What are the potential benefits and risks of niacin supplementation. How does vitamin B3 impact various health conditions. Can niacin effectively manage cholesterol levels and cardiovascular health.

Understanding Vitamin B3: Forms and Functions

Vitamin B3, also known as niacin, is a crucial member of the B-complex vitamin family. It comes in three primary forms: niacin (nicotinic acid), niacinamide (nicotinamide), and inositol hexanicotinate. Each form has distinct effects on the body, making it essential to understand their unique properties and applications.

What role does vitamin B3 play in the body? Niacin is integral to numerous physiological processes:

• Converting carbohydrates into glucose for energy production
• Facilitating the utilization of fats and proteins
• Supporting liver health
• Maintaining healthy skin, hair, and eyes
• Ensuring proper nervous system function
• Aiding in the production of sex and stress-related hormones
• Improving circulation
• Suppressing inflammation

How does the body process vitamin B3? Like all B vitamins, niacin is water-soluble, meaning the body doesn’t store it. This characteristic necessitates regular intake through diet or supplementation to maintain adequate levels.

Niacin Deficiency: Causes, Symptoms, and Consequences

While niacin deficiency is rare in developed countries, certain factors can lead to inadequate levels of this vital nutrient. What are the primary causes of vitamin B3 deficiency?

• Alcoholism (the main cause in the United States)
• Malnutrition
• Certain medical conditions affecting nutrient absorption

How can you recognize a mild niacin deficiency? Look out for these symptoms:

• Indigestion
• Fatigue
• Canker sores
• Vomiting
• Poor circulation
• Depression

In severe cases, niacin deficiency can lead to a condition called pellagra. What are the hallmark signs of pellagra?

• Cracked, scaly skin
• Dementia
• Diarrhea
• Burning sensation in the mouth
• Swollen, bright red tongue

How is pellagra typically treated? The standard approach involves a nutritionally balanced diet combined with niacin supplements under medical supervision.

Niacin and Cholesterol Management: A Double-Edged Sword

Since the 1950s, niacin has been recognized for its potential in managing cholesterol levels. How does niacin affect lipid profiles?

• Lowers elevated LDL (bad) cholesterol
• Reduces triglyceride levels in the blood

Despite these benefits, high-dose niacin supplementation comes with significant risks. What are the potential side effects of high-dose niacin?

• Flushing of the skin (can be reduced with time-release formulations)
• Stomach upset (usually subsides within a few weeks)
• Headache
• Dizziness
• Blurred vision
• Increased risk of liver damage

Given these risks, it’s crucial to use high-dose niacin only under medical supervision. How should niacin be used for cholesterol management? Always consult with a healthcare provider before starting any niacin regimen, especially if you’re taking other cholesterol-lowering medications.

Cardiovascular Health: Niacin’s Potential Impact

Research has explored niacin’s role in cardiovascular health beyond cholesterol management. What evidence supports niacin’s use in heart disease prevention?

Several studies have shown promising results:

• Men with existing heart disease who took niacin along with colestipol slowed the progression of atherosclerosis and experienced fewer heart attacks and deaths.
• Individuals with heart disease and high cholesterol taking niacin with simvastatin had a lower risk of first heart attack or stroke, as well as reduced mortality risk.
• Men taking niacin alone appeared to have a reduced risk of second heart attack, though mortality risk remained unchanged.

These findings suggest potential benefits, but more research is needed to fully understand niacin’s role in cardiovascular health. How should individuals with heart concerns approach niacin supplementation? Always consult with a cardiologist before incorporating niacin into your heart health regimen.

Diabetes and Niacin: A Complex Relationship

Niacin’s interaction with diabetes is multifaceted and depends on the type of diabetes in question. How does niacin affect type 1 diabetes?

In type 1 diabetes, niacinamide may offer some protection to insulin-producing pancreatic cells, potentially slowing disease progression. However, research results have been mixed:

• One study found that high-dose niacinamide reduced the risk of type 1 diabetes in at-risk children.
• A larger study failed to demonstrate protective effects against developing type 1 diabetes.

What about niacin’s impact on type 2 diabetes? The relationship is more complicated:

• Niacin can help lower elevated lipid levels often seen in type 2 diabetes.
• However, niacin may also raise blood sugar levels, posing a risk for individuals with diabetes.

Given these complexities, how should people with diabetes approach niacin supplementation? If you have diabetes, only take niacin under close medical supervision with regular blood sugar monitoring.

Niacin in Osteoarthritis Management

Preliminary research has explored niacin’s potential in managing osteoarthritis symptoms. What evidence supports niacin’s use in osteoarthritis?

