Price range:  1-2 containers: $11.50 each    3-5:  $10.50    6+: $9.95

 

 

Niacin, or vitamin B3, works with the liver.  It reduces the production of LDL (“bad”) cholesterol, a leading cause of high blood pressure.  In addition, niacin helps decrease platelet aggregation and blood clotting. 

According to the University of Maryland, niacin “is more effective in increasing HDL ("good") levels than other cholesterol-lowering medications.”

Niacin must be time-released to reduce the potency of side effects.  Because its action on cholesterol levels is so strong, the body may react to niacin supplements adversely, causing discomfort.  Time release capsules in this formula prevent this danger while preserving the extraordinary health benefits of the vitamin.

 

(Click to Read What the University of Maryland Medical Center Has to Say About Niacin)

 

Other Uses for Niacin:

Niacin also plays a role in the production of sex and stress-related hormones in the adrenal gland.  All B vitamins are used to make glucose out of carbohydrates, the quintessential phase of energy production.  Similarly, B vitamins are necessary for breaking down fats and proteins.  Furthermore, B vitamins help promote the health of skin and hair, eyes, liver, and mouth. 

The body can convert the amino acid tryptophan into niacin, making niacin easier for the body to come by.  However, extra high doses of niacin are necessary in order to experience its cholesterol-lowering effects.  Niacin supplements are the only way to achieve the proper dosage.

Another possible use for niacin treatment is in cases of osteoarthritis.  Nacinamide, a derivative of vitamin B3 niacin, may help relieve the symptoms of arthritis or reduce the need for anti-inflammatory drugs. 

Healthy niacin levels are needed to prevent cataracts.

Because niacin is such an important vitamin, people suffering from burns are recommended to take niacin supplements because high amounts of nutrients are essential to healing serious burns.

The latest research on niacin is investigating its use in skin care products as an anti-aging supplement, treatment for acne, and even prevention of skin cancer.

 

 

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“What is cholesterol-lowering niacin?”  From MedicineNet.com.  Doctor's Response:

Niacin, one of the water-soluble B vitamins, improves all lipoproteins when given in doses well above the vitamin requirement. Niacin lowers the total cholesterol, "bad" LDL-cholesterol, and triglyceride levels, while raising the "good" HDL-cholesterol level.

Niacin is inexpensive and widely accessible to patients without a prescription but must not be used for cholesterol lowering without the monitoring of a physician because of the potential side effects. (Nicotinamide, another form of the vitamin niacin, does not lower cholesterol levels and should not be used in the place of nicotinic acid.)

All patients taking naicin acid to lower serum cholesterol should be closely monitored by their doctor to avoid complications from this medication. Self-medication with niacin should definitely be avoided because of the possibility of missing a serious side effect if not under a doctor's care.

Niacin reduces LDL-cholesterol levels by 10 to 20 percent, reduces triglycerides by 20 to 50 percent, and raises HDL-cholesterol by 15 to 35 percent.

A common and troublesome side effect of niacin is flushing or hot flashes, which are the result of the widening of blood vessels. Most patients develop a tolerance to flushing, and in some patients, it can be decreased by taking the drug during or after meals or by the use of aspirin or other similar medications prescribed by your doctor. The effect of high blood pressure medicines may also be increased while you are on niacin.

If you are taking high blood pressure medication, it is important to set up a blood pressure monitoring system while you are getting used to your new niacin regimen. A variety of gastrointestinal symptoms including nausea, indigestion, gas, vomiting, diarrhea, and the activation of peptic ulcers have been seen with the use of niacin.

Three other major adverse effects include liver problems, gout, and high blood sugar. Risk of these three complications increases as the dose of niacin is increased. Your doctor will probably not prescribe this medicine for you if you have diabetes, because of the effect on your blood sugar.

 

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Niacin, University of Maryland Medical Center:
Common Forms: Niacinamide, Nicotinic acid, Nicotinamide, Inositol hexaniacinate

Overview
Vitamin B3, also called niacin, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy. These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein. B complex vitamins also play an important role in maintaining muscle tone along the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver.

Niacin plays an important role in ridding the body of toxic and harmful chemicals. It also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. Niacin is effective in improving circulation and reducing cholesterol levels in the blood. Niacin needs can be partially met by eating foods containing protein because the human body is able to convert tryptophan, an amino acid, into niacin.

