Overview
Do not confuse niacin with NADH, niacinamide, inositol nicotinate, IP-6, or tryptophan. See the separate listings for these topics.
Prescription forms of niacin are approved by the US Food and Drug Administration (FDA) for high cholesterol and to increase levels of a specific type of good cholesterol, known as HDL. Niacin supplements and prescription products are also taken by mouth for preventing vitamin B3 deficiency and related conditions such as pellagra.
How does it work ?
Niacin is required for the proper function of fats and sugars in the body and to maintain healthy cells. At high doses, 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.
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 some foods containing flour 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 & Effectiveness ?
Likely Effective for
- Abnormal levels of cholesterol or blood fats (dyslipidemia). 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. 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.
- A disease caused by niacin deficiency (pellagra). Niacin is approved by the U.S. Food and Drug Administration (FDA) for this use. However, niacin can cause "flushing" (redness, itching, and tingling). So another product, called niacinamide, is sometimes preferred because it doesn't cause this side effect.
Possibly Effective for
- Abnormal levels of blood fats in people with HIV/AIDS. Taking niacin seems to improve levels of cholesterol and blood fats called triglycerides in patients with this condition.
- A grouping of symptoms that increase the risk of diabetes, heart disease, and stroke (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.
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 disease. People who consume higher amounts of niacin from food and multivitamins seem to have a lower risk of getting Alzheimer disease than people who consume less niacin. But there is no evidence that taking a niacin supplement helps to prevent Alzheimer 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.
- An infection of the intestines that causes diarrhea (cholera). Taking niacin by mouth seems to reduce diarrhea in people with cholera.
- Erectile dysfunction (ED). Taking extended-release niacin at bedtime for 12 weeks seems to help men who have ED and high lipid levels maintain an erection during sexual intercourse.
- High levels of phosphate in the blood (hyperphosphatemia). People with kidney failure might have high blood levels of phosphate. Some early research shows that taking niacin 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 does not lower blood phosphate levels in people who are also taking medications 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 this condition.
- 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 use disorder.
- Athletic performance.
- Attention deficit-hyperactivity disorder (ADHD).
- Depression.
- Dizziness.
- Drug-induced hallucinations.
- Migraine.
- Motion sickness.
- Schizophrenia.
- Other conditions.
Side Effects
A common 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.
Special Precautions and Warnings
Children: Niacin is LIKELY SAFE when taken by mouth in the recommended amounts for each age group. But children should avoid taking doses of niacin above the daily upper limits, which are 10 mg for children 1-3 years of age, 15 mg for children 4-8 years of age, 20 mg for children 9-13 years of age, and 30 mg for children 14-18 years of age.
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 disease: People with Crohn 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 ?
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).
Moderate Interaction
Be cautious 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.
Minor Interaction
Be watchful with this combination
Dosing
ADULTS
BY MOUTH:
- General: Some dietary supplement products list niacin on the label in niacin equivalents (NE). 1 mg of niacin is the same as 1 mg NE. When niacin is listed on a label as NE, it might include other forms of niacin as well, including niacinamide, inositol nicotinate, and tryptophan. The daily recommended dietary allowances (RDAs) for niacin in adults are 16 mg NE for men, 14 mg NE for women, 18 mg NE for pregnant women, and 17 mg NE for lactating women.
- 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).
- For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 60 mg of niacin has been used.
- For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 60 mg of niacin has been used.
BY MOUTH:
- General: The daily recommended dietary allowances (RDAs) for niacin in children are 2 mg NE for infants 0-6 months of age, 4 mg NE for infants 7-12 months of age, 6 mg NE for children 1-3 years of age, 8 mg NE for children 4-8 years of age, 12 mg NE for children 9-13 years of age, 16 mg NE for boys 14-18 years of age, and 14 mg NE for girls 14-18 years of age.
- For preventing and treating vitamin B3 deficiency and related conditions such as pellagra: 100-300 mg per day of niacin, given in divided doses.
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