A single preliminary study suggested that niacinamide might offer benefits for arthritis symptoms:

• Increased joint mobility
• Reduced need for non-steroidal anti-inflammatory drugs (NSAIDs)

While these results are promising, more research is needed to confirm niacin’s efficacy in osteoarthritis management. How should individuals with osteoarthritis approach niacin supplementation? Consult with a rheumatologist before incorporating niacin into your arthritis management plan.

Niacin and Neurological Health: Alzheimer’s Disease Prevention

Population studies have suggested a potential link between niacin intake and reduced risk of Alzheimer’s disease. What do these studies reveal about niacin and cognitive health?

• People with higher dietary niacin intake appear to have a lower risk of developing Alzheimer’s disease.
• No studies have evaluated the effects of niacin supplements specifically on Alzheimer’s risk.

While these findings are intriguing, more research is needed to establish a definitive link between niacin and Alzheimer’s prevention. How can individuals support their cognitive health through nutrition? Focus on a balanced diet rich in B vitamins, including niacin, from whole food sources.

Niacin and Eye Health: Potential Cataract Prevention

Emerging research has explored the relationship between niacin intake and eye health, particularly concerning cataract risk. What have population studies revealed about niacin and cataracts?

• One large population study found that individuals with higher dietary niacin intake had a lower risk of developing cataracts.

While this association is promising, more research is needed to confirm niacin’s role in cataract prevention. How can individuals support their eye health through nutrition? Incorporate a variety of niacin-rich foods into your diet as part of a comprehensive approach to eye health.

Niacin Supplementation: Guidelines and Precautions

Given the potential benefits and risks associated with niacin supplementation, it’s crucial to approach its use with caution. What guidelines should individuals follow when considering niacin supplements?

• Consult with a healthcare provider before starting any niacin supplementation regimen.
• Do not exceed the Recommended Daily Allowance (RDA) without medical supervision.
• Be aware of potential side effects, especially at high doses.
• Monitor for any adverse reactions, particularly if taking other medications.

How can individuals ensure they’re getting adequate niacin through diet? Focus on incorporating niacin-rich foods into your meals:

• Lean meats
• Poultry
• Fish
• Nuts and seeds
• Legumes
• Whole grains

By prioritizing dietary sources of niacin, most individuals can meet their vitamin B3 needs without resorting to supplementation.

Interactions and Contraindications

Niacin can interact with various medications and medical conditions. What are some key interactions to be aware of?

• Statins: Niacin may enhance the effect of cholesterol-lowering medications but also increase the risk of side effects.
• Diabetes medications: Niacin can interfere with blood sugar control.
• Blood thinners: Niacin may increase the risk of bleeding when taken with anticoagulants.

Who should exercise caution or avoid niacin supplementation?

• Individuals with liver disease
• People with a history of gout
• Those with unstable angina or active peptic ulcer disease
• Pregnant or breastfeeding women (unless advised by a healthcare provider)

Always inform your healthcare provider about all medications and supplements you’re taking to avoid potential interactions.

Future Directions in Niacin Research

As our understanding of niacin’s diverse effects on the body continues to grow, researchers are exploring new potential applications and refining existing uses. What areas of niacin research show promise for the future?

• Neuroprotective effects: Further investigation into niacin’s potential role in preventing or managing neurodegenerative diseases.
• Metabolic health: Exploring niacin’s impact on metabolic syndrome and related conditions.
• Cancer prevention: Investigating the potential anti-cancer properties of niacin and its derivatives.
• Skin health: Examining niacin’s role in maintaining skin barrier function and preventing skin aging.

How might future research shape niacin supplementation practices? As we gain more insights into niacin’s mechanisms of action and long-term effects, we may see more targeted and personalized approaches to niacin supplementation based on individual health profiles and genetic factors.

Emerging Forms of Niacin

Researchers are also exploring new forms of niacin that may offer the benefits of traditional niacin supplementation with fewer side effects. What are some promising developments in this area?

• Inositol hexanicotinate: This form of niacin is being studied for its potential to provide similar benefits to nicotinic acid with reduced flushing and other side effects.
• Nanoformulations: Advanced delivery systems may help improve niacin’s bioavailability and reduce side effects.
• Combination therapies: Researchers are exploring how niacin may synergize with other nutrients or medications to enhance its therapeutic effects.

As research progresses, we may see new niacin formulations that offer improved efficacy and tolerability, potentially expanding its therapeutic applications.