Dietary deficiency of niacin tends to only occur in areas of the world where people eat corn as a staple and don't use lime in fertilization. Corn is the only grain that is low in niacin. Lime releases tryptophan which, again, can be converted to niacin in the body. Symptoms of mild deficiency include indigestion, fatigue, canker sores, vomiting, and depression. Severe deficiency of both niacin and tryptophan 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 results in burning in the mouth and a swollen, bright red tongue In the United States alcoholism is the prime cause of Vitamin B3 deficiency.

Uses
Extremely high doses of niacin (available by prescription) have been shown to prevent and/or improve symptoms of the following conditions. Because of risk of toxicity people should always consult a knowledgeable health care provider before starting high doses of niacin.

High Cholesterol
Niacin is commonly used to lower elevated LDL ("bad") cholesterol and triglyceride (fat) levels in the blood and is more effective in increasing HDL ("good") levels than other cholesterol-lowering medications. However. high doses of niacin produce the side effects of flushing of the skin (which can be reduced by taking aspirin 30 minutes before the niacin), stomach upset (which usually subsides in a few weeks), headache, dizziness, blurred vision, and liver damage. Although the time-release form of niacin reduces flushing, long-term use of high doses is associated with liver damage. (This product is not a high dose.)

Atherosclerosis
High doses of niacin medications are used to prevent development of atherosclerosis (plaque along the blood vessels that can cause blockage) and to reduce recurrent complications such as heart attack and peripheral vascular disease (atherosclerosis of the blood vessels in the legs that can cause pain with walking, called intermittent claudication) in those with the condition.

According to a review of major clinical trials, the use of niacin for prevention and treatment of atherosclerosis and related conditions is "based on strong and consistent evidence" and appears to be as effective as certain medications for heart disease. Studies also suggest that high dose niacin may help relieve the symptoms of claudication – namely diminish the pain experienced with walking.

A recent study also found that the combination of niacin and a cholesterol-lowering drug called simvastatin (which belongs to a class known as HmG CoA reductase inhibitors or statins) may dramatically slow the progression of heart disease, reducing risk of heart attack, and even death.

Diabetes
Because diabetes is often associated with atherosclerosis and heart disease, people with diabetes may benefit from nutrients that help manage elevated cholesterol levels and high blood pressure. Although niacin has been shown to boost HDL cholesterol and decrease triglyceride and LDL levels, there has been some concern that it may also raise blood sugar levels. In a recent study of 125 people with diabetes and 343 people without the condition, high doses of niacin (roughly 3000 mg/day), increased blood sugar in both groups, but hemoglobin A1C (considered a better measure of blood sugar over time) actually decreased in the diabetes group over a 60-week follow-up period. For this reason, if you have diabetes, niacin should only be used under the close monitoring of a qualified health care provider.

Osteoarthritis
Some preliminary studies suggest that vitamin B3, as niacinamide, may improve arthritis symptoms, including increasing joint mobility and reducing the amount of anti-inflammatory medications needed. Researchers speculate that niacinamide may aid cartilage repair (damage to joint cartilage causes arthritis) and suggest that it may be used safely along with NSAIDs (non-steroidal anti-inflammatory medications) to reduce inflammation. Further research is needed to fully understand how vitamin B3 benefits people with OA and to determine whether the results apply to large numbers of people with the condition. It does appear, however, that niacinamide must be used for at least 3 weeks before the benefits described are seen. Experts also suggest that long-term use (1 to 3 years) may slow the progression of the disease.

Cataracts
Dietary vitamin B3, along with other nutrients is important for normal vision and prevention of cataracts (damage to the lens of the eye which can lead to cloudy vision.) One study including 2900 people living in Australia found that people who consumed the most protein, vitamin A, and vitamins B1 (thiamine), B2, and B3 (niacin) in their diets were significantly less likely to develop cataracts. A follow-up study also found that many supplemental B complex vitamins (including B12, B9, B3, B2, and B1) exert a protective effect against cataracts.

Burns
It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. When skin is burned, a substantial percentage of micronutrients may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the B complex vitamins may aid in the recovery process.

Other
An interesting area of research currently underway is the use of niacin skin care products as anti-aging agents, for treatment of acne, and, possibly, for prevention of skin cancer. Dermatologists expect that there will be information emerging about topical forms of niacin for these purposes over the next few years.

