2009 Sep;63(9):1369-77. [PMC free article: PMC2779993] [PubMed: 19691622]

10.

Dunbar RL, Gelfand JM. Seeing red: flushing out instigators of niacin-associated skin toxicity. J Clin Invest. 2010 Aug;120(8):2651-5. [PMC free article: PMC2912206] [PubMed: 20664168]

11.

Hanson J, Gille A, Zwykiel S, Lukasova M, Clausen BE, Ahmed K, Tunaru S, Wirth A, Offermanns S. Nicotinic acid- and monomethyl fumarate-induced flushing involves GPR109A expressed by keratinocytes and COX-2-dependent prostanoid formation in mice. J Clin Invest. 2010 Aug;120(8):2910-9. [PMC free article: PMC2912194] [PubMed: 20664170]

12.

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jul 9, 2020. Niacin. [PubMed: 31643504]

13.

Durham SH, Covington EW, Clemmons KJ. Hepatotoxicity upon using niacin to pass a drug test: A case report. J Am Pharm Assoc (2003). 2018 Sep-Oct;58(5):564-567. [PubMed: 29941333]

14.

Mittal MK, Florin T, Perrone J, Delgado JH, Osterhoudt KC. Toxicity from the use of niacin to beat urine drug screening. Ann Emerg Med. 2007 Nov;50(5):587-90. [PubMed: 17418450]

15.

Rastogi V, Singh D, Mazza JJ, Parajuli D, Yale SH. Flushing Disorders Associated with Gastrointestinal Symptoms: Part 2, Systemic Miscellaneous Conditions. Clin Med Res. 2018 Jun;16(1-2):29-36. [PMC free article: PMC6108508] [PubMed: 29650526]

16.

Leung K, Quezada M, Chen Z, Kanel G, Kaplowitz N. Niacin-Induced Anicteric Microvesicular Steatotic Acute Liver Failure. Hepatol Commun. 2018 Nov;2(11):1293-1298. [PMC free article: PMC6211325] [PubMed: 30411075]

Disclosure: Michael Habibe declares no relevant financial relationships with ineligible companies.

Disclosure: Jesse Kellar declares no relevant financial relationships with ineligible companies.

The main scientifically proven beneficial properties of niacin. What is niacin. How Niacin Works

Niacin, also known to many as vitamin B3, is considered one of the most important nutrients for the human body. This vitamin is necessary for almost every organ for normal functioning.

Supplementation with niacin can lower blood cholesterol levels, relieve symptoms of arthritis and pain associated with this disease, improve brain function, as well as the functioning of several vital systems.

It should be remembered that excessive consumption of this substance can cause a number of side effects.

In this article, we’ll look at what niacin is, how it affects the human body, recommended amounts of the vitamin, and possible side effects.

What is niacin

Niacin is a B vitamin. It is also known as B3. This trace element can be found both in natural products and in nutritional supplements, where it is presented in several forms, each of which has a different effect on the body.

The first form is nicotinic acid, which lowers cholesterol levels and reduces the risk of developing diseases of the cardiovascular system.

The second form is called nicotinamide or niacinamide. This form is not able to affect the level of cholesterol in the blood, but it can prevent the development of non-melanoma skin cancer and psoriasis.

Both of the above forms of vitamin B3 can dissolve in water, making it unable to accumulate in the human body. In other words, excessive amounts of niacin are almost instantly excreted by the body.

In most cases, the main source of vitamin B3 is food, but in some cases the body is able to independently generate this element from tryptophan, an amino acid stored in the human body.

How Niacin Works

Like other B vitamins, niacin is used by the body to convert food into energy. Moreover, vitamin B3 is part of the NADP and NAD enzymes involved in cellular metabolism. Also, this vitamin is used to transmit signals from cells to the brain and create DNA. It is important to note that, in addition to all of the above, niacin has antioxidant properties.

An acute deficiency of vitamin B3 in the body may be accompanied by the following symptoms:

memory impairment;

confusion;

increased level of fatigue;

headaches;

deterioration of skin quality;

disruption of the gastrointestinal tract;

depression.

But it is worth noting that the deficiency of this vitamin can be observed in the least developed countries, since the diet of the inhabitants of these states is not very diverse.

Recommended intake of vitamin B3

The recommended daily intake of niacin depends on age and gender. Volumes exceeding the recommended daily allowance should be taken only on the recommendation of the attending physician.

1. Daily intake of vitamin B3 for children from 0 to 6 months – 2 mg, from 7 to 12 months – 4 mg, from 1 year to 3 years – 6 mg, from 4 -x to 8 years – 8 mg, from 9 to 13 years – 12 mg.
2. For adults 14 years of age and older, the recommended adult dose of vitamin B3 is 16 mg per day for men and 14 mg per day for women.

For women during pregnancy, the recommended intake of niacin is 18 mg per day, but during breastfeeding it is recommended to reduce the dosage to 17 mg per day.

Benefits of Niacin

Next, we’ll look at the positive effects of vitamin B3 on the human body.

Reducing Bad Cholesterol

Since the 1950s, niacin has been used as a cholesterol-lowering supplement. According to research, adding vitamin B3 to your diet can reduce bad cholesterol levels by 5-20 percent.

