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Niacin Disease Interactions

There are 6 disease interactions with niacin.

Major

Niacin/niacinamide (applies to niacin) coronary artery disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: 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. 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
  9. "Niacin and myocardial metabolism." Nutr Rev 31 (1973): 80-1
  10. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
  11. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
  12. Coronary Drug Project "Clofibrate and niacin in coronary heart disease." JAMA 231 (1975): 360-81
  13. 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 13 references
Major

Niacin/niacinamide (applies to niacin) hepatotoxicity

Major Potential Hazard, High plausibility. Applicable conditions: 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. 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
  9. Knopp RH "Niacin and hepatic failure." Ann Intern Med 111 (1989): 769
  10. 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
  11. Dearing BD, Lavie CJ, Lohmann TP, Genton E "Niacin-induced clotting factor synthesis deficiency with coagulopathy." Arch Intern Med 152 (1992): 861-3
  12. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  13. Henkin Y, Johnson KC, Segrest JP "Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin." JAMA 264 (1990): 241-3
  14. Hodis HN "Acute hepatic failure associated with the use of low-dose sustained- release niacin." JAMA 264 (1990): 181
  15. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
  16. Lavie CJ, Milani RV "Safety and side effects of sustained-release niacin." JAMA 272 (1994): 513-4;disc. 514-5
  17. Keenan JM, Ripsin CM, Huang Z, McCaffrey DJ "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d513;isc. 514-5
  18. 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
  19. 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
  20. Drinka PJ "Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin." Mayo Clin Proc 67 (1992): 1206
  21. Patterson DJ, Dew EW, Gyorkey F, Graham DY "Niacin hepatitis." South Med J 76 (1983): 239-41
  22. Coppola A, Brady PG, Nord HJ "Niacin-induced hepatotoxicity: unusual presentations." South Med J 87 (1994): 30-2
  23. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  24. 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
  25. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  26. Jungnickel PW, Maloley PA "Comment: adverse-effect profile of sustained-release niacin." DICP 25 (1991): 1014-5
  27. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  28. Reimund E, Ramos A "Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use." J Clin Gastroenterol 18 (1994): 270-1
  29. Lawrence SP "Transient focal hepatic defects related to sustained-release niacin." J Clin Gastroenterol 16 (1993): 234-6
  30. Mullin GE, Greenson JK, Mitchell MC "Fulminant hepatic failure after ingestion of sustained-release nicotinic acid." Ann Intern Med 111 (1989): 253-5
  31. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  32. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  33. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  34. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  35. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
  36. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
  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 (applies to niacin) hypotension

Major Potential Hazard, High plausibility. Applicable conditions: 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. 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
  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. Hoffer A "Niacin reaction." J Fam Pract 34 (1992): 677,680-1
  11. Whelan AM, Price SO, Fowler SF, Hainer BL "The effect of aspirin on niacin-induced cutaneous reactions." J Fam Pract 34 (1992): 165-8
  12. 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
  13. Weiner M "Safety and side effects of sustained-release niacin." JAMA 272 (1994): d514;isc. 514-5
  14. 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
  15. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  16. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  17. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  18. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  19. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  20. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  21. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  22. Florkowski CM, Cramb R "Approaches to the management of hypercholesterolaemia." J Clin Pharm Ther 17 (1992): 81-9
  23. Simpson T "Extended-release niacin not problem free." Am J Hosp Pharm 48 (1991): 237-8
  24. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
  25. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
View all 25 references
Major

Niacin/niacinamide (applies to niacin) peptic ulcer disease

Major Potential Hazard, High plausibility. Applicable conditions: 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. 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
  9. 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
  10. Truswell AS "ABC of nutrition. Vitamins I." Br Med J (Clin Res Ed) 291 (1985): 1033-5
  11. Knopp RH "New approaches to cholesterol lowering: efficacy and safety." Hosp Pract (Off Ed) 23 Suppl 1 (1988): 22-30
  12. Ranchoff RE, Tomecki KJ "Niacin or niacinamide? Nicotinic acid or nicotinamide? What is the difference?." J Am Acad Dermatol 15 (1986): 116-7
  13. 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
  14. Darby WJ, McNutt KW, Todhunter EN "Niacin." Nutr Rev 33 (1975): 289-97
  15. Malloy MJ, Frost PH, Kane JP "Niacin--the long and the short of it." West J Med 155 (1991): 424-6
  16. Knapp TR, Middleton RK "Adverse effects of sustained-release niacin." DICP 25 (1991): 253-4
  17. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  18. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  19. DiPalma JR, Thayer WS "Use of niacin as a drug." Annu Rev Nutr 11 (1991): 169-87
  20. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
  21. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
  22. 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 22 references
Moderate

Niacin/niacinamide (applies to niacin) hyperglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. 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
  9. Gorrell RL "Niacin caution." Postgrad Med 89 (1991): 262
  10. Malinow MR "Adverse effects of the treatment for hyperlipidemia." Cardiol Clin 4 (1986): 95-103
  11. Witztum JL "Current approaches to drug therapy for the hypercholesterolemic patient." Circulation 80 (1989): 1101-14
  12. Hunninghake DB "The pharmacology and therapeutics of lipid-lowering drugs." Am Pharm ns27 (1987): s18-25
  13. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  14. "Product Information. Nicobid Tempules (niacin)." Rhone Poulenc Rorer
  15. "Product Information. Slo-Niacin (niacin)." Upsher-Smith Laboratories Inc (2001):
  16. 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 16 references
Moderate

Niacin/niacinamide (applies to niacin) hyperuricemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. 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
  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. Perry RS "Contemporary recommendations for evaluating and treating hyperlipidemia." Clin Pharm 5 (1986): 113-27
  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
View all 14 references

Niacin drug interactions

There are 99 drug interactions with niacin.

Niacin alcohol/food interactions

There are 2 alcohol/food interactions with niacin.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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

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