Integrating Niacin into a Holistic Health Approach

While niacin supplementation can offer potential benefits for certain health conditions, it’s essential to view it as part of a comprehensive approach to health and wellness. How can individuals incorporate niacin into a holistic health strategy?

• Prioritize a balanced diet rich in whole foods, including niacin-rich sources.
• Engage in regular physical activity to support overall health and complement niacin’s cardiovascular benefits.
• Manage stress through relaxation techniques, as niacin plays a role in stress hormone production.
• Ensure adequate sleep, as B vitamins are crucial for energy metabolism and cognitive function.
• Consider regular health check-ups to monitor cholesterol levels, blood sugar, and other relevant markers.

By taking a holistic approach, individuals can maximize the potential benefits of niacin while supporting overall health and well-being.

The Role of Healthcare Providers

Given the complexity of niacin’s effects and potential interactions, healthcare providers play a crucial role in guiding its use. How can individuals work effectively with their healthcare team regarding niacin supplementation?

• Discuss your health goals and concerns openly with your provider.
• Provide a complete list of all medications and supplements you’re taking.
• Ask about potential benefits, risks, and alternatives to niacin supplementation for your specific health needs.
• Follow recommended monitoring protocols, such as regular blood tests, when using high-dose niacin.
• Report any side effects or concerns promptly to your healthcare provider.

By maintaining open communication with your healthcare team, you can ensure that any niacin supplementation is safe, appropriate, and optimally integrated into your overall health plan.

Vitamin B3 (Niacin) Information | Mount Sinai

Inositol hexaniacinate; Niacin; Niacinamide; Nicotinamide; Nicotinic acid

Vitamin B3 is one of 8 B vitamins. It is also known as niacin (nicotinic acid) and has 2 other forms, niacinamide (nicotinamide) and inositol hexanicotinate, which have different effects from niacin.

All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which the body uses to produce energy. These B vitamins, often referred to as B-complex vitamins, also help the body use fats and protein. B-complex vitamins are needed for a healthy liver, healthy skin, hair, and eyes, and to help the nervous system function properly.

Niacin also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. Niacin helps improve circulation, and it has been shown to suppress inflammation.

All the B vitamins are water-soluble, meaning that the body does not store them.

You can meet all of your body’s needs for B3 through diet. It is rare for anyone in the developed world to have a B3 deficiency. In the U.S., alcoholism is the main cause of vitamin B3 deficiency.

Symptoms of mild B3 deficiency include:

• Indigestion
• Fatigue
• Canker sores
• Vomiting
• Poor circulation
• Depression

Severe deficiency can cause a condition known as pellagra. Pellagra is characterized by cracked, scaly skin, dementia, and diarrhea. It is generally treated with a nutritionally balanced diet and niacin supplements. Niacin deficiency also causes burning in the mouth and a swollen, bright red tongue.

Very high doses of B3, available by prescription, have been studied to prevent or improve symptoms of the following conditions. However, at high doses niacin can be toxic. You should not take doses higher than the Recommended Daily Allowance (RDA) except under your doctor’s supervision. Researchers are trying to determine if inositol hexanicotinate has similar benefits without serious side effects. But results are inconclusive.

High cholesterol

Niacin, but not niacinamide, has been used since the 1950s to lower elevated LDL (bad) cholesterol and triglyceride (fat) levels in the blood. However, side effects can be unpleasant and even dangerous. High doses of niacin cause:

• Flushing of the skin
• Stomach upset (which usually subsides within a few weeks)
• Headache
• Dizziness
• Blurred vision
• An increased risk of liver damage

A time-release form of niacin reduces flushing. But long-term use is associated with liver damage. In addition, niacin can interact with other cholesterol-lowering medicines. You should not take niacin at high doses without your doctor’s supervision.

Atherosclerosis and heart disease

In one study, men with existing heart disease slowed down the progression of atherosclerosis by taking niacin along with colestipol. They experienced fewer heart attacks and deaths, as well.

In another study, people with heart disease and high cholesterol who took niacin along with simvastatin (Zocor) had a lower risk of having a first heart attack or stroke. Their risk of death was also lower. In another study, men who took niacin alone seemed to reduce the risk of having a second heart attack, although it did not reduce the risk of death.

Diabetes

In type 1 diabetes, the body’s immune system mistakenly attacks the cells in the pancreas that make insulin, eventually destroying them. Niacinamide may help protect those cells for a time. More research is needed.

Researchers have also looked at whether high-dose niacinamide might reduce the risk of type 1 diabetes in children at risk for the disease. One study found that it did. But another, larger study found it did not protect against developing type 1 diabetes. More research is needed.