However, please note that this supplement should not be used as a primary cholesterol lowering agent due to possible side effects.

In most cases, this supplement is recommended for people with statin intolerance.

Increasing “good” cholesterol

In addition to the previous effect, vitamin B3 can also increase the level of “good” cholesterol by 15-35 percent.

Lower triglycerides

It is also worth paying attention to the fact that niacin is able to lower the level of triglycerides in the blood by 20-50 percent by blocking the enzyme involved in their synthesis.

This effect, among other things, also reduces the production of harmful cholesterol and low density lipoproteins.

Many people with high cholesterol are prescribed therapeutic doses of vitamin B3 to improve their condition.

Reducing the risk of cardiovascular diseases

Thanks to the effect of niacin on lowering cholesterol levels, the risk of developing diseases of the cardiovascular system is significantly reduced. This risk is also reduced by reducing the level of oxidative stress and inflammation. The latter effects also prevent the development of atherosclerosis and strengthen the arteries.

Combining vitamin B3 and a statin, also called niacin therapy, has been shown to significantly reduce the risk of heart disease.

However, it should be noted that the results of studying this effect of niacin are mixed.

For example, a recent study found that niacin supplementation did not reduce the risk of stroke, heart attack, and cardiovascular-related death.

May be used to treat type 1 diabetes

Type 1 diabetes is an autoimmune disease in which the body has a damaging effect on the pancreatic cells responsible for producing insulin. According to scientists, vitamin B3 can protect these cells and significantly reduce the risk of developing this disease, especially in children.

However, the use of this vitamin in the treatment of type 2 diabetes is a matter of controversy. This is because vitamin B3 is able to lower blood cholesterol levels in individuals suffering from type 2 diabetes, but at the same time, it can increase blood sugar levels.

This is why people using niacin to treat diabetes need to constantly monitor their blood sugar levels.

Improving brain function

The human brain needs vitamin B3, as it is part of the NADP and NAD coenzymes that ensure the normal functioning of this organ by providing it with the right amount of energy.

Researchers note that most mental disorders are caused by niacin deficiency, which can lead to brain cell destruction and schizophrenia. That is why this vitamin is used by many psychiatric hospitals to treat various mental disorders.

Preliminary research suggests that niacin may also be used to promote brain health in individuals suffering from Alzheimer’s disease.

Skin improvement

Researchers claim that vitamin B3 helps to protect the skin from the negative effects of ultraviolet radiation. To accomplish this task, niacin is often used in the form of a lotion or specialized nutritional supplements. According to some scientists, this property of this vitamin can reduce the risk of developing skin cancer.

So, during one of the experiments, the researchers found that taking up to 500 mg of nicotinamide per day can significantly reduce the risk of developing non-melanoma skin cancer.

Relief of arthritis symptoms

In one study, niacin significantly reduced pain and the need for non-steroidal anti-inflammatory drugs in people with symptoms of osteoarthritis, thereby increasing their level of mobility.

In another animal study, vitamin B3 injections were found to reduce inflammatory markers associated with arthritis.

Can be used to treat pellagra

An acute deficiency of vitamin B3 in the body can cause a disease such as pellagra. One of the best remedies to treat it is niacin supplements.

It should be noted that vitamin B3 deficiency is extremely rare. The cause of its occurrence can be Hartnup’s disease, alcoholism and anorexia.

The amount of vitamin B3 the human body needs can be obtained from many foods, including beef, poultry, fish, certain nuts, and legumes. It is important to note that B vitamins can also be found in energy drinks.

Foods with the highest niacin content include:

chicken breast – 59 percent of the RDI;

tuna in oil 53 percent of the RDI;

beef 33 percent of the RDI;

cold smoked salmon 32 per cent of the RDI;

peanuts 19 percent of the RDI;

lentils – 10 percent of the RDI.

In this list, RDI refers to the recommended daily intake of vitamin B3.

Niacin Recommendations

Obtaining niacin from natural foods is absolutely safe for human health, while excessive intake of this vitamin can cause a number of side effects, such as nausea, gag reflex and liver damage.

Some of the most common side effects when taking large amounts of vitamin B3 include:

blood flow to the face, chest, or neck due to vasodilation, which may also be accompanied by pain and burning;

gag reflex and nausea most commonly associated with nicotinic acid, which affects certain liver enzymes;

damage to liver cells and malfunction of this organ can be caused by a long course of treatment with nicotinic acid;

uncharacteristic changes in blood sugar levels may be associated with the use of excessively large doses of niacin – from 3 to 9 grams per day;

visual impairment associated with excess of recommended doses;

gout caused by abnormal levels of uric acid due to the abuse of vitamin B3.

What else you need to know about niacin

Many people need niacin, but some people may well get enough of the vitamin from natural foods.

However, if there is a deficiency of this microelement in the body, it is necessary to contact your doctor, who will be able to prescribe certain supplements and determine the individual amount of their intake.

In most cases, vitamin B3 supplements are recommended for people with high cholesterol and people suffering from cardiovascular diseases.

