What are the potential side effects of niacin. How does vitamin B3 affect cholesterol levels. Can niacin supplementation help with heart disease. Is niacin beneficial for diabetes management. Does niacin play a role in osteoarthritis treatment.

The Multifaceted Role of Vitamin B3 in Human Health

Vitamin B3, also known as niacin, is a crucial nutrient that plays a vital role in various bodily functions. As one of the eight essential B vitamins, it helps the body convert carbohydrates into glucose, which is then used to produce energy. Additionally, niacin aids in the utilization of fats and proteins, contributing to overall metabolic health.

Beyond its metabolic functions, niacin is involved in the production of sex and stress-related hormones in the adrenal glands and other parts of the body. It also promotes improved circulation and has demonstrated anti-inflammatory properties. Given its water-soluble nature, the body doesn’t store vitamin B3, making regular dietary intake essential for maintaining optimal health.

Forms of Vitamin B3

• Niacin (nicotinic acid)
• Niacinamide (nicotinamide)
• Inositol hexanicotinate

Each form of vitamin B3 has distinct effects on the body, with niacin being the most well-studied for its therapeutic potential.

Recognizing Niacin Deficiency: Symptoms and Consequences

While niacin deficiency is rare in developed countries, certain populations, particularly those struggling with alcoholism, may be at risk. Identifying the signs of mild B3 deficiency is crucial for early intervention and prevention of more severe health complications.

Mild Niacin Deficiency Symptoms

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

Is severe niacin deficiency a serious concern? Indeed, a severe deficiency can lead to a condition called pellagra, characterized by the “3 Ds”: dermatitis, diarrhea, and dementia. Pellagra patients often present with cracked, scaly skin, cognitive impairment, and persistent diarrhea. Treatment typically involves a balanced diet and niacin supplementation under medical supervision.

High-Dose Niacin Therapy: Potential Benefits and Risks

Research has explored the use of high-dose niacin, available by prescription, for various health conditions. However, it’s crucial to understand that such doses can be toxic and should only be administered under strict medical supervision.

Conditions Studied for High-Dose Niacin Treatment

1. High cholesterol
2. Atherosclerosis and heart disease
3. Diabetes
4. Osteoarthritis
5. Alzheimer’s disease
6. Cataracts

Can high-dose niacin effectively manage these conditions? While some studies have shown promising results, the potential side effects and risks associated with high doses necessitate careful consideration and medical oversight.

Niacin and Cholesterol Management: A Double-Edged Sword

Since the 1950s, niacin has been used to lower elevated LDL (bad) cholesterol and triglyceride levels in the blood. Its effectiveness in improving lipid profiles has made it a valuable tool in cardiovascular health management. However, the benefits come with potential drawbacks that require careful consideration.

Side Effects of High-Dose Niacin for Cholesterol Management

• Flushing of the skin
• Stomach upset (usually temporary)
• Headache
• Dizziness
• Blurred vision
• Increased risk of liver damage

How can these side effects be mitigated? Time-release formulations of niacin have been developed to reduce flushing, one of the most common and uncomfortable side effects. However, long-term use of these formulations has been associated with an increased risk of liver damage, underscoring the importance of medical supervision when using high-dose niacin therapy.

Niacin’s Role in Cardiovascular Health: Beyond Cholesterol

Research has indicated that niacin may have broader implications for cardiovascular health beyond its cholesterol-lowering effects. Several studies have explored its potential in reducing the progression of atherosclerosis and lowering the risk of heart attacks and strokes in individuals with existing heart disease.

Key Findings from Cardiovascular Studies

1. Slowed progression of atherosclerosis when combined with colestipol
2. Reduced risk of first heart attack or stroke when used with simvastatin
3. Potential reduction in the risk of second heart attacks when used alone

Does niacin therapy significantly impact mortality rates in heart disease patients? While some studies have shown a reduction in death risk, results have been mixed, and more research is needed to fully elucidate niacin’s impact on cardiovascular mortality.

The Complex Relationship Between Niacin and Diabetes

Niacin’s relationship with diabetes is multifaceted and depends on the type of diabetes being considered. Its effects on blood sugar levels and potential protective properties for pancreatic cells make it a subject of ongoing research in the field of diabetes management.