The effect of niacin on type 2 diabetes is more complicated. People with type 2 diabetes often have high levels of fats and cholesterol in the blood. Niacin, often along with other medications, can lower those levels. However, niacin may also raise blood sugar levels, which is particularly dangerous for someone with diabetes. For that reason, if you have diabetes, you should take niacin only under the direction of your doctor, and you should be carefully monitored for high blood sugar.

Osteoarthritis

One preliminary study suggested that niacinamide may improve arthritis symptoms, including increasing joint mobility and reducing the amount of non-steroidal anti-inflammatory drugs (NSAIDs) needed. More research is needed.

Other

Alzheimer disease: Population studies show that people who get higher levels of niacin in their diet have a lower risk of Alzheimer disease. No studies have evaluated niacin supplements, however.

Cataracts: One large population study found that people who got a lot of niacin in their diets had a lower risk of developing cataracts.

Skin conditions: Researchers are studying topical forms of niacin as treatments for rosacea, aging, and prevention of skin cancer, although it is too early to know whether it is effective.

Although there is no evidence that it helps treat any of these conditions, researchers are also studying the use of vitamin B3 in treating:

• ADHD
• Migraines
• Dizziness
• Depression
• Motion sickness
• Alcohol dependence

Dietary Sources

The best food sources of vitamin B3 are:

• Beets
• Brewer’s yeast
• Beef liver
• Beef kidney
• Fish
• Salmon
• Swordfish
• Tuna
• Sunflower seeds
• Peanuts

Bread and cereals are usually fortified with niacin. In addition, foods that contain tryptophan, an amino acid the body coverts into niacin, include poultry, red meat, eggs, and dairy products.

Available Forms

Vitamin B3 is available in several different supplement forms:

• Niacinamide
• Niacin
• Inositol hexaniacinate.

Niacin is available as a tablet or capsule in both regular and timed-release forms. The timed-release tablets and capsules may have fewer side effects than regular niacin. However, the timed-release versions are more likely to cause liver damage. Regardless of which form of niacin you are using, doctors recommend periodic liver function tests when using high doses (above 100 mg per day) of niacin.

How to Take It

Generally, high doses of niacin are used to control specific diseases. Such high doses must be prescribed by a doctor who will increase the amount of niacin slowly, over the course of 4 to 6 weeks. Take niacin with meals to avoid stomach irritation.

Daily recommendations for niacin in the diet of healthy individuals are:

Pediatric

• Infants, birth to 6 months: 2 mg (adequate intake)
• Infants, 7 months to 1 year: 4 mg (adequate intake)
• Children, 1 to 3 years: 6 mg (RDA)
• Children, 4 to 8 years: 8 mg (RDA)
• Children, 9 to 13 years: 12 mg (RDA)
• Boys, 14 to 18 years: 16 mg (RDA)
• Girls, 14 to 18 years: 14 mg (RDA)

Adult

• Men, 19 years and older: 16 mg (RDA)
• Women, 19 years and older: 14 mg (RDA)
• Pregnant women: 18 mg (RDA)
• Breastfeeding women: 17 mg (RDA)

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider. Side effects may include diarrhea, headache, stomach discomfort, and bloating.

High doses (50 mg or more) of niacin can cause side effects. The most common side effect is called “niacin flush,” which is a burning, tingling sensation in the face and chest, and red or flushed skin. Taking an aspirin 30 minutes prior to the niacin may help reduce this symptom.

At very high doses, used to lower cholesterol and treat other conditions, liver damage and stomach ulcers can occur. Your doctor will regularly check your liver function through a blood test.

People with a history of liver disease, kidney disease, or stomach ulcers should not take niacin supplements. Those with diabetes or gallbladder disease should do so only under the close supervision of their doctors.

Stop taking niacin or niacinamide at least 2 weeks before a scheduled surgery.

Niacin and niacinamide may make allergies worse by increasing histamine.

People with low blood pressure should not take niacin or niacinamide because they may cause a dangerous drop in blood pressure. DO NOT take niacin if you have a history of gout.

People with coronary artery disease or unstable angina should not take niacin without their doctor’s supervision, as large doses can raise the risk of heart rhythm problems.

Taking any one of the B vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, you may want to take a B-complex vitamin, which includes all the B vitamins.

Possible Interactions

Because of its impact on the liver, vitamin B3 can interact with several medications. If you are currently taking medications, or regularly drink alcohol, you should not use niacin without talking to your health care provider first. Below is a partial list of medications that may interact with vitamin B3.