Because excessive consumption of niacin can adversely affect health, it is recommended that you consult your healthcare professional before including this vitamin in your diet.

Conclusion

Niacin is one of the B vitamins used by most organs and vital systems of the body. Fortunately, today almost everyone can get the required amount of niacin from common foods such as meat, fish and nuts.

However, in some cases, people are advised to take dietary supplements with a high content of this vitamin, namely in the treatment of heart disease and high blood cholesterol.

It is recommended that you consult with your healthcare professional before taking vitamin B3 supplements.

Research links

1. Mechanism of action of niacin.

https://www.ncbi.nlm.nih.gov/pubmed/18375237

2. Nicotinamide: a potential addition to the anti-psoriatic weaponry.

https://www.ncbi.nlm.nih.gov/pubmed/12890690

3. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention.

https://www.ncbi.nlm.nih.gov/pubmed/26488693

Niacin: Pediatric Medication | Memorial Sloan Kettering Cancer Center

Pediatric Medicine

Share

This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: US

Niacin-50 [OTC] [DSC]; Niacor; Niaspan [DSC]; Slo-Niacin [OTC]

Trade names: Canada

Niaspan FCT [DSC]

What is this drug used for?

• It is used to lower bad cholesterol, lower triglycerides and increase good cholesterol (HDL).
• Some medications are used to correct niacin deficiency.
• This drug can be given to children for other indications. Consult your doctor.

Niaspan:

• If your child has taken this form of this drug, ask your doctor about the benefits and risks. Talk to your doctor if you have questions or concerns about the use of this drug in your child.

What should I tell the doctor BEFORE my child takes this drug?

• If your child has an allergy to this drug, any of its ingredients, other drugs, foods, or substances. Tell the doctor about the allergy and how it manifested itself in the child.
• If your child has any of the following problems: Bleeding, liver problems, elevated levels of liver enzymes in the blood, or peptic ulcers.

If your daughter is breastfeeding:

• Make sure your daughter is not breastfeeding while taking this drug.

This list of drugs and conditions that may interact unfavorably with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medicines your child is taking (prescription and over-the-counter, natural, and vitamins) and any health problems. You need to make sure it is safe to take this drug for your child’s illnesses and in combination with other drugs they are already taking. Do not start, stop taking, or change the dosage of any drug your child is taking without the doctor’s approval.

What do I need to know or do while my child is taking this drug?

• Tell all health care providers who care for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
• If your child has high blood glucose (diabetes), check the child’s blood glucose regularly.
• Get your child’s blood tested often. Check with your child’s doctor.
• This drug may affect the results of some lab tests. Tell all health care workers and laboratory workers who provide your child’s health care that your child is taking this drug.
• Make sure your child follows the diet and exercise program recommended by the doctor.
• Do not give colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking this drug.
• Alcohol can interact with this drug. Make sure your child does not drink alcohol.
• Severe muscle problems (rhabdomyolysis) have been reported when this drug was used with certain high cholesterol drugs, such as atorvastatin and simvastatin. In some cases, this has led to death.

If your daughter is pregnant:

• Consult a doctor if the girl is pregnant or becomes pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.

What side effects should I report to my child’s doctor right away?

WARNING/CAUTION: Although rare, some people may have very serious and sometimes deadly side effects of this drug. Call your child’s doctor right away or get medical help if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Signs of high blood sugar, such as confusion, drowsiness, unusual feelings of thirst and hunger, increased urination, flushing, rapid breathing, and fruity breath.
• Muscle pain or weakness.
• Pain or pressure in the chest.
• Dizziness or fainting.
• Dyspnea.
• Excessive sweating.
• Severe and sometimes fatal liver disease has been reported with this drug. Call your child’s doctor right away if your child shows signs of liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.

What are some other side effects of this drug?

Any drug can cause side effects. However, for many people, side effects are either minor or non-existent. Contact your child’s doctor or seek medical attention if any of these or other side effects bother your child or if they persist:

• Hyperemia (blush).
• Itching.
• Diarrhea, indigestion or vomiting.
• Cough.

This list of possible side effects is not exhaustive. If you have any questions about side effects, ask your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Board.

What is the best way to give this drug?

Give this drug to your child as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All forms:

• Give this drug with food.
• Do not give your child spicy foods, hot drinks, or hot food while they are taking this drug.
• Keep giving this drug as directed by your child’s doctor or other health care provider, even if your child is feeling well.

All extended-release preparations:

• Ask your child to swallow whole. Ask your child not to chew or crumble.

Long acting tablets:

• Some drugs can be broken in half. If you are not sure if you can break this medicine in half, ask your doctor.

What if my child misses a dose of medication?

• Give the missed dose as soon as possible.
• If it is time for your child to take the next dose, do not take the missed dose and then go back to your child’s normal schedule.
• Do not give a double dose at the same time or additional doses.
• Talk to your doctor if you stop giving this drug to your child. You may need to restart your child at a lower dose and gradually increase the dose.

How do I store and/or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug recycling programs may be in place in your area.

General drug information

• If your child’s symptoms or health problems do not improve, or worsen, contact your child’s doctor.
• Do not share your child’s medicine with others and do not give anyone else’s medicine to your child.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options.