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Niacin Dosage

Medically reviewed on May 15, 2018.

Applies to the following strengths: 500 mg; 50 mg; 100 mg; 750 mg; 1000 mg; 125 mg; 250 mg; 50 mg/5 mL; 400 mg

Usual Adult Dose for Hyperlipoproteinemia Type IV (Elevated VLDL)

Immediate-release:
-Initial dose: 250 mg orally once a day following the evening meal; increase frequency and/or dose every 4 to 7 days to the desired effect or first-level therapeutic dose (1.5 to 2 g/day in 2 to 3 divided doses); if the response is inadequate after 2 months, the dose can be increased at 2 to 4 week intervals to 1
-Maintenance dose: 1 to 2 g orally 2 to 3 times a day
-Maximum dose: 6 g/day (in 2 to 3 divided doses)

Sustained-release:
-Weeks 1 to 4: 500 mg orally at bedtime
-Weeks 5 to 8: 1000 mg orally at bedtime
-After week 8: Titrate to patient response and tolerance; if response to 1000 mg a day is inadequate, increase to 1500 mg a day; may subsequently increase to 2000 mg a day: daily dose should not be increased more than 500 mg in a 4-week period
-Maintenance dose: 1000 to 2000 mg orally at bedtime
-Maximum dose: 2000 mg/day

Comments:
-Individualize doses according to patient response.
-Women may respond at lower doses than men.
-Tolerance to flushing develops rapidly over the course of several weeks; flushing, pruritus, and GI distress can be reduced by slowly increasing the dose and avoiding administration on an empty stomach.
-Concomitant alcoholic drinks, hot drinks, or spicy foods may increase the side effects of flushing and pruritus and should be avoided near the time this drug is taken.
-If therapy with the extended-release formulation is discontinued for an extended period, reinstitution of therapy should include a titration phase.
-The extended-release formulation should be taken whole and should not be broken, crushed, or chewed before swallowing.
-Flushing can be minimized by pretreatment with aspirin or nonsteroidal anti-inflammatory drugs.
-Flushing, pruritus, and GI distress can be reduced by slowly increasing the dose and avoiding administration on an empty stomach.

Uses:
-To reduce elevated TC, LDL-C, Apo B and TG, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia; to reduce the risk of recurrent nonfatal myocardial infarction in patients with a history of myocardial infarction and hyperlipidemia
-In combination with a bile acid binding resin: Slows progression or promotes regression of atherosclerotic disease in patients with a history of coronary artery disease (CAD) and hyperlipidemia
-As an adjunct to diet to reduce elevated TC and LDL-C in adult patients with primary hyperlipidemia
-To reduce TG in adult patients with severe hypertriglyceridemia

Usual Adult Dose for Hyperlipoproteinemia Type V (Elevated Chylomicrons + VLDL)

Immediate-release:
-Initial dose: 250 mg orally once a day following the evening meal; increase frequency and/or dose every 4 to 7 days to the desired effect or first-level therapeutic dose (1.5 to 2 g/day in 2 to 3 divided doses); if the response is inadequate after 2 months, the dose can be increased at 2 to 4 week intervals to 1
-Maintenance dose: 1 to 2 g orally 2 to 3 times a day
-Maximum dose: 6 g/day (in 2 to 3 divided doses)

Sustained-release:
-Weeks 1 to 4: 500 mg orally at bedtime
-Weeks 5 to 8: 1000 mg orally at bedtime
-After week 8: Titrate to patient response and tolerance; if response to 1000 mg a day is inadequate, increase to 1500 mg a day; may subsequently increase to 2000 mg a day: daily dose should not be increased more than 500 mg in a 4-week period
-Maintenance dose: 1000 to 2000 mg orally at bedtime
-Maximum dose: 2000 mg/day

Comments:
-Individualize doses according to patient response.
-Women may respond at lower doses than men.
-Tolerance to flushing develops rapidly over the course of several weeks; flushing, pruritus, and GI distress can be reduced by slowly increasing the dose and avoiding administration on an empty stomach.
-Concomitant alcoholic drinks, hot drinks, or spicy foods may increase the side effects of flushing and pruritus and should be avoided near the time this drug is taken.
-If therapy with the extended-release formulation is discontinued for an extended period, reinstitution of therapy should include a titration phase.
-The extended-release formulation should be taken whole and should not be broken, crushed, or chewed before swallowing.
-Flushing can be minimized by pretreatment with aspirin or nonsteroidal anti-inflammatory drugs.
-Flushing, pruritus, and GI distress can be reduced by slowly increasing the dose and avoiding administration on an empty stomach.

Uses:
-To reduce elevated TC, LDL-C, Apo B and TG, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia; to reduce the risk of recurrent nonfatal myocardial infarction in patients with a history of myocardial infarction and hyperlipidemia
-In combination with a bile acid binding resin: Slows progression or promotes regression of atherosclerotic disease in patients with a history of coronary artery disease (CAD) and hyperlipidemia
-As an adjunct to diet to reduce elevated TC and LDL-C in adult patients with primary hyperlipidemia
-To reduce TG in adult patients with severe hypertriglyceridemia

Usual Adult Dose for Vitamin/Mineral Supplementation

Recommended Dietary Allowance (RDA):
-Males: 16 mg/day
-Females: 14 mg/day
-Pregnancy: 18 mg/day
-Lactation: 17 mg/day

Comments:
-Niacin may be given orally and also parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products.
-The best way to get the daily requirement of essential vitamins is to eat a balanced diet that contains a variety of foods.

Uses:
-Recommended Dietary Allowance (RDA): Average daily level of intake that is enough to meet the nutrient requirements of nearly all (97 to 98%) healthy people.

Usual Adult Dose for Vitamin/Mineral Supplementation during Pregnancy/Lactation

Recommended Dietary Allowance (RDA):
-Males: 16 mg/day
-Females: 14 mg/day
-Pregnancy: 18 mg/day
-Lactation: 17 mg/day

Comments:
-Niacin may be given orally and also parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products.
-The best way to get the daily requirement of essential vitamins is to eat a balanced diet that contains a variety of foods.

Uses:
-Recommended Dietary Allowance (RDA): Average daily level of intake that is enough to meet the nutrient requirements of nearly all (97 to 98%) healthy people.

Usual Pediatric Dose for Vitamin/Mineral Supplementation

Adequate Intake (AI):
-Infants 0 to 6 months: 2 mg/day
-Infants 7 to 12 months: 4 mg/day

Recommended Dietary Allowance (RDA):
-Children 1 to 3 years: 6 mg/day
-Children 4 to 8 years: 8 mg/day
-Children 9 to 13 years: 12 mg/day
-Males: 14 to 18 years: 16 mg/day
-Females: 14 to 18 years: 14 mg/day
-Pregnancy: 18 mg/day
-Lactation: 17 mg/day

Comments:
-Niacin may be given orally and also parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products.
-The best way to get the daily requirement of essential vitamins is to eat a balanced diet that contains a variety of foods.

Uses:
-Adequate Intake (AI): When there is not enough evidence to develop an RDA, the AI is set at a level that is thought to ensure enough nutrition.
-Recommended Dietary Allowance (RDA): Average daily level of intake that is enough to meet the nutrient requirements of nearly all (97 to 98%) healthy people.

Usual Pediatric Dose for Vitamin/Mineral Supplementation during Pregnancy/Lactation

Adequate Intake (AI):
-Infants 0 to 6 months: 2 mg/day
-Infants 7 to 12 months: 4 mg/day

Recommended Dietary Allowance (RDA):
-Children 1 to 3 years: 6 mg/day
-Children 4 to 8 years: 8 mg/day
-Children 9 to 13 years: 12 mg/day
-Males: 14 to 18 years: 16 mg/day
-Females: 14 to 18 years: 14 mg/day
-Pregnancy: 18 mg/day
-Lactation: 17 mg/day

Comments:
-Niacin may be given orally and also parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products.
-The best way to get the daily requirement of essential vitamins is to eat a balanced diet that contains a variety of foods.

Uses:
-Adequate Intake (AI): When there is not enough evidence to develop an RDA, the AI is set at a level that is thought to ensure enough nutrition.
-Recommended Dietary Allowance (RDA): Average daily level of intake that is enough to meet the nutrient requirements of nearly all (97 to 98%) healthy people.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

-Mild to moderate liver dysfunction with alcohol use: No specific dose adjustment guidelines have been suggested; however, caution is recommended.
-Severe or unexplained hepatic dysfunction: Contraindicated

Precautions

Safety and efficacy of the extended-release formulation have not been established in patients younger than 16 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Switching from immediate release to extended release products: Patients previously receiving other niacin products should be started with the recommended niacin extended-release tablets titration schedule, and the dose should subsequently be individualized based on patient response.
-This drug should be administered at bedtime following a snack.
-Concomitant alcohol or hot drinks may increase flushing and pruritus and should be avoided at the time of dosing.

General:
-Equivalent doses of niacin extended-release tablets should not be substituted for sustained-release (modified-release, timed-release) niacin preparations or immediate-release (crystalline) niacin.
-Extended-release formulations should not be broken, crushed, or chewed before swallowing.

Further information

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

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