Dietary Sources
The best dietary sources of vitamin B3 are found in beets, brewer's yeast, beef liver, beef kidney, pork, turkey, chicken, veal, fish, salmon, swordfish, tuna, sunflower seeds, and peanuts.

Available Forms
Niacin is available in several different supplement forms: niacinamide, nicotinic acid, and inositol hexaniacinate. The form of niacin that is best tolerated with the least symptoms is 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 the regular niacin; however, the timed-release are more likely to cause liver damage and are therefore not recommended for long-term treatment. Regardless of the form of niacin being used, periodic checking of liver function tests is recommended when high-dose (2 – 6 gm per day) of niacin is used.

How to Take It
Daily requirements for niacin may be higher for those who have cancer, those who are being treated with isoniazid (for tuberculosis), and people with protein deficiencies.

Daily recommendations for niacin from the diet for healthy individuals are listed below.

It is important to note, however, that only extremely high doses of niacin (in the range of 1,500 to 3,000 mg per day in divided doses) are helpful for most medical conditions. Such high doses are considered "pharmacologic" and must be prescribed by a qualified healthcare practitioner. The practitioner will instruct you on increasing the amount of niacin slowly, over the course of 4 to 6 weeks, and to take the medicine with meals to avoid stomach irritation.

Precautions
Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

High doses (75 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 the very high doses used to lower cholesterol and the other conditions mentioned previously, liver damage and stomach ulcers can occur. When taking pharmacologic doses of niacin, your doctor or other healthcare practitioner will periodically check your liver function through a blood test. People with a history of liver disease or stomach ulcers should not take niacin supplements.

Those with diabetes or gallbladder disease should do so only under the close supervision of a healthcare provider. Niacin should not be used if you have gout.

Taking any one of the B complex vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.

Possible Interactions
If you are currently being treated with any of the following medications, you should not use niacin without first talking to your healthcare provider.

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. Niacin either alone or in combination with other B vitamins should be taken at different times from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)

Aspirin
Taking aspirin before taking niacin may reduce flushing associated with this vitamin. This should only be done under the advice of a healthcare practitioner.

Blood Pressure Medications, Alpha-blockers
When niacin is taken with certain blood pressure medications known as alpha-blockers (such as prazosin, doxazosin, and guanabenz), the likelihood of side effects from these medications is increased.

Cholesterol-lowering Medications
Niacin binds bile-acid sequestrants (cholesterol-lowering medications such as colestipol, colesevelam, and cholestyramine) and may decrease their effectiveness. For this reason, niacin and these medications should be taken at different times of the day.

As described earlier, recent scientific evidence suggests that taking niacin with simvastatin (a drug that belongs to a class of cholesterol-lowering medications known as HMG-CoA reductase inhibitors or statins including atorvastatin and lovastatin as well), appears to slow down the progression of heart disease. However, the combination may also increases the likelihood for serious side effects, such as muscle inflammation or liver damage.

Diabetes Medications
People taking insulin, metformin, glyburide, glipizide, or other medications used to treat high blood sugar levels should monitor their blood sugar levels closely when taking niacin supplements.

Isoniazid (INH)
INH, a medication used to treat tuberculosis, may deplete levels of niacin and cause a deficiency.

Nicotine Patches
The use of nicotine patches with niacin may worsen or increase the risk of flushing reactions associated with this vitamin when used medicinally.

 

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Supporting Research

Adding vitamins to the mix : skin care products that can benefit the skin [press release]. American Academy of Dermatology; March 11, 2000.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Safety. 1998;19(5):355-371.

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.

Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol. Dec 17, 1998;82:74U–81U.

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

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Ding RW, Kolbe K, Merz B, de Vries J, Weber E, Benet Z. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther. 1989;46(6):642-647.

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.

Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.

Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother. 1997;31(6):677-682.

Gardner SF, Schneider EF, Granberry MC, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacother. 1996;16:419–423.

Garg A. Lipid-lowering therapy and macrovascular disease in diabetes mellitus. Diabetes. 1992;41(Suppl 2):111-115.

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. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol. Dec 17, 1998;82:18U–23U.

Guyton JR, Capuzzi DM. Treatment of hyperlipidemia with combined niacin-statin regimens. Am J Cardiol. Dec 17, 1998;82:82U–84U.

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.

Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J ClinPract. 1996;77A(Suppl):28-32.

Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: A pilot study. Inflamm Res. 1996;45:330-334.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:88-99.

Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Dig Dis Sci. 1993;38(9):1614-1618.

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.

Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther. 1982;4(6):423-440.

McCarty MF. Niacinamide therapy for osteoarthritis – does it inhibit nitric oxide synthase induction by interleukin-1 in chondrocytes? Med Hypotheses. 1999;53(4):350-360.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

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

O'Hara J, Nicol CG. The therapeutic efficacy of inositol nicotinate (Hexopal) in intermittent claudication: a controlled trial. Br J Clin Prac. 1988;42(9):377-381.

Omray A. Evaluation of pharmacokinetic parameters of tetracylcine hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.

Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Co., Inc.: 2000:1519-1523.

Rockwell KA. Potential interaction between niacin and transdermal nicotine. Ann Pharmacother. 1993;27(10):1283-1288.

Torkos S. Drug-nutrient interactions: a focus on cholesterol-lowering agents. Int J Integrative Med. 2000;2(3):9-13.

Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (the IMDIAB VI). Diabetes Metab Res Rev. 1999;15(3):181-185.

Whelan AM, Price SO, Fowler SF, et al. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract. 1992;34(2):165-168.

Yee HS, Fong NT, Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother. 1998 Oct;32(10):1030-1043.

Review Date: April 2002

Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; Margie Ullmann-Weil, MS, RD, specializing in combination of complementary and traditional nutritional therapy, Boston, MA. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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Medline—National Institutes of Health
Diet - niacin; Nicotinic acid; Vitamin B3

Definition   
Niacin is a type of B vitamin. It is water-soluble, which means it is not stored in the body. Water-soluble vitamins dissolve in water. Leftover amounts of the vitamin leave the body through the urine. That means you need a continuous supply of such vitamins in your diet.

Function    
Niacin assists in the functioning of the digestive system, skin, and nerves. It is also important for the conversion of food to energy.

Food Sources   
Niacin (also known as vitamin B3) is found in dairy products, poultry, fish, lean meats, nuts, and eggs. Legumes and enriched breads and cereals also supply some niacin.

Side Effects   
A deficiency of niacin causes pellagra. The symptoms include inflamed skin, digestive problems, and mental impairment.

Large doses of niacin can cause liver damage, peptic ulcers, and skin rashes. Even normal doses can be associated with skin flushing. It can be prescribed as a treatment for elevated total cholesterol and other types of lipid disorders, but it should only be used with medical supervision due to its potential for severe side effects.

Why is this medication prescribed?
Niacin is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol and certain fatty substances in your blood. Niacin is also used to prevent and treat pellagra (niacin deficiency), a disease caused by inadequate diet and other medical problems. Niacin is a B-complex vitamin.

How should this medicine be used?
Niacin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet usually is taken two to three times a a day with meals, and the extended-release tablet is taken once a day, at bedtime, with food. Follow the directions on your prescription label or package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take niacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release tablets whole; do not split, chew, or crush them.

Your doctor will probably start you on a low dose of niacin and gradually increase your dose.
Continue to take niacin even if you feel well. Do not stop taking niacin without talking to your doctor.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow? Before taking niacin,
•          tell your doctor and pharmacist if you are allergic to niacin, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs.
•          tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticoagulants (blood thinners) such as warfarin (Coumadin), medications for high blood pressure or diabetes and other vitamins. If you take insulin or oral diabetes medication, your dose may need to be changed because niacin may increase the amount of sugar in your blood and urine.
•          tell your doctor if you drink large amounts of alcohol and if you have or have ever had diabetes; gout; ulcers; allergies; jaundice (yellowing of the skin or eyes); or gallbladder, heart, or liver disease.
•          tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking niacin, call your doctor.
•          if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking niacin.
•          you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
•          remember that alcohol can add to the drowsiness caused by this drug.
•          you should know that niacin causes flushing (redness) of the face and neck. This side effect usually goes away after taking the medicine for a few weeks. Avoid drinking alcohol or hot drinks around the time you take niacin. Taking aspirin or another nonsteroidal anti-inflammatory medication such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) 30 minutes before niacin may reduce the flushing. If you take extended-release niacin at bedtime, the flushing will probably happen while you are asleep. If you wake up and feel flushed, get up slowly, especially if you feel dizzy or faint.