Antibiotics, tetracycline: Niacin should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. All vitamin B complex supplements act in this way and should be taken at different times from tetracycline.

Aspirin: Taking aspirin before taking niacin may reduce flushing from niacin. But take it only under your doctor’s supervision.

Anti-seizure medications: Phenytoin (Dilantin) and valproic acid (Depakote) may cause niacin deficiency in some people. Taking niacin with carbamazepine (Tegretol) or mysoline (Primidone) may increase levels of these medications in the body.

Anticoagulants (blood thinners): Niacin may make the effects of these medications stronger, increasing the risk of bleeding.

Blood pressure medications, alpha-blockers: Niacin can make the effects of medications taken to lower blood pressure stronger, leading to the risk of low blood pressure.

Cholesterol-lowering medications: Niacin binds the cholesterol-lowering medications known as bile-acid sequestrants and may make them less effective. For this reason, niacin and these medications should be taken at different times of the day. Bile-acid sequestrants include colestipol (Colestid), colesevelam (Welchol), and cholestyramine (Questran).

Statins: Some scientific evidence suggests that taking niacin with simvastatin (Zocor) appears to slow the progression of heart disease. However, the combination may also increase the likelihood for serious side effects, such as muscle inflammation or liver damage.

Diabetes medications: Niacin may increase blood sugar levels. People taking insulin, metformin (Glucophage), glyburide (Dibeta, Micronase), glipizide (Glucotrol), or other medications used to treat high blood glucose levels should monitor their blood sugar levels closely when taking niacin supplements.

Isoniazid (INH): INH, a medication used to treat tuberculosis, may cause a niacin deficiency.

Nicotine patches: Using nicotine patches with niacin may worsen or increase the risk of flushing associated with niacin.

These medications may lower levels of niacin in the body:

• Azathioprine (Imuran)
• Chloramphenicol (Chloromycetin)
• Cycloserine (Seromycin)
• Fluorouracil
• Levodopa and carbidopa
• Mercaptopurine (Purinethol)

Supporting Research

AIM-HIGH Investigators. The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated low-density lipoprotein cholesterol Rationale and study design. The Atherothrombosis Intervention in Metabolic syndrome with low HDL/high triglycerides: Impact on Global Health outcomes (AIM-HIGH). Am Heart J. 2011 Mar;161(3):471-477.e2.

Bissett DL, Oblong JE, Berge CA, et al. Niacinamide: A B vitamin that improves aging facial skin appearance. Dermatol Surg. 2005;31:860-865; discussion 865.

Boden WE, Sidhu MS. Toth PP. The therapeutic role of niacin in dyslipidemia management. J Cardiovasc Pharmacol Ther. 2014;19(2):141-58.

Brown BG, Zhao XQ, Chalt A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583-1592.

Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology. 2000;107(3):450-456.

Draelos ZD, Ertel K, Berge C, et al. Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea. Cutis. 2005;76:135-141.

Elam M, Hunninghake DB, Davis KB, et al. Effects of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: a randomized trial. Arterial Disease Multiple Intervention Trial. JAMA. 2000;284:1263-1270.

Garcia-Closas R. et al. Food, nutrient and heterocyclic amine intake and the risk of bladder cancer. Eur J Cancer. 2007;43(11):1731-1740.

Ginsberg HN, reyes-Soffer G. Niacin: a long history, but a questionable future. Curr Opin Lipidol. 2013;24(6):475-9.

Goldberg A, Alagona P, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in management of hyperlipidemia. Am J Cardiol. 2000;85:1100-1105.

Guyton JR. Niacin in cardiovascular prevention: mechanisms, efficacy, and safety. Curr Opin Lipidol. 2007 Aug;18(4):415-420.

Jacques PF, Chylack LT Jr, Hankinson SE, et al. Long-term nutrient intake and early age related nuclear lens opacities. Arch Ophthalmol. 2001;119(7):1009-1019.

Jones KW. Do patients on statins also need niacin? JAAPA. 2013;26(7):9-10.

Kuzniarz M, Mitchell P, Cumming RG, Flood VM. Use of vitamin supplements and cataract: the Blue Mountains Eye Study. Am J Ophthalmol. 2001;132(1):19-26.

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;50(5):587-590.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, MO: 2000;4-5.

Raja R, Thomas JM, Greenhill-Hopper M, Ley SV, Almeida Paz FA. Facile, one-step production of niacin (vitamin B3) and other nitrogen-containing pharmaceutical chemicals with a single-site heterogeneous catalyst. Chemistry. 2008;14(8):2340-2348.