Niacin and Type 1 Diabetes

In type 1 diabetes, the body’s immune system attacks and destroys insulin-producing cells in the pancreas. Some research has suggested that niacinamide, a form of vitamin B3, may help protect these cells for a time, potentially slowing the progression of the disease. However, studies investigating whether high-dose niacinamide can reduce the risk of type 1 diabetes in at-risk children have yielded conflicting results, highlighting the need for further research.

Niacin and Type 2 Diabetes

The relationship between niacin and type 2 diabetes is more complicated. While niacin can help lower the high levels of fats and cholesterol often seen in type 2 diabetes patients, it may also raise blood sugar levels. This dual effect creates a challenging scenario for diabetes management.

Is niacin supplementation safe for individuals with type 2 diabetes? Due to the potential for increased blood sugar levels, niacin therapy should only be undertaken under close medical supervision for individuals with diabetes. Regular monitoring of blood glucose levels is essential to ensure safe and effective treatment.

Exploring Niacin’s Potential in Osteoarthritis Treatment

While research on niacin’s role in osteoarthritis is still in its early stages, preliminary studies have shown promising results. One study suggested that niacinamide, a form of vitamin B3, may improve arthritis symptoms and potentially reduce the need for non-steroidal anti-inflammatory drugs (NSAIDs).

Potential Benefits of Niacinamide for Osteoarthritis

• Increased joint mobility
• Reduced reliance on NSAIDs
• Potential improvement in overall arthritis symptoms

How does niacinamide potentially alleviate osteoarthritis symptoms? While the exact mechanisms are not fully understood, it’s thought that niacinamide may have anti-inflammatory properties and could help improve joint function. However, more comprehensive research is needed to confirm these initial findings and establish optimal dosing and treatment protocols.

Niacin’s Emerging Role in Cognitive Health and Eye Disease Prevention

Recent research has begun to explore niacin’s potential benefits for cognitive health and eye disease prevention. While these areas of study are still in their early stages, the preliminary findings suggest intriguing possibilities for niacin’s role in maintaining brain and eye health as we age.

Niacin and Alzheimer’s Disease

Population studies have revealed an interesting correlation between dietary niacin intake and the risk of Alzheimer’s disease. Individuals with higher levels of niacin in their diet appear to have a lower risk of developing this neurodegenerative condition. However, it’s important to note that these studies have focused on dietary intake rather than supplementation, and no clinical trials have yet evaluated the effects of niacin supplements on Alzheimer’s disease prevention or progression.

What mechanisms might explain niacin’s potential protective effect against Alzheimer’s disease? While the exact pathways are not yet clear, niacin’s role in cellular energy production, DNA repair, and antioxidant functions may contribute to its potential neuroprotective properties. Further research is needed to elucidate these mechanisms and determine whether niacin supplementation could be a viable strategy for Alzheimer’s prevention or treatment.

Niacin and Cataract Prevention

Eye health is another area where niacin may play a beneficial role. A large population study found that individuals with higher dietary niacin intake had a lower risk of developing cataracts. Cataracts, a clouding of the eye’s natural lens, are a common age-related condition that can significantly impact vision and quality of life.

How might niacin contribute to cataract prevention? Niacin’s antioxidant properties may help protect the lens from oxidative stress, a key factor in cataract formation. Additionally, niacin’s role in cellular energy production could support the metabolic needs of the lens, potentially slowing age-related changes that lead to cataract development.

Navigating Niacin Supplementation: Safety Considerations and Best Practices

While niacin offers numerous potential health benefits, it’s crucial to approach supplementation with caution, particularly when considering high doses. Understanding the proper use of niacin supplements and potential interactions with other medications is essential for safe and effective treatment.

Guidelines for Safe Niacin Supplementation

1. Consult with a healthcare provider before starting niacin supplementation, especially if you have pre-existing health conditions or are taking other medications.
2. Start with low doses and gradually increase as tolerated to minimize side effects such as flushing.
3. Be aware of potential interactions with other cholesterol-lowering medications, diabetes drugs, and blood thinners.
4. Monitor liver function regularly when taking high-dose niacin supplements.
5. Choose the appropriate form of niacin (niacin, niacinamide, or inositol hexanicotinate) based on your health goals and tolerance.

