Related to Vitamins & Supplements

NIACIN AND NIACINAMIDE (VITAMIN B3)

OTHER NAME(S):

3-Pyridine Carboxamide, 3-Pyridinecarboxylic Acid, Acide Nicotinique, Acide Pyridine-Carboxylique-3, Amide de l’Acide Nicotinique, Anti-Blacktongue Factor, Antipellagra Factor, B Complex Vitamin, Complexe de Vitamines B, Facteur Anti-Pellagre, Niacin-Niacinamide, Niacin/Niacinamide, Niacina y Niacinamida, Niacinamide, Niacine, Niacine et Niacinamide, Nicamid, Nicosedine, Nicotinamide, Nicotinic Acid, Nicotinic Acid Amide, Nicotylamidum, Pellagra Preventing Factor, Vitamin B3, Vitamin PP, Vitamina B3, Vitamine B3, Vitamine PP.

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Overview

Overview Information

Niacin is a form of vitamin B3. It is found in foods such as yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Niacin is also produced in the body from tryptophan, which is found in protein-containing food. When taken as a supplement, niacin is often found in combination with other B vitamins.

Do not confuse niacin with niacinamide, inositol nicotinate, IP-6, or tryptophan. See the separate listings for these topics.

Niacin is commonly taken by mouth for high cholesterol and to increase levels of a specific type of good cholesterol, known as HDL. Niacin is also taken by mouth for preventing vitamin B3 deficiency and related conditions such as pellagra. It is also taken by mouth for metabolic syndrome and diarrhea caused by cholera infection.

How does it work?

Niacinamide can be made from niacin in the body. Niacin is converted to niacinamide when it is taken in amounts greater than what is needed by the body. Niacin and niacinamide are easily dissolved in water and are well-absorbed when taken by mouth.

Niacin and niacinamide are required for the proper function of fats and sugars in the body and to maintain healthy cells. At high doses, niacin and niacinamide can have different effects. Niacin might help people with heart disease because of its beneficial effects on clotting. It may also improve levels of a certain type of fat called triglycerides in the blood. Niacinamide has no beneficial effects on fats and should not be used for treating high cholesterol or high fat levels in the blood.

Niacin deficiency can cause a condition called pellagra, which causes skin irritation, diarrhea, and dementia. Pellagra was common in the early twentieth century, but is less common now, since foods are now fortified with niacin. Pellagra has been virtually eliminated in western culture.

People with poor diet, alcoholism, and some types of slow-growing tumors called carcinoid tumors might be at risk for niacin deficiency.

Uses

Uses & Effectiveness?

Likely Effective for

Abnormal levels of blood fats. Some niacin products are approved by the U.S. Food and Drug Administration (FDA) as prescription products for treating abnormal levels of blood fats. These prescription niacin products typically come in high strengths of 500 mg or higher. Dietary supplement forms of niacin usually come in strengths of 250 mg or less. Since very high doses of niacin are required for improving cholesterol levels, dietary supplement niacin usually isn't appropriate. For people who need to lower low-density lipoprotein (LDL or "bad") cholesterol, the prescription drug class called "statins" is used. Niacin might be used in people with high levels of both cholesterol AND blood fats called triglycerides. Niacin may be combined with other cholesterol-lowering drugs when diet and single-drug therapy is not enough. Niacin improves cholesterol levels, but does not improve cardiovascular outcomes such as heart attacks and strokes.
Treatment and prevention of niacin deficiency, and certain conditions related to niacin deficiency such as pellagra. Niacin is approved by the U.S. Food and Drug Administration (FDA) for these uses. However, using niacinamide instead of niacin is sometimes preferred because niacinamide doesn't cause "flushing," (redness, itching and tingling), a side effect of niacin treatment.

Possibly Effective for

Diarrhea from an infection called cholera. Taking niacin by mouth seems to control the loss of fluid due to cholera.
Abnormal levels of blood fats in people with HIV/AIDS. Taking niacin seems to improve levels of cholesterol and blood fats called triglycerides in HIV/AIDS patients with abnormal blood fat levels due to antiretroviral treatment.
Metabolic syndrome. Taking niacin seems to increase levels of high-density lipoprotein (HDL or "good") cholesterol and reduce levels of blood fats called triglycerides in people with metabolic syndrome. Taking the niacin along with a prescription omega-3 fatty acid seems to work even better.

Ineffective for

Cardiovascular disease. High quality research shows that niacin does not prevent cardiovascular events such as a heart attack or stroke or death related to cardiovascular disease in people who take niacin to prevent or treat cardiovascular disease. Niacin has not been shown to reduce the risk of death. Niacin improves cholesterol levels, but it does not improve outcomes related to cardiovascular disease. Niacin should not be taken to treat or prevent cardiovascular disease.

