Nicotinic Acid [Niacin] interactions

Checked as Niacin in this data source.

Full monograph for Nicotinic Acid [Niacin]Check it against another medicine

Medicines

493 documented

Severity

Mechanism

Medicines documented to interact with Nicotinic Acid [Niacin], worst severity first.
Medicine	Severity	Mechanism	Effect	Sources
Amlodipine Besilate + Atorvastatin	Major	Synergy · Unknown	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…2 documented mechanisms	20 sources — open the full entry
Atorvastatin + Ezetimibe	Major	Synergy · Unknown	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…2 documented mechanisms	20 sources — open the full entry
Atorvastatin Calcium	Major	Synergy	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…	20 sources — open the full entry
Leflunomide	Major	Synergy	The recent, concomitant, or subsequent use (without the recommended leflunomide washout period or procedure) of other agents known to induce hepatotoxicity may…	3 sources — open the full entry
Pitavastatin Calcium	Major	Synergy	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…	20 sources — open the full entry
Rosuvastatin + Ezetimibe	Major	Synergy · Unknown	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…2 documented mechanisms	20 sources — open the full entry
Rosuvastatin Calcium	Major	Synergy	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…	20 sources — open the full entry
Simvastatin	Major	Synergy	Severe myopathy and rhabdomyolysis have been reported with concomitant use of HMG-CoA reductase inhibitors (i.e., statins) and niacin. The mechanism is…	20 sources — open the full entry
Acarbose	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Alogliptin Benzoate	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Biphasic Insulin Aspart	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Canagliflozin Hemihydrate	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Dapagliflozin Propanediol	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Dulaglutide	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Efavirenz	Moderate	Synergy	Coadministration of efavirenz with other agents known to induce hepatotoxicity may potentiate the risk of liver injury. Efavirenz has been associated with…	7 sources — open the full entry
Empagliflozin	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Empagliflozin + Linagliptin	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Empagliflozin + Metformin Hydrochloride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Epirubicin Hydrochloride	Moderate	Synergy	The concomitant or sequential use of epirubicin with agents known to induce hepatotoxicity may potentiate the risk of liver injury. Epirubicin undergoes…	4 sources — open the full entry
Ertugliflozin	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Ethanol + Isopropyl alcohol	Moderate	Synergy	Ethanol can exacerbate the cutaneous flushing that is a common side effect of niacin. At least one case of delirium and lactic acidosis has been reported with…	1 sources — open the full entry
Fluvastatin	Moderate	Others	Severe myopathy and rhabdomyolysis have been reported with concomitant use of lovastatin and niacin, and may be possible with other HMG-CoA inhibitors such as…	7 sources — open the full entry
Glibenclamide	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Glimepiride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Glimepiride + Metformin	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Glipizide	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Glipizide + Metformin Hydrochloride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Insulin Aspart	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Aspart + Insulin Aspart Protamine	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Insulin Aspart [Protamine Crystallised]	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Degludec	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Degludec + Insulin Aspart Premixed	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Insulin Detemir	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Glargine	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Glulisine	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Human [rDNA]	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Lispro	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Insulin Lispro Protamine + Insulin Lispro	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
L-Asparginase	Moderate	Synergy	Concomitant use of asparaginase with other hepatotoxic agents may potentiate the risk of liver injury. Hepatomegaly, acute severe hepatotoxicity, and fatal…	13 sources — open the full entry
Lamivudine + Zidovudine	Moderate	Synergy · Unknown	Prolonged use of certain nucleoside reverse transcriptase inhibitors may commonly cause myopathy, including rare cases of rhabdomyolysis. It is not known if…2 documented mechanisms	2 sources — open the full entry
Lamivudine + Zidovudine + Nevirapine	Moderate	Synergy · Unknown	Prolonged use of certain nucleoside reverse transcriptase inhibitors may commonly cause myopathy, including rare cases of rhabdomyolysis. It is not known if…2 documented mechanisms	2 sources — open the full entry
Linagliptin	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Linagliptin + Metformin Hydrochloride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Liraglutide	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Metformin Hydrochloride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Methotrexate	Moderate	Synergy	Coadministration of methotrexate with other agents known to induce hepatotoxicity may potentiate the risk of liver injury. Methotrexate, especially at higher…	3 sources — open the full entry
Miglitol	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Pioglitazone	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…	95 sources — open the full entry
Pioglitazone + Glimepiride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry
Pioglitazone + Metformin Hydrochloride	Moderate	Antagonism	The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics…2 documented mechanisms	95 sources — open the full entry

Food & lifestyle

alcohol
Moderate
Synergy
Ethanol can exacerbate the cutaneous flushing that is a common side effect of niacin. At least one case of delirium and lactic acidosis has been reported with coadministration of these drugs, although data are limited.
What to do: Coadministration should probably be discouraged, particularly since chronic consumption of large amounts of alcohol is associated with hyperlipidemia.
1 source
1. Schwab RA, Bachhuber BH "Delirium and lactic acidosis caused by ethanol and niacin coingestion." Am J Emerg Med 9 (1991): 363-5

Conditions

Conditions in which Nicotinic Acid [Niacin] needs care, as documented in this source.

