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B3-500-Gr (niacin) Disease Interactions

There are 6 disease interactions with B3-500-Gr (niacin):

Major

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  4. "Niacin and myocardial metabolism." Nutr Rev 31 (1973): 80-1
  5. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  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
  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. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  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. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  11. Coronary Drug Project "Clofibrate and niacin in coronary heart disease." JAMA 231 (1975): 360-81
  12. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  13. 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
View all 13 references
Major

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  4. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  5. Hodis HN "Acute hepatic failure associated with the use of low-dose sustained- release niacin." JAMA 264 (1990): 181
  6. 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
  7. Lavie CJ, Milani RV "Safety and side effects of sustained-release niacin." JAMA 272 (1994): 513-4;disc. 514-5
  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. Knopp RH "Niacin and hepatic failure." Ann Intern Med 111 (1989): 769
  10. Patterson DJ, Dew EW, Gyorkey F, Graham DY "Niacin hepatitis." South Med J 76 (1983): 239-41
  11. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  12. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  13. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  14. Alhadeff L, Gualtieri CT, Lipton M "Toxic effects of water-soluble vitamins." Nutr Rev 42 (1984): 33-40
  15. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  16. Reimund E, Ramos A "Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use." J Clin Gastroenterol 18 (1994): 270-1
  17. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  18. 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
  19. Keenan JM, Ripsin CM, Huang Z, McCaffrey DJ "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d513;isc. 514-5
  20. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
  21. Lawrence SP "Transient focal hepatic defects related to sustained-release niacin." J Clin Gastroenterol 16 (1993): 234-6
  22. Henkin Y, Johnson KC, Segrest JP "Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin." JAMA 264 (1990): 241-3
  23. Mullin GE, Greenson JK, Mitchell MC "Fulminant hepatic failure after ingestion of sustained-release nicotinic acid." Ann Intern Med 111 (1989): 253-5
  24. Drinka PJ "Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin." Mayo Clin Proc 67 (1992): 1206
  25. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  26. 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
  27. Rader JI, Calvert RJ, Hathcock JN "Hepatic toxicity of unmodified and time-release preparations of niacin." Am J Med 92 (1992): 77-81
  28. Frost PH "All niacin is not the same." Ann Intern Med 114 (1991): 1065
  29. Jungnickel PW, Maloley PA "Comment: adverse-effect profile of sustained-release niacin." DICP 25 (1991): 1014-5
  30. Dalton TA, Berry RS "Hepatotoxicity associated with sustained-release niacin." Am J Med 93 (1992): 102-4
  31. Goldstein MR "Potential problems with the widespread use of niacin." Am J Med 85 (1988): 881
  32. 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
  33. Coppola A, Brady PG, Nord HJ "Niacin-induced hepatotoxicity: unusual presentations." South Med J 87 (1994): 30-2
  34. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  35. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  36. 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
  37. 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
View all 37 references
Major

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. Florkowski CM, Cramb R "Approaches to the management of hypercholesterolaemia." J Clin Pharm Ther 17 (1992): 81-9
  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. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  7. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  8. Simpson T "Extended-release niacin not problem free." Am J Hosp Pharm 48 (1991): 237-8
  9. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  10. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  11. Hoffer A "Niacin reaction." J Fam Pract 34 (1992): 677,680-1
  12. 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
  13. Whelan AM, Price SO, Fowler SF, Hainer BL "The effect of aspirin on niacin-induced cutaneous reactions." J Fam Pract 34 (1992): 165-8
  14. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  15. 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
  16. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  17. 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
  18. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
  19. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
  20. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  21. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
  22. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  23. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  24. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  25. 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 25 references
Major

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  4. 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
  5. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  6. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  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. 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
  9. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  10. 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
  11. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
  12. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  13. 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
  14. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  15. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  16. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  17. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  18. 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
  19. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  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. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  22. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
View all 22 references
Moderate

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. Schwartz ML "Severe reversible hyperglycemia as a consequence of niacin therapy." Arch Intern Med 153 (1993): 2050-2
  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. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  5. 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
  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. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
  8. "Product Information. Nicobid (niacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  9. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  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. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  12. 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
  13. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  14. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  15. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  16. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
View all 16 references
Moderate

Niacin/Niacinamide (Includes B3-500-Gr) ↔ 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. Blum CB, Levy RI "Rational drug therapy of the hyperlipoproteinemias, Part II." Ration Drug Ther 20 (1986): 1-4
  3. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc, Minneapolis, MN.
  4. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  5. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  6. Capurso A "Drugs affecting triglycerides." Cardiology 78 (1991): 218-25
  7. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
  8. 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
  9. 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
  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. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  14. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
View all 14 references

B3-500-Gr (niacin) drug Interactions

There are 178 drug interactions with B3-500-Gr (niacin)

B3-500-Gr (niacin) alcohol/food Interactions

There are 2 alcohol/food interactions with B3-500-Gr (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.

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