Insufficient Evidence for

Hardening of the arteries (atherosclerosis). Taking niacin by mouth along with medicines called bile acid sequestrants might reduce hardening of the arteries in men with this condition. It seems to work best in men with high levels of blood fats called triglycerides. But taking niacin does not seem to reduce hardening of the arteries in patients with a condition called peripheral arterial disease (PAD). Also, niacin does not prevent cardiovascular events such as a heart attack or stroke.
Alzheimer's disease. People who consume higher amounts of niacin from food and multivitamins seem to have a lower risk of getting Alzheimer's disease than people who consume less niacin. But there is no evidence that taking a stand-alone niacin supplement helps to prevent Alzheimer's disease.
Cataracts. People who eat a diet high in niacin might have a reduced chance of developing nuclear cataracts. Nuclear cataract is the most common type of cataract. The effect of taking niacin supplementation is unknown.
Erectile dysfunction. Taking extended-release niacin 1.5 grams at bedtime for 12 weeks seems to help men with erectile dysfunction and high lipid levels maintain an erection during sexual intercourse.
Exercise performance. Research shows that taking a supplement containing niacin and other ingredients before exercise does not improve performance during exercise in men.
High levels of phosphate in the blood (hyperphosphatemia). High blood levels of phosphate can result from kidney dysfunction. Some early research shows that taking niacin by mouth can reduce blood levels of phosphate in people with end-stage kidney disease and high levels of blood phosphate. But other research shows that taking niacin by mouth at a higher dose does not lower blood phosphate levels when taken along with medication used to lower blood phosphate levels.
Blockage of the vein in the eye (retinal vein occlusion): Early research shows that taking niacin might improve eyesight in people with a blockage in the retinal vein.
Sickle cell disease: Early research shows that taking niacin does not improve the levels of blood fats in people with sickle cell disease.
Acne.
Alcohol dependence.
Attention deficit-hyperactivity disorder (ADHD).
Depression.
Dizziness.
Drug-induced hallucinations.
Migraine or premenstrual headache.
Motion sickness.
Schizophrenia.
Other conditions.

More evidence is needed to rate niacin for these uses.

Side Effects

Side Effects & Safety

Niacin is LIKELY SAFE for most people when taken by mouth. A common minor side effect of niacin is a flushing reaction. This might cause burning, tingling, itching, and redness of the face, arms, and chest, as well as headaches. Starting with small doses of niacin and taking 325 mg of aspirin before each dose of niacin will help reduce the flushing reaction. Usually, this reaction goes away as the body gets used to the medication. Alcohol can make the flushing reaction worse. Avoid large amounts of alcohol while taking niacin.

Other minor side effects of niacin are stomach upset, intestinal gas, dizziness, pain in the mouth, and other problems.

When doses of over 3 grams per day of niacin are taken, more serious side effects can happen. These include liver problems, gout, ulcers of the digestive tract, loss of vision, high blood sugar, irregular heartbeat, and other serious problems.

When used daily for multiple years, niacin might increase the risk of developing diabetes.

Some concern has been raised about stroke risk in people taking niacin. In one large study, people who took high doses of niacin had a two-fold greater risk of stroke compared to those not taking niacin. However, it is unlikely that this outcome was due to niacin. Other research has shown that niacin has no effect on the risk of stroke.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Niacin is LIKELY SAFE for pregnant and breast-feeding women when taken in the recommended amounts. The recommended amount of niacin for pregnant or breast-feeding women is 30 mg per day for women under 18 years of age, and 35 mg for women over 18.

Allergies: Niacin might worsen allergies by causing histamine, the chemical responsible for allergic symptoms, to be released.

Heart disease/unstable angina: Large amounts of niacin can increase the risk of irregular heartbeat. Use with caution.

Crohn's disease: People with Crohn's disease might have low niacin levels and require supplementation during flare-ups.

Diabetes: Niacin might increase blood sugar. People with diabetes who take niacin should check their blood sugar carefully.

Gallbladder disease: Niacin might make gallbladder disease worse.

Gout: Large amounts of niacin might bring on gout.

Kidney disease: Niacin might accumulate in people with kidney disease. This might cause harm.

Liver disease: Niacin might increase liver damage. Don't use large amounts if you have liver disease.

Stomach or intestinal ulcers: Niacin might make ulcers worse. Don't use large amounts if you have ulcers.

Very low blood pressure: Niacin might lower blood pressure and worsen this condition.

Surgery: Niacin might interfere with blood sugar control during and after surgery. Stop taking niacin at least 2 weeks before a scheduled surgery.

Fatty deposits around tendons (tendon xanthomas): Niacin might increase the risk of infections in xanthomas.

Thyroid disorders: Thyroxine is a hormone produced by the thyroid gland. Niacin might lower blood levels of thyroxine. This might worsen symptoms of certain thyroid disorders.

Interactions

Interactions?

Moderate Interaction

Be cautious with this combination

Alcohol (ethanol) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Niacin can cause flushing and itchiness. Consuming alcohol along with niacin might make the flushing and itching worse. There is also some concern that consuming alcohol with niacin might increase the chance of having liver damage.
Allopurinol (Zyloprim) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Allopurinol (Zyloprim) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of allopurinol (Zyloprim).
Carbamazepine (Tegretol) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Carbamazepine (Tegretol) is broken down by the body. There is some concern that niacinamide might decrease how fast the body breaks down carbamazepine (Tegretol). But there is not enough information to know if this is important.
Clonidine (Catapres) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Clonidine and niacin both lower blood pressure. Taking both niacin with clonidine might cause your blood pressure to become too low.
Medications for diabetes (Antidiabetes drugs) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Long-term use of niacin and niacinamide might increase blood sugar. By increasing blood sugar, niacin and niacinamide might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), metformin (Glucophage), nateglinide (Starlix), repaglinide (Prandin), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
Medications used for lowering cholesterol (Bile acid sequestrants) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Some medication for lowering cholesterol called bile acid sequestrants can decrease how much niacin or niacinamide the body absorbs. This might reduce the effectiveness of niacin or niacinamide. Take niacin or niacinamide and the medications at least 4 hours apart. Some of these medications used for high cholesterol include cholestyramine (Questran) and colestipol (Colestid).
Medications used for lowering cholesterol (Statins) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Niacin can adversely affect the muscles. Some medications used for lowering cholesterol called statins can also affect the muscles. Taking niacin along with these medications for lowering cholesterol might increase the risk of muscle problems. Some of these medications used for high cholesterol include rosuvastatin (Crestor), atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor).
Primidone (Mysoline) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Primidone (Mysoline) is broken down by the body. There is some concern that niacinamide might decrease how fast the body breaks down primidone (Mysoline). But there is not enough information to know if this is important.
Probenecid interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Probenecid is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of probenecid.
Sulfinpyrazone (Anturane) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Sulfinpyrazone (Anturane) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of sulfinpyrazone (Anturane).

Minor Interaction

Be watchful with this combination

Aspirin interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Aspirin is often used with niacin to reduce the flushing caused by niacin. Taking high doses of aspirin might decrease how fast the body gets rid of niacin. This could cause there to be too much niacin in the body and possibly lead to side effects. But the low doses of aspirin most commonly used for niacin-related flushing don't seem to be a problem.
Nicotine patch (Transdermal nicotine) interacts with NIACIN AND NIACINAMIDE (VITAMIN B3)

Niacin can sometimes cause flushing and dizziness. The nicotine patch can also cause flushing and dizziness. Taking niacin and/or niacinamide (vitamin B3) and using a nicotine patch can increase the possibility of becoming flushed and dizzy.

Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

For high cholesterol:The effects of niacin are dose-dependent. Doses of niacin as low as 50 mg and as high as 12 grams each day have been used. However, the biggest increases in HDL and decreases in triglycerides occur at 1200 to 1500 mg/day. Niacin's greatest effects on LDL occur at 2000 to 3000 mg/day. Niacin is often used with other medications for improving cholesterol levels.
For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 300-1000 mg daily in divided doses.
For treating hardening of the arteries: Doses of niacin have been as high as 12 grams daily. However, a dose of about 1 to 4 grams of niacin daily, alone or along with statins or bile acid sequestrants (a cholesterol-lowering medicine), has been used for up to 6.2 years.
For reducing fluid loss caused by cholera toxin: 2 grams daily has been used.
For abnormal blood fat levels due to treatment for HIV/AIDS: Up to 2 grams daily has been used.
For metabolic syndrome: 2 grams of niacin has been taken daily for 16 weeks. In some cases, niacin 2 grams daily, alone or at this dosage, is taken along with 4 grams of prescription omega-3 ethyl esters (Lovaza, GlaxoSmithKline Pharmaceuticals).

BY IV:

For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 60 mg of niacin has been used.

AS A SHOT:

For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 60 mg of niacin has been used.

CHILDREN

BY MOUTH:

For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 100-300 mg per day of niacin, given in divided doses.

The daily recommended dietary allowances (RDAs) of niacin are: Infants 0-6 months, 2 mg; Infants 7-12 months, 4 mg; Children 1-3 years, 6 mg; Children 4-8 years, 8 mg; Children 9-13 years, 12 mg; Men 14 years and older, 16 mg; Women 14 years and older, 14 mg; Pregnant women, 18 mg; and Lactating women, 17 mg. The tolerable upper level (UL) for maximum daily dose of niacin is: Children 1-3 years, 10 mg; Children 4-8 years, 15 mg; Children 9-13 years, 20 mg; Adults, including Pregnant and Lactating women, 14-18 years, 30 mg; and Adults, including pregnant and breast-feeding women, older than 18 years, 35 mg.

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