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Nicotinic Acid (niacin) Disease Interactions

There are 6 disease interactions with Nicotinic Acid (niacin):

Major

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Coronary Artery Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Ischemic Heart Disease, Arrhythmias

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.

References

  1. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  2. Pasternak RC, Kolman BS "Unstable myocardial ischemia after the initiation of niacin therapy." Am J Cardiol 67 (1991): 904-6
  3. "Niacin and myocardial metabolism." Nutr Rev 31 (1973): 80-1
  4. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  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
  6. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  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. 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
  9. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
  10. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  11. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  12. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  13. Coronary Drug Project "Clofibrate and niacin in coronary heart disease." JAMA 231 (1975): 360-81
View all 13 references
Major

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Alcoholism, Gallbladder Disease

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.

References

  1. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  2. Dearing BD, Lavie CJ, Lohmann TP, Genton E "Niacin-induced clotting factor synthesis deficiency with coagulopathy." Arch Intern Med 152 (1992): 861-3
  3. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  4. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  5. Hodis HN "Acute hepatic failure associated with the use of low-dose sustained- release niacin." JAMA 264 (1990): 181
  6. Reimund E, Ramos A "Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use." J Clin Gastroenterol 18 (1994): 270-1
  7. Knopp RH "Niacin and hepatic failure." Ann Intern Med 111 (1989): 769
  8. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  9. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  10. Alhadeff L, Gualtieri CT, Lipton M "Toxic effects of water-soluble vitamins." Nutr Rev 42 (1984): 33-40
  11. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  12. 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
  13. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  14. 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
  15. 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
  16. Keenan JM, Ripsin CM, Huang Z, McCaffrey DJ "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d513;isc. 514-5
  17. Lavie CJ, Milani RV "Safety and side effects of sustained-release niacin." JAMA 272 (1994): 513-4;disc. 514-5
  18. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
  19. Dalton TA, Berry RS "Hepatotoxicity associated with sustained-release niacin." Am J Med 93 (1992): 102-4
  20. Goldstein MR "Potential problems with the widespread use of niacin." Am J Med 85 (1988): 881
  21. Lawrence SP "Transient focal hepatic defects related to sustained-release niacin." J Clin Gastroenterol 16 (1993): 234-6
  22. 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
  23. Patterson DJ, Dew EW, Gyorkey F, Graham DY "Niacin hepatitis." South Med J 76 (1983): 239-41
  24. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  25. Coppola A, Brady PG, Nord HJ "Niacin-induced hepatotoxicity: unusual presentations." South Med J 87 (1994): 30-2
  26. Mullin GE, Greenson JK, Mitchell MC "Fulminant hepatic failure after ingestion of sustained-release nicotinic acid." Ann Intern Med 111 (1989): 253-5
  27. Henkin Y, Johnson KC, Segrest JP "Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin." JAMA 264 (1990): 241-3
  28. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  29. Drinka PJ "Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin." Mayo Clin Proc 67 (1992): 1206
  30. 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
  31. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  32. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  33. Rader JI, Calvert RJ, Hathcock JN "Hepatic toxicity of unmodified and time-release preparations of niacin." Am J Med 92 (1992): 77-81
  34. Frost PH "All niacin is not the same." Ann Intern Med 114 (1991): 1065
  35. 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
  36. 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
  37. Jungnickel PW, Maloley PA "Comment: adverse-effect profile of sustained-release niacin." DICP 25 (1991): 1014-5
View all 37 references
Major

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Hypotension, Syncope

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).

References

  1. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  2. 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
  3. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  4. Simpson T "Extended-release niacin not problem free." Am J Hosp Pharm 48 (1991): 237-8
  5. Florkowski CM, Cramb R "Approaches to the management of hypercholesterolaemia." J Clin Pharm Ther 17 (1992): 81-9
  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. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  8. Whelan AM, Price SO, Fowler SF, Hainer BL "The effect of aspirin on niacin-induced cutaneous reactions." J Fam Pract 34 (1992): 165-8
  9. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  10. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
  11. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  12. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  13. 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
  14. Hoffer A "Niacin reaction." J Fam Pract 34 (1992): 677,680-1
  15. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  16. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  17. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  18. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  19. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  20. Hoeg JM, Maher MB, Bailey KR, Brewer HB Jr "Comparison of six pharmacologic regimens for hypercholesterolemia." Am J Cardiol 59 (1987): 812-5
  21. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  22. 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
  23. 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
  24. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
  25. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
View all 25 references
Major

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Peptic Ulcer Disease

Severe Potential Hazard, High plausibility

Applies to: Peptic Ulcer, History - Peptic Ulcer

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.

References

  1. Goldstein MR "Potential problems with the widespread use of niacin." Am J Med 85 (1988): 881
  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. 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
  4. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  5. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  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. 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
  8. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  9. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  10. 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
  11. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  12. 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
  13. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  14. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  15. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  16. 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
  17. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  18. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  19. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
  20. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
  21. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  22. Hoeg JM, Maher MB, Bailey KR, Brewer HB Jr "Comparison of six pharmacologic regimens for hypercholesterolemia." Am J Cardiol 59 (1987): 812-5
View all 22 references
Moderate

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Hyperglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

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.

References

  1. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  2. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  3. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  4. Schwartz ML "Severe reversible hyperglycemia as a consequence of niacin therapy." Arch Intern Med 153 (1993): 2050-2
  5. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  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. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  8. 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
  9. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  10. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  11. 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
  12. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  13. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
  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
  15. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  16. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
View all 16 references
Moderate

Niacin/Niacinamide (Includes Nicotinic Acid) ↔ Hyperuricemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Gout

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.

References

  1. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  2. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  3. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  4. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  5. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
  6. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  7. 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
  8. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  9. 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
  10. 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
  11. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  12. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  13. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  14. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
View all 14 references

Nicotinic Acid (niacin) drug Interactions

There are 178 drug interactions with Nicotinic Acid (niacin)

Nicotinic Acid (niacin) alcohol/food Interactions

There are 2 alcohol/food interactions with Nicotinic Acid (niacin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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