Lipid-modifying agent, nicotinic acid derivative; vitamin B3 in acid form
ATC code: C04AC01 (Nicotinic acid (niacin))
Brand names
Niaspan, Niacor
Nicotinic acid reduces fatty acid mobilization from adipocytes through GPR109A activation, decreasing hepatic VLDL synthesis. Lowers total cholesterol, , triglycerides and raises more than any other lipid-modifying drug. GPR109A activation also drives the classic flushing reaction – vasodilation via prostaglandin D2. Therapeutic doses (1-2 g/day) differ markedly from the vitamin dose (15-18 mg/day).
First line
Nicotinic acid is the treatment of choice for confirmed pellagra. recommends nicotinamide 100-300 mg/day orally in 3-4 divided doses for 3-4 weeks, then physiological maintenance. Pellagra is treated with nicotinamide rather than nicotinic acid to avoid flushing in severely ill patients. Other B vitamins are replenished in parallel (deficiency is often combined) and adequate protein intake is ensured to restore tryptophan synthesis.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Niacin is a potent lipid-modifying agent used for decades in dyslipidaemia. The AIM-HIGH trial (NEJM 2011) and HPS2-THRIVE (NEJM 2014) showed that adding niacin to statin therapy in patients with controlled does not reduce cardiovascular mortality or myocardial infarction while doubling the risk of serious adverse effects – diabetes, myopathy, GI bleeding, infections. withdrew Tredaptive (niacin plus laropiprant) from the European market in January 2013. 2019 and SEA 2023 do not recommend niacin on top of statins. If niacin was prescribed for cholesterol, consider seeking a second opinion: statins and PCSK9 inhibitors have proven benefit.
Sources
Opens the checker prefilled with this drug. Pick the second one from your regimen.
FDA Category C. At vitamin doses (15-18 mg/day) niacin is safe and required in pregnancy. Lipid-lowering doses (1-2 g/day) are contraindicated in pregnancy: teratogenic risk cannot be excluded and risk outweighs benefit.
Compatible at vitamin doses (Hale L1). Not compatible at lipid-lowering doses – Hale L4, transfers into milk in significant amounts. If dyslipidaemia treatment is needed in a lactating woman, choose other agents.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Nicotinic acid (niacin) is evaluated for the following indications with varying evidence strength: Pellagra (vitamin B3 deficiency) (evidence tier A), Dyslipidemia (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Nicotinic acid (niacin) (≥ 1 in 100): Flushing – facial and upper-body redness, warmth, itching (most common; mitigate with aspirin 30 min before dose), Skin itching, Nausea, Epigastric pain, Elevated transaminases, Hyperglycaemia. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. At vitamin doses (15-18 mg/day) niacin is safe and required in pregnancy. Lipid-lowering doses (1-2 g/day) are contraindicated in pregnancy: teratogenic risk cannot be excluded and risk outweighs benefit.
Compatible at vitamin doses (Hale L1). Not compatible at lipid-lowering doses – Hale L4, transfers into milk in significant amounts. If dyslipidaemia treatment is needed in a lactating woman, choose other agents.
Nicotinic acid (niacin) is contraindicated in: Hypersensitivity to niacin; Active peptic ulcer; Arterial bleeding; Severe hepatic impairment; Pregnancy (at lipid-lowering doses). Full list in the Safety section.