What special dietary instructions should I follow? If you take niacin to reduce the amount of cholesterol and fats in your blood, eat a low-cholesterol, low-fat diet. Follow the diet prescribed by your doctor.

What should I do if I forget a dose?
 Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Niacin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

•          itching, stinging, tingling, or burning of the skin
•          headache
•          blurred vision
•          upset stomach
•          vomiting
•          diarrhea
•          heartburn
•          bloating

If you experience any of the following symptoms, call your doctor immediately:
•          dizziness
•          faintness
•          fast heartbeat
•          yellowing of the skin or eyes

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

 

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Niacin (B3)
A Closer Look @ Supplements  By Jennifer Gruenemay, ACE-Certified, LifeScript Staff Writer
Friday, July 22, 2005

Most people expect that just being alive means they’re healthy enough. But underlying vitamin deficiencies could be causing major problems. Could your energy problems really be a vitamin problem? Could your cranky mood and dry skin really be helped by a supplement? Find out how niacin could be the answer to a number of your deficiency problems. Plus: Test your supplement IQ.

 What Is Niacin?
Niacin (vitamin B3) is a member of the B-complex vitamin family. Like most of the B-vitamins, niacin is primarily utilized for energy metabolism.

 Nicotinic acid (nicotinate), niacinamide, and inositol hexaniacinate are the three forms of this vitamin that are available to us, but all three work in different ways. Of the three, only nicotinic acid and niacinamide can satisfy the recommended daily allowance (RDA) for this nutrient.
 Proper intake of niacin keeps the skin healthy. It can also be used therapeutically to control cholesterol levels, maintain proper circulation, and ease inflammation in arthritics.

Niacin is also useful for balancing blood sugar levels, which helps in the prevention of diabetes.Niacin can also be used to stimulate a healthy nervous system, and eases symptoms of depression, anxiety and insomnia.

How does Niacin work?
B-complex vitamins are a group of eight compounds that scientists used to believe was actually one vitamin.

 When it was later discovered that “vitamin B” was actually a combination of a number of different compounds, it was separated into eight different compounds.

 Each of these compounds are very different, and yet similar in one major way: energy metabolism.

 Along with vitamins B1, B2, B6, pantothenic acid (B5), and biotin, niacin works to release energy from the foods that we eat: protein, fat and carbohydrates.

 Niacin is specifically involved in carbohydrate metabolism, supplying our bodies with much needed energy.

 Studies have discovered one very surprising effect that niacin has on the body. High doses of niacin have been shown to raise HDL (good) cholesterol, and lower LDL (bad) cholesterol and triglycerides.

What is so surprising about this is that niacin has shown an ability to perform this function with more efficiency and fewer side effects than traditional cholesterol-lowering prescription drugs.
This heart-healthy benefit is still being studied, but is showing a promising future. Of the three forms of niacin, only nicotinic acid and inositol hexaniacinate act as cholesterol-lowering agents.

 Circulation disorders are painful and often debilitating problems. Intermittent claudication is a circulation disorder characterized by painful cramping in the calf region, usually brought on by walking.

 Another aggravating disease caused by poor circulation is Raynaud’s disease, causing pain and numbness in the extremities when exposed to cold.

 Niacin allows blood vessels to relax, which improves blood flow and circulation to all regions of the body, including hands and feet. Inositol hexaniacinate is one form of niacin that can have this kind of effect on the circulatory system.

Niacin has shown anti-inflammatory abilities, making it useful for the treatment of rheumatoid arthritis, a disease characterized by inflammation of the joints.

 Anti-inflammatory agents provide a stable environment in the joint region, allowing the body to use other compounds to rebuild damaged cartilage.

 Persons suffering from osteoarthritis may benefit from therapeutic niacin use to help rebuild worn down cartilage.

Make the Most of Niacin
Niacin is an essential vitamin, meaning the body requires a suitable intake of niacin every day in order to function properly.

 The RDA for niacin differs for men and women. Men require 16 mg/day and women need 14 mg/day.

For therapeutic usages, niacin is taken in doses ranging from 1,000-2,000 mg/day. Doses this high absolutely need to be administered and monitored by a physician. Toxicity will not only cause stomach upset, but may also cause bleeding problems, flushed, itchy skin, and liver damage, a very serious side effect.