Is it possible to meet niacin requirements through diet alone? For most individuals, a balanced diet rich in niacin-containing foods such as lean meats, nuts, legumes, and fortified grains can provide adequate amounts of this essential nutrient. Supplementation should be considered only when dietary intake is insufficient or when therapeutic doses are recommended by a healthcare provider.

Potential Interactions and Precautions

• Statins: Combining niacin with statins may increase the risk of muscle damage (rhabdomyolysis).
• Diabetes medications: Niacin can interfere with blood sugar control, necessitating careful monitoring and potential dosage adjustments.
• Blood thinners: Niacin may enhance the effects of blood-thinning medications, increasing the risk of bleeding.
• Alcohol: Consuming alcohol while taking high-dose niacin can exacerbate flushing and increase the risk of liver damage.

How can individuals minimize the risk of adverse effects when taking niacin supplements? Adhering to recommended dosages, regular medical check-ups, and open communication with healthcare providers about all medications and supplements being taken are crucial steps in ensuring safe and effective niacin supplementation.

Future Directions in Niacin Research: Promising Avenues and Unanswered Questions

As our understanding of niacin’s diverse physiological roles continues to expand, researchers are exploring new potential applications and seeking to refine existing therapies. Several areas of ongoing research hold promise for unlocking further benefits of this versatile vitamin.

Emerging Areas of Niacin Research

1. Niacin’s role in cellular aging and DNA repair
2. Potential applications in neurodegenerative disorders beyond Alzheimer’s disease
3. Exploration of niacin’s impact on gut microbiome health
4. Development of novel niacin formulations with improved safety profiles
5. Investigation of niacin’s potential in cancer prevention and treatment

What challenges must be overcome to fully realize niacin’s therapeutic potential? One major hurdle is developing formulations that maintain niacin’s benefits while minimizing side effects, particularly flushing and liver toxicity. Additionally, larger, long-term clinical trials are needed to definitively establish niacin’s efficacy and safety for various health conditions.

The Promise of Personalized Niacin Therapy

As the field of personalized medicine advances, researchers are exploring how individual genetic variations may influence responses to niacin therapy. This approach could lead to more tailored treatment strategies, optimizing benefits while minimizing risks for each patient.

How might genetic testing inform niacin therapy in the future? Genetic markers related to niacin metabolism, lipid processing, and inflammatory responses could help predict an individual’s likelihood of benefiting from niacin treatment, as well as their risk of experiencing side effects. This personalized approach could revolutionize the use of niacin in preventive and therapeutic contexts.

Integrating Niacin into a Holistic Health Strategy

While niacin supplementation can offer significant health benefits in certain situations, it’s important to view it as part of a broader approach to health and wellness. Integrating niacin into a comprehensive health strategy that includes a balanced diet, regular exercise, stress management, and other lifestyle factors can maximize its potential benefits.

Complementary Approaches to Enhance Niacin’s Effects

• Dietary modifications to support cardiovascular health
• Regular physical activity to improve lipid profiles and overall metabolism
• Stress reduction techniques to support adrenal function and hormone balance
• Adequate hydration to help manage flushing and support overall health
• Incorporation of other antioxidant-rich foods and supplements to enhance niacin’s protective effects

How can individuals create a balanced approach to niacin supplementation? Working with healthcare providers to develop a personalized plan that considers individual health goals, risk factors, and lifestyle factors is key. This collaborative approach can help ensure that niacin supplementation is used safely and effectively as part of a comprehensive health strategy.

In conclusion, niacin’s multifaceted role in human health offers exciting possibilities for disease prevention and treatment. From its well-established effects on cholesterol management to its emerging potential in cognitive health and beyond, niacin continues to be a subject of intense scientific interest. As research progresses, our understanding of how to best harness niacin’s benefits while minimizing risks will undoubtedly evolve, potentially opening new avenues for improving human health and longevity.

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.

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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.