Sahebkar A. effect of niacin on endothelial function: a systematic review and meta-analysis of randomized controlled trials. Vasc Med. 2014;19(1):54-66.

Sanyal S, Karas RH, Kuvin JT. Present-day uses of niacin: effects on lipid and non-lipid parameters. Expert Opin Pharmacother. 2007 Aug;8(11):1711-17.

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Niacin (Vitamin B3) : Benefits, Dosage, Sources, Risks

Written by R. Morgan Griffin

In this Article

• Why do people take niacin?
• How much niacin should you take?
• Can you get niacin naturally from foods?
• What are the risks of taking niacin?

Having enough niacin, or vitamin B3, in the body is important for general good health. As a treatment, higher amounts of niacin can improve cholesterol levels.

As a cholesterol treatment, there are good studies showing that niacin can boost levels of good HDL cholesterol and lower triglycerides. Niacin also modestly lowers bad LDL cholesterol. It’s sometimes prescribed in combination with statins for cholesterol control, such as rosuvastatin (Crestor, Ezallor), simvastatin (Flolipid, Zocor), fluvastatin (Lescol), atorvastatin (Lipitor) and pravastatin (Pravachol).

However, niacin is only effective as a cholesterol treatment at fairly high doses. These doses could pose risks, such as liver damage, gastrointestinal problems, or glucose intolerance. So don’t treat yourself with over-the-counter niacin supplements. Instead, get advice from your health care provider, who can prescribe FDA-approved doses of niacin instead if recommended.

In addition, niacin is an FDA-approved treatment for pellagra, a rare condition that develops from niacin deficiency.

Since niacin can be used in different ways, talk to your health care provider about the best dosage for you.

Everyone needs a certain amount of niacin — from food or supplements — for the body to function normally. This amount is called the dietary reference intake (DRI), a term that is replacing the older and more familiar RDA (recommended daily allowance). For niacin, the DRIs vary with age and other factors and are given in milligrams of niacin equivalents: 

• Children: between 2-16 milligrams daily, depending on age
• Men: 16 milligrams daily
• Women: 14 milligrams daily
• Women (pregnant): 18 milligrams daily
• Women (breastfeeding): 17 milligrams daily
• Maximum daily intake for adults of all ages: 35 milligrams daily

Most people can get the amount of niacin they need by eating a healthy diet.

If your doctor prescribes niacin, you might want to take it with food. This can prevent upset stomach. To reduce flushing — a harmless but uncomfortable side effect of niacin that describes redness and warmth in the face and neck — your health care provider might recommend taking niacin along with aspirin and avoiding alcohol and spicy foods.

Niacin occurs naturally in many foods, including greens, meat, poultry, fish, and eggs, although in a fraction of the dose shown to achieve changes in cholesterol. Many products are also fortified with niacin during manufacturing.

• Side effects. Niacin can cause flushing, especially when you first begin taking it. Your health care provider will probably suggest increasing the dose slowly to reduce this problem. They might also offer a time-release prescription formulation to control flushing. Niacin can cause upset stomach and diarrhea. However, all of these side effects tend to fade over time.
• Risks. Niacin does have risks. It can cause liver problems, stomach ulcers, changes to glucose levels, muscle damage, low blood pressure, heart rhythm changes, and other issues. People with any health condition including liver or kidney disease, diabetes, high blood pressure, or cardiovascular problems need to talk to a doctor before using niacin supplements. Do not treat high cholesterol on your own with over-the-counter niacin supplements.
• Interactions. If you take any medicines or supplements regularly, talk to your doctor before you start using niacin supplements. They could interact with medicines like diabetes drugs, blood thinners, anticonvulsants, blood pressure medicines, thyroid hormones, and antibiotics as well as supplements like ginkgo biloba and some antioxidants. Alcohol might increase the risk of liver problems. Though niacin is often used along with statins for high cholesterol, this combination may increase the risk for side effects. Get advice from your healthcare provider.

At the low DRI doses, niacin is safe for everyone. However, at the higher amounts used to treat medical conditions, it can have risks. For that reason, children and women who are pregnant or breastfeeding should not take niacin supplements in excess of the DRI unless it’s recommended by a doctor. 

People with uncontrolled gout should also not take niacin supplements.