Using the form inositol hexaniacinate will reduce skin flushing and risk of liver damage, but keep in mind that this form of niacin does not satisfy nutritional requirements. Unless you are under the supervision of a doctor, it is important that you follow only the RDA for this nutrient.
Niacin deficiencies used to be fairly common, resulting in a disease known as Pellagra, a serious condition marked by rash, bright red coloring of the tongue, vomiting, fatigue and memory loss.

Today, deficiencies of niacin are extremely rare, as most grain products are now enriched in niacin. Besides the obvious intake of niacin from diet or supplementation, the human body also has the ability to make niacin.

The amino acid, tryptophan, which is found in eggs, milk and poultry, can be converted to niacin to satisfy the body’s daily nutritional requirements. In fact, half of all the niacin we get from foods is from the conversion of tryptophan.

 For normal daily dietary intake, niacin is found in enriched grain products, and also high protein foods, dairy products and eggs (as tryptophan).

 

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“Antihyperlipidaemic effect of a Monascus purpureus brand dietary supplement on a large sample of subjects at low risk for cardiovascular disease: a pilot study.”

Cicero,-A-F; Brancaleoni,-M; Laghi,-L; Donati,-F; Mino,-M Complement-Ther-Med. 2005 Dec; 13(4): 273-8

Abstract: OBJECTIVES: We planned to carry out a pilot study to evaluate the efficacy and safety as an antihypercholesterolemic agent of a brand dietary supplement made of Monascus purpureus titrated extract, octacosanols and niacin on 111 Caucasian patients with low cardiovascular disease risk (<20% by Framingham algorithms), comparing them with the antihypercholesterolemic effect of a low dosage of Pravastatin on 20 subjects with similar risk profile. RESULTS: In our study, the tested dietary supplement determined a significant decrease of Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C), and Triglycerides (TG) in moderately hypercholesterolemic subjects without clinically relevant change in liver and muscular toxicity markers. The reduction of LDL-C reached the 20%, and it is similar to that obtained with a well-known effective statin like Pravastatin. CONCLUSIONS: Further long-term and double blind evaluation have to be carried out before to infer the observed results, however it appears that the studied dietary supplements could be a safe and efficacious antihypercholesterolemic agent for patients at low risk for cardiovascular diseases.

“Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.”

Brown, B G : Zhao, X Q : Chait, A : Fisher, L D : Cheung, M C : Morse, J S : Dowdy, A A : Marino, E K : Bolson, E L : Alaupovic, P : Frohlich, J : Albers, J J. N-Engl-J-Med. 2001 Nov 29; 345(22): 1583-92 

Abstract:

 

BACKGROUND: Both lipid-modifying therapy and antioxidant vitamins are thought to have benefit in patients with coronary disease. We studied simvastatin-niacin and antioxidant-vitamin therapy, alone and together, for cardiovascular protection in patients with coronary disease and low plasma levels of HDL.

 

METHODS: In a three-year, double-blind trial, 160 patients with coronary disease, low HDL cholesterol levels and normal LDL cholesterol levels were randomly assigned to receive one of four regimens: simvastatin plus niacin, vitamins, simvastatin-niacin plus antioxidants; or placebos. The end points were arteriographic evidence of a change in coronary stenosis and the occurrence of a first cardiovascular event (death, myocardial infarction, stroke, or revascularization).

 

RESULTS: The mean levels of LDL and HDL cholesterol were unaltered in the antioxidant group and the placebo group; these levels changed substantially (by -42 percent and +26 percent, respectively) in the simvastatin-niacin group. The protective increase in HDL2 with simvastatin plus niacin was attenuated by concurrent therapy with antioxidants. The average stenosis progressed by 3.9 percent with placebos, 1.8 percent with antioxidants (P=0.16 for the comparison with the placebo group), and 0.7 percent with simvastatin-niacin plus antioxidants (P=0.004) and regressed by 0.4 percent with simvastatin-niacin alone (P<0.001). The frequency of the clinical end point was 24 percent with placebos; 3 percent with simvastatin-niacin alone; 21 percent in the antioxidant-therapy group; and 14 percent in the simvastatin-niacin-plus-antioxidants group.

 

CONCLUSIONS: Simvastatin plus niacin provides marked clinical and angiographically measurable benefits in patients with coronary disease and low HDL levels. The use of antioxidant vitamins in this setting must be questioned.

 

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