Dosage Forms. Capsule, Extended Release: 250 mg, 500 mg; Tablet: 50 mg, 100 mg, 250 mg, 500 mg; Tablet, Extended Release: 250 mg, 500 mg, 750 mg, 1000 mg
Common FDA Label Indication, Dosing, and Titration.
1. Coronary arteriosclerosis, hypercholesterolemia: Extended release, 500 mg po daily; may titrate to 2000 mg/d po
2. Dyslipidemia: Immediate release, Adults, 100-1000 mg po tid, may titrate to 4500 mg/d po; Children, 100-250 mg/d in 3 divided doses with meals, may titrate to 10 mg/kg/d; Extended release, Adults, 500-2000 mg po daily hs; may titrate to 2000 mg/d po
3. Myocardial infarction, secondary prophylaxis: Extended release, 500-2000 mg po daily hs; may titrate to 2000 mg/d po
4. Pellagra: 50-100 mg po tid, may titrate to 500 mg/d po
Off-Label Uses. None
MOA. Not well defined. May involve partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma. Niacin decreases the rate of hepatic synthesis of VLDL and LDL, and does not appear to affect fecal excretion of fats, sterols, or bile acids.
Drug Characteristics: Niacin
Medication Safety Issues: Niacin
Drug Interactions: Niacin
Adverse Reactions: Niacin
Efficacy Monitoring Parameters. Reduction in total cholesterol, LDL, and triglycerides levels; increase in HDL.
Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue), yellowing of eyes or skin, severe abdominal pain, monitor LFT, CBC; serum creatine kinase if muscle pain occurs.
Key Patient Counseling Points. Start with a low dose and titrate based on tolerability (primarily flushing). Avoid alcohol and warm beverages with niacin to reduce flushing. If discontinued for several days, may need to restart on a lower dose and retitrate. Aspirin or NSAID 30 min prior to niacin may reduce flushing.
Clinical Pearls. Also known as vitamin B3. Statins are the most effective anti-lipid agents available; bile acid sequestrants can be added to therapy if deemed necessary and appropriate; niacin may be added to increase concentrations of high-density lipoprotein cholesterol.