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Vitamin B3: indications for use, benefits, dosage

March 25
2021

Vitamin B3 (niacin, vitamin PP) is produced in the body from tryptophan and in small quantities, so in order to maintain normal levels of this element, it is necessary to follow a diet. Vitamin B3 takes part in the breakdown and further synthesis of amino acids, carbohydrates, fatty acids, it also regulates cholesterol levels, so a deficiency of the element is dangerous for the human body. It is useful to find out what nicotinic acid is used for and what is the dosage of nicotinic acid.

What is Vitamin B3 (Nicotinic Acid, Vitamin PP)

Niacin is considered to be a vitamin with increased stability, as it is not particularly sensitive to oxygen, heat and UV rays.

The role of vitamin B3 for the body is great. The substance is water-soluble and contributes to the correct functioning of the nervous system. Niacin is also required for the synthesis of steroid hormones (including estrogen, progesterone, testosterone, hydrocortisone), pancreatic hormones (in particular, insulin) and the thyroid gland (thyroxine).

Vitamin PP has an effect on metabolic changes that release energy. When poisoned, it slows down the toxic effect of certain chemical compounds and drugs.

Niacin is an important component that regulates blood cholesterol levels. It also dilates blood vessels, has a positive effect on mental well-being. Niacin improves carbohydrate metabolism, increases wound healing, improves general condition, and normalizes body weight.

Sources of vitamin B3

What foods contain vitamin B3? Niacin acid is mainly found in meat, fish, grains and legumes, in milk, green leafy vegetables (among them with the highest content of lettuce, dill, parsley, sorrel, spinach), in a small percentage – in tea and coffee.

Vitamin B3 is found in lean meats: veal, turkey and chicken. You can find it in almonds, pork, dairy products, organ meats, soybeans, peas and beans. Supplements in the form of vitamin preparations can compensate for the lack of vitamin PP, such an element can be chromium, which increases the absorption of the vitamin.

Vitamin B3 is also found in foods such as yeast, wheat bran and peanuts, as well as fish, especially smoked mackerel and salmon, as a source enriched with niacin. Niacin can be present in lean protein foods, both animal and vegetable.

Why vitamin B3 is prescribed

Niacin is prescribed:

• for diabetes and hypertension;
• for the treatment of disorders of the nervous system;
• for migraine;
• to improve digestion;
• to increase blood sugar;
• to improve metabolism;
• to increase the protective properties of the pancreas.

The main thing when niacin is prescribed is the lack of this substance in the body. More information on the site.

How to take vitamin B3

Breastfeeding women, as well as those using contraceptives, cancer patients and people who lack protein, especially need nicotinic acid.

Recommended daily value of vitamin B3:

1. 6-10 – children 1-3 years old;
2. 8-16 – children 4-8 years old;
3. 14 – women;
4. 16 – men;
5. 17-18 – pregnant.

The normal dosage of niacin for each individual may vary according to age and sex.

Medical use

In the medical field, vitamin B3 is used to treat lipid and lipoprotein problems. They more often than others lead to the development of such a disease as atherosclerosis. A dosage of more than 1 gram per day is able to increase HDL cholesterol levels in the blood plasma, and at the same time to reduce cholesterol and triglyceride levels of LDL.

At higher doses (>100 mg/day), vitamin B3 intake may cause side effects:

• flushing of the skin, mainly on the face;
• fever;
• pruritus and tingling;
• gastrointestinal disturbances (nausea, gagging, gas, diarrhea and possibly worsening peptic ulcer).

Niacin increases the production of adiponectin in fat cells. It is a hormone with anti-atherosclerotic action. Based on clinical studies, niacin is known to relieve migraine symptoms.

More information here.

Contraindications for use

Main contraindications for nicotinic acid:

• hypersensitivity to the substance;
• atherosclerosis;
• hyperuricemia;
• liver failure;
• pancreatitis;
• glaucoma;
• the presence of duodenal ulcer and stomach ulcer, especially during the period of exacerbation;
• arterial hypertension;
• gout;
• arterial hypotension.

It is also important to control the level of niacin in the body. Deviations from the norm are unacceptable, namely, surpluses and deficits.

Excess niacin

Excess vitamin B3 occurs when more than 35 mg per day is consumed. This is often seen with niacin tablets.

Symptoms of vitamin B3 excess:

• skin itching, dryness and redness;
• hyperglycemia;
• liver failure;
• rash;
• abdominal pain, nausea and vomiting;
• arrhythmia.

Therefore, it is not recommended to self-administer – consult your doctor.

Vitamin B3 deficiency

Diet, isoniazid drugs, sugar and alcohol abuse cause niacin deficiency. This can lead to consequences that include a decrease in resistance to cold due to a slowdown in metabolism. Also, the result of a lack of vitamin B3 can be a serious disease – pellagra.