Coronary Artery Disease
Major
The Coronary Drug Project (1975) reported a significant increase in cardiac arrhythmias associated with the use of niacin at lipid-lowering dosages. Treatment using pharmacologic dosages of niacin and niacinamide (nicotinamide) should be administered cautiously in patients with coronary heart disease or arrhythmias. Particular caution is advised in the presence of unstable angina or in the acute phase of myocardial infarction, especially if the patient is also receiving vasoactive drugs such as nitrates, calcium channel blockers, or adrenergic blocking agents.
13 sources
1. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
2. Pasternak RC, Kolman BS "Unstable myocardial ischemia after the initiation of niacin therapy." Am J Cardiol 67 (1991): 904-6
3. Davignon J, Roederer G, Montigny M, Hayden MR, Tan MH, Connelly PW, Hegele R, McPherson R, Lupien PJ, Gagne C, et al. "Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia." Am J Cardiol 73 (1994): 339-45
4. Gray DR, Morgan T, Chretien SD, Kashyap ML "Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans." Ann Intern Med 121 (1994): 252-8
5. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
6. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
7. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
8. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
Show all 13 sourcesShow fewer sources
1. "Niacin and myocardial metabolism." Nutr Rev 31 (1973): 80-1
2. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
3. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
4. Coronary Drug Project "Clofibrate and niacin in coronary heart disease." JAMA 231 (1975): 360-81
5. Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F "Nicotinic acid: a review of its clinical use in the treatment of lipid disorders." Pharmacotherapy 8 (1988): 287-94
Hypotension
Major
The use of niacin and niacinamide (nicotinamide) is contraindicated in patients with severe hypotension. These agents have peripheral vasodilating effects and may commonly cause flushing at dosages substantially exceeding those for physiologic requirements (e.g., lipid-lowering dosages).
25 sources
1. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
2. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
3. Hoeg JM, Maher MB, Bailey KR, Brewer HB Jr "Comparison of six pharmacologic regimens for hypercholesterolemia." Am J Cardiol 59 (1987): 812-5
4. Davignon J, Roederer G, Montigny M, Hayden MR, Tan MH, Connelly PW, Hegele R, McPherson R, Lupien PJ, Gagne C, et al. "Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia." Am J Cardiol 73 (1994): 339-45
5. Keenan JM, Fontaine PL, Wenz JB, Myers S, Huang ZQ, Ripsin CM "Niacin revisited. A randomized, controlled trial of wax-matrix sustained-release niacin in hypercholesterolemia." Arch Intern Med 151 (1991): 1424-32
6. Illingworth DR, Stein EA, Mitchel YB, Dujovne CA, Frost PH, Knopp RH, Tun P, Zupkis RV, Greguski RA "Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial." Arch Intern Med 154 (1994): 1586-95
7. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
8. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
Show all 25 sourcesShow fewer sources
1. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
2. Hoffer A "Niacin reaction." J Fam Pract 34 (1992): 677,680-1
3. Whelan AM, Price SO, Fowler SF, Hainer BL "The effect of aspirin on niacin-induced cutaneous reactions." J Fam Pract 34 (1992): 165-8
4. Tornvall P, Walldius G "A comparison between nicotinic acid and acipimox in hypertriglyceridaemia--effects on serum lipids, lipoproteins, glucose tolerance and tolerability." J Intern Med 230 (1991): 415-21
5. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
6. McKenney JM, Proctor JD, Harris S, Chinchili VM "A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients." JAMA 271 (1994): 672-7
7. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
8. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
9. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
10. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
11. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
12. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
13. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
14. Florkowski CM, Cramb R "Approaches to the management of hypercholesterolaemia." J Clin Pharm Ther 17 (1992): 81-9
15. Simpson T "Extended-release niacin not problem free." Am J Hosp Pharm 48 (1991): 237-8
16. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
17. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
Liver Diseases
Major
The use of nicotinic acid and its derivatives at dosages substantially exceeding those for physiologic requirements is contraindicated in patients with active liver disease or unexplained, persistent elevations of serum transaminases. Hepatotoxicity, including biochemical abnormalities of liver function, cholestatic jaundice, increased prothrombin time, and fulminant hepatic necrosis and failure, has been reported during therapy with niacin and niacinamide (nicotinamide), particularly in patients who have substituted sustained-release nicotinic acid products for immediate-release preparations at equivalent dosages. Treatment using pharmacologic dosages (e.g., lipid-lowering dosages) of these agents should be administered cautiously in patients with gallbladder disease or a history of jaundice, liver disease and/or heavy alcohol use. Liver transaminase levels should be evaluated prior to initiation of therapy, every 6 to 12 weeks for the first year, and periodically thereafter (e.g., semiannually). Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, therapy should be withdrawn. Liver biopsy should be considered in patients with elevations that persist beyond cessation of therapy.
