No Flush Niacin (niacin (inositol niacinate))

Dosage of niacin must be carefully adjusted according to the patient's response and tolerance.

Because the pharmacokinetics and, therefore, metabolism of different formulations (i.e., immediate-release, extended-release) of niacin may vary, the manufacturers state that these preparations should not be used interchangeably.

Symptoms of flushing, pruritus, and GI distress associated with niacin therapy may be reduced by initiating therapy with low dosages, gradual escalation of dosage, and avoiding administration of niacin on an empty stomach. Because niacin-induced cutaneous vasodilation appears to be mediated by prostaglandins (e.g., prostacyclin, prostaglandin D2), pretreatment with an inhibitor of prostaglandin synthesis (e.g., aspirin up to the recommended dose of 325 mg administered up to approximately 30 minutes prior to administration of niacin) may reduce flushing.

Niacin should be used with caution in patients with renal or hepatic impairment. In addition, the drug also should be used with caution in patients who consume substantial amounts of alcohol and/or who have a history of liver disease; such patients should be closely monitored. Use of niacin is contraindicated in patients with active liver disease or unexplained, persistent increases in serum aminotransferase concentrations.

Niacin is administered orally. As an antilipemic agent, immediate-release niacin (Niacor(R)) preferably is administered orally with meals. Extended-release niacin (Niaspan(R)) should be administered at bedtime following a low-fat snack. In addition, the manufacturers state that Niaspan(R) tablets should be taken whole and should not be broken, crushed, or chewed before swallowing.

Concomitant administration of niacin with alcohol, hot drinks, or spicy foods may increase the risk of flushing or pruritus; these beverages or foods should be avoided at the time of drug ingestion.

Niacin and niacinamide are administered orally.

No dosing information is available for this tab.

No dosing information is available for this tab.

Niacin reportedly potentiates the hypotensive effect of ganglionic blocking drugs.

Long-term administration of isoniazid may interfere with the conversion of dietary tryptophan to niacin and increase the requirement of niacin.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

• Arterial hemorrhage
• Disease of liver

• Alcohol use disorder
• Invasive surgical procedure
• Peptic ulcer

• 30 day risk period post-myocardial infarction
• Diabetes mellitus
• Disease of liver
• Gout
• Hypophosphatemia
• Hypotension
• Increased risk of bleeding due to coagulation disorder
• Unstable angina pectoris

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

Less Frequent

• Cardiac arrhythmia
• Diarrhea
• Dizziness
• Dry eye
• Dry skin
• Exacerbation of peptic ulcer
• Flushing
• Headache disorder
• Hyperglycemia
• Hyperuricemia
• Myalgia
• Nausea
• Pruritus of skin
• Syncope
• Vomiting

No enhanced messaging available.

No enhanced messaging available.

Animal reproduction studies have not been performed with niacin, and it is also not known whether the drug (at antilipemic dosages) can cause fetal harm or affect reproduction capacity when administered to pregnant women. Niacin should not be used in women who are or may become pregnant or in nursing women unless the possible benefits outweigh the potential risks. Currently, most experts recommend that hyperlipoproteinemias in pregnant women be managed with dietary measures; consultation with a lipid specialist may be indicated for pregnant women with severe forms of hyperlipidemia. If the patient becomes pregnant while receiving niacin for primary hypercholesterolemia, the drug should be discontinued. If the patient being treated with niacin for hypertriglyceridemia or mixed dyslipidemia becomes pregnant, the benefits and risks of continued therapy should be assessed on an individual basis.

Administration of supplementary doses of niacin during pregnancy has not been associated with any adverse effects to the mother or fetus. However, toxicologic studies have not been performed with large doses of niacin, and large doses of the drug should not be used in women who are or may become pregnant unless the possible benefits outweigh the potential risks to the fetus.

Niacin is distributed in human milk. Because of the potential for serious adverse effects in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

Administration of supplementary doses of niacin during lactation has not been associated with any adverse effects to the mother or fetus.

No enhanced messaging available.