Possible consequences of pellagra:

• dermatitis disease;
• dementia;
• death.

Distinguish between physical and psychological symptoms of vitamin B3 deficiency.

Psychological symptoms:

• increased anxiety;
• irritability;
• delusions and hallucinations;
• amnesia;
• apathy and depression.

Physical symptoms:

• hyperpigmentation;
• skin thickening;
• inflammation in the mouth;
• indigestion.

Self-diagnosis is unacceptable. It is necessary to consult a doctor with the delivery of tests.

Vitamin B3 deficiency and other diseases

Initially, a small deficiency of vitamin B3 provokes a slow metabolism. This may have different consequences. One option is to lower the thermal threshold. If niacin is not enough, it causes a disease called pellagra (Lombard erythema).

Abnormal metabolism of niacin is observed in many diseases. This is mainly found in schizophrenia, hypercholesterolemia, Hodkins’ disease, and depression. A carcinoid tumor that increases the production of serotonin is also triggered by a lack of B3.

Manifestations of pellagra:

• rashes;
• diseases of the gastrointestinal tract, including diarrhea, constipation, vomiting;
• scarlet tongue;
• diseases of the nervous system – apathy, depression, inability to concentrate, headaches, memory problems.

Pellagra is a fatal disease if left untreated. Before taking niacin, a consultation with a specialist is required. Only he can prescribe the drug, indicate the recommended dosages and duration of treatment.

Remember that self-medication can make the situation worse.

Drug Comparison Chart

References

1. https://pubmed.ncbi.nlm.nih.gov/30097857/902 43
2. https://pubmed.ncbi.nlm.nih.gov/27457213/
3. https://pubmed.ncbi.nlm.nih.gov/28983799/
4. https://pubmed.ncbi.nlm.nih.gov/24993939/

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Memorial Sloan Kettering Cancer Center

Adult Medication

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Provided by Lexicomp ^® , this document 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: USA

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

Brand 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 may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• If you have any of the following problems: Bleeding, liver problems, high blood levels of liver enzymes, or peptic ulcers.
• If you are breastfeeding. Do not breastfeed while taking this drug.

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

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

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

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• If you have high blood sugar (diabetes), you should check your blood sugar regularly.
• Perform blood tests and other laboratory tests as directed by your doctor.
• This drug may affect the results of some lab tests. Tell all your health care workers and laboratory staff that you are taking this drug.
• Stick to the diet and exercise program recommended by your doctor.
• Do not take colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking this drug.
• Avoid or limit alcohol to less than 3 drinks per day. Drinking too much alcohol can raise your risk of liver disease. Alcohol can increase flushing.
• Watch for gout attacks.
• If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
• Tell your doctor if you are pregnant or plan to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.

Which side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

• 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 liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.
• Signs of high blood sugar such as confusion, drowsiness, unusual thirst and hunger, increased urination, flushing, rapid breathing, and fruity breath.
• Pain or pressure in the chest.
• Feeling of abnormal heartbeat.
• Dizziness or fainting.
• Dyspnea.
• Excessive sweating.
• Black, tarry or bloody stools.
• There have been rare cases of a severe muscle disorder (rhabdomyolysis) when this drug has been used with certain drugs to lower high cholesterol, such as atorvastatin and simvastatin. This can lead to kidney problems and death. If you experience muscle pain, tenderness, or weakness (with a high or normal temperature, with or without feeling unwell), contact your doctor immediately.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

• Blush (redness). Taking an aspirin 30 minutes before taking this drug may help. If you wake up at night with a flushed face, get up slowly if you feel faint or dizzy.
• Itching.
• Diarrhea, indigestion or vomiting.
• Cough.
• Dry skin.
• Headache.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

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

All forms:

• Take this drug with food.
• Avoid alcohol, hot drinks, or spicy foods while you are taking this drug.
• Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.

All long-acting preparations:

• Swallow whole. Don’t 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.
• Some medications should be taken before bed. For some drugs, this does not matter. Ask the pharmacist how to take this drug.

What if I miss a dose of a drug?

• Take the missed dose as soon as you can.
• If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.
• If you stop taking this drug, talk to your doctor. You may need to start taking the drug again at a lower dose and gradually increase the dosage.

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 disposal programs may be in place in your area.

General information about medicines

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have any questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• Some medicines may come with other patient information leaflets. Check with your pharmacist. If you have any questions about this drug, talk with your 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. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances.