Evigrade
DrugsCosmetic ingredientsCalculatorsInteractionsEvigrade SkinEvigrade Meds ↗
ConditionsJournalMethodologyPro for practitioners
ESRU

Nicotinic acid (niacin)

Lipid-modifying agent, nicotinic acid derivative; vitamin B3 in acid form

ATC code: C04AC01

Brand names: Niaspan, Niacor

Updated · Methodology

Indications

A

Pellagra (vitamin B3 deficiency)

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.

Sources

  1. WHO: Thiamine deficiency and its prevention and control in major emergencies (2018)
  2. AEMPS: Ficha técnica de ácido nicotínico (2022)

ICD-10: E52 · ICD-11: 5B5C.0

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Dyslipidemia

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

  1. NEJM (AIM-HIGH investigators): Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy (2011)
  2. NEJM (HPS2-THRIVE investigators): Effects of extended-release niacin with laropiprant in high-risk patients (2014)
  3. ESC/EAS: 2019 ESC/EAS Guidelines for the management of dyslipidaemias (2019)

ICD-10: E78 · ICD-11: 5C80

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

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).

Safety

Contraindications

  • Hypersensitivity to niacin
  • Active peptic ulcer
  • Arterial bleeding
  • Severe hepatic impairment
  • Pregnancy (at lipid-lowering doses)
  • Severe gout

Serious adverse effects

  • Hepatitis and liver failure (especially with sustained-release formulations)
  • Myopathy and rhabdomyolysis (when combined with statins)
  • Diabetes decompensation
  • Gout flare
  • Ischaemic stroke (HPS2-THRIVE signal)

Common adverse effects

  • 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

Pregnancy: can you take Nicotinic acid (niacin)?

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.

Breastfeeding: can you take Nicotinic acid (niacin)?

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.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Nicotinic acid (niacin) used for?

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.

What are the side effects of Nicotinic acid (niacin)?

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.

Is Nicotinic acid (niacin) safe during pregnancy?

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.

Is Nicotinic acid (niacin) compatible with breastfeeding?

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.

Who should not take Nicotinic acid (niacin)?

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.

Other drugs in this group

Aged garlic extract (AGE, Kyolic)