37 sources
1. Etchason JA, Miller TD, Squires RW, et al. "Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin." Mayo Clin Proc 66 (1991): 23-8
2. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
3. Alhadeff L, Gualtieri CT, Lipton M "Toxic effects of water-soluble vitamins." Nutr Rev 42 (1984): 33-40
4. Dalton TA, Berry RS "Hepatotoxicity associated with sustained-release niacin." Am J Med 93 (1992): 102-4
5. Rader JI, Calvert RJ, Hathcock JN "Hepatic toxicity of unmodified and time-release preparations of niacin." Am J Med 92 (1992): 77-81
6. Henkin Y, Oberman A, Hurst DC, Segrest JP "Niacin revisited: clinical observations on an important but underutilized drug." Am J Med 91 (1991): 239-46
7. Goldstein MR "Potential problems with the widespread use of niacin." Am J Med 85 (1988): 881
8. Frost PH "All niacin is not the same." Ann Intern Med 114 (1991): 1065
Show all 37 sourcesShow fewer sources
1. Knopp RH "Niacin and hepatic failure." Ann Intern Med 111 (1989): 769
2. Gray DR, Morgan T, Chretien SD, Kashyap ML "Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans." Ann Intern Med 121 (1994): 252-8
3. Dearing BD, Lavie CJ, Lohmann TP, Genton E "Niacin-induced clotting factor synthesis deficiency with coagulopathy." Arch Intern Med 152 (1992): 861-3
4. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
5. Henkin Y, Johnson KC, Segrest JP "Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin." JAMA 264 (1990): 241-3
6. Hodis HN "Acute hepatic failure associated with the use of low-dose sustained- release niacin." JAMA 264 (1990): 181
7. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
8. Lavie CJ, Milani RV "Safety and side effects of sustained-release niacin." JAMA 272 (1994): 513-4;disc. 514-5
9. Keenan JM, Ripsin CM, Huang Z, McCaffrey DJ "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d513;isc. 514-5
10. McKenney JM, Proctor JD, Harris S, Chinchili VM "A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients." JAMA 271 (1994): 672-7
11. Etchason JA, Miller TD, Squires RW, Allison TG, Gau GT, Marttila JK, Kottke BA "Niacin-induced hepatitis: a potential side effect with low-dose time- release niacin." Mayo Clin Proc 66 (1991): 23-8
12. Drinka PJ "Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin." Mayo Clin Proc 67 (1992): 1206
13. Patterson DJ, Dew EW, Gyorkey F, Graham DY "Niacin hepatitis." South Med J 76 (1983): 239-41
14. Coppola A, Brady PG, Nord HJ "Niacin-induced hepatotoxicity: unusual presentations." South Med J 87 (1994): 30-2
15. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
16. Fischer DJ, Knight LL, Vestal RE "Fulminant hepatic failure following low-dose sustained-release niacin therapy in hospital." West J Med 155 (1991): 410-2
17. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
18. Jungnickel PW, Maloley PA "Comment: adverse-effect profile of sustained-release niacin." DICP 25 (1991): 1014-5
19. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
20. Reimund E, Ramos A "Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use." J Clin Gastroenterol 18 (1994): 270-1
21. Lawrence SP "Transient focal hepatic defects related to sustained-release niacin." J Clin Gastroenterol 16 (1993): 234-6
22. Mullin GE, Greenson JK, Mitchell MC "Fulminant hepatic failure after ingestion of sustained-release nicotinic acid." Ann Intern Med 111 (1989): 253-5
23. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
24. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
25. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
26. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
27. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
28. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
29. Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F "Nicotinic acid: a review of its clinical use in the treatment of lipid disorders." Pharmacotherapy 8 (1988): 287-94
Peptic Ulcer
Major
The use of niacin and niacinamide (nicotinamide) at dosages substantially exceeding those for physiologic requirements is contraindicated in patients with active peptic ulcer disease. These agents have been reported to activate peptic ulcer. Treatment using pharmacologic dosages (e.g., lipid-lowering dosages) should be administered cautiously in patients with a history of peptic ulcer disease.
22 sources
1. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
2. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
3. Hoeg JM, Maher MB, Bailey KR, Brewer HB Jr "Comparison of six pharmacologic regimens for hypercholesterolemia." Am J Cardiol 59 (1987): 812-5
4. Davignon J, Roederer G, Montigny M, Hayden MR, Tan MH, Connelly PW, Hegele R, McPherson R, Lupien PJ, Gagne C, et al. "Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia." Am J Cardiol 73 (1994): 339-45
5. Henkin Y, Oberman A, Hurst DC, Segrest JP "Niacin revisited: clinical observations on an important but underutilized drug." Am J Med 91 (1991): 239-46
6. Goldstein MR "Potential problems with the widespread use of niacin." Am J Med 85 (1988): 881
7. Gray DR, Morgan T, Chretien SD, Kashyap ML "Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans." Ann Intern Med 121 (1994): 252-8
8. Keenan JM, Fontaine PL, Wenz JB, Myers S, Huang ZQ, Ripsin CM "Niacin revisited. A randomized, controlled trial of wax-matrix sustained-release niacin in hypercholesterolemia." Arch Intern Med 151 (1991): 1424-32
Show all 22 sourcesShow fewer sources
1. Illingworth DR, Stein EA, Mitchel YB, Dujovne CA, Frost PH, Knopp RH, Tun P, Zupkis RV, Greguski RA "Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial." Arch Intern Med 154 (1994): 1586-95
2. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
3. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
4. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
5. McKenney JM, Proctor JD, Harris S, Chinchili VM "A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients." JAMA 271 (1994): 672-7
6. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
7. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
8. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
9. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
10. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
11. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
12. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
13. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
14. Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F "Nicotinic acid: a review of its clinical use in the treatment of lipid disorders." Pharmacotherapy 8 (1988): 287-94
Hyperglycemia
Moderate
Elevated fasting blood sugars and decreased glucose tolerance have been reported during niacin and niacinamide (nicotinamide) therapy at dosages substantially exceeding those for physiologic requirements. Patients with diabetes mellitus should be monitored more closely during therapy with these agents, and adjustments made accordingly in their antidiabetic regimen.
16 sources
1. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
2. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
3. Henkin Y, Oberman A, Hurst DC, Segrest JP "Niacin revisited: clinical observations on an important but underutilized drug." Am J Med 91 (1991): 239-46
4. Schwartz ML "Severe reversible hyperglycemia as a consequence of niacin therapy." Arch Intern Med 153 (1993): 2050-2
5. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
6. Tornvall P, Walldius G "A comparison between nicotinic acid and acipimox in hypertriglyceridaemia--effects on serum lipids, lipoproteins, glucose tolerance and tolerability." J Intern Med 230 (1991): 415-21
7. McKenney JM, Proctor JD, Harris S, Chinchili VM "A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients." JAMA 271 (1994): 672-7
8. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
Show all 16 sourcesShow fewer sources
1. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
2. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
3. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
4. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
5. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
6. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
7. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
8. Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F "Nicotinic acid: a review of its clinical use in the treatment of lipid disorders." Pharmacotherapy 8 (1988): 287-94
Hyperuricemia
Moderate
Large doses of niacin and niacinamide (nicotinamide) can compete with uric acid for excretion by the kidney. Hyperuricemia and precipitation of gout have been reported during long-term therapy. Treatment using pharmacologic dosages (e.g., lipid-lowering dosages) of these agents should be administered cautiously in patients with or predisposed to gout.
14 sources
1. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
2. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
3. Henkin Y, Oberman A, Hurst DC, Segrest JP "Niacin revisited: clinical observations on an important but underutilized drug." Am J Med 91 (1991): 239-46
4. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
5. McKenney JM, Proctor JD, Harris S, Chinchili VM "A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients." JAMA 271 (1994): 672-7
6. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
7. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
8. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
Show all 14 sourcesShow fewer sources
1. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
2. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
3. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
4. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
5. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
6. Figge HL, Figge J, Souney PF, Mutnick AH, Sacks F "Nicotinic acid: a review of its clinical use in the treatment of lipid disorders." Pharmacotherapy 8 (